2020 -- S 2915 | |
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LC005419 | |
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STATE OF RHODE ISLAND | |
IN GENERAL ASSEMBLY | |
JANUARY SESSION, A.D. 2020 | |
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A N A C T | |
RELATING TO LABOR AND LABOR AND LABOR RELATIONS -- WORKERS' | |
COMPENSATION | |
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Introduced By: Senator Frank A. Ciccone | |
Date Introduced: June 18, 2020 | |
Referred To: Senate Labor | |
It is enacted by the General Assembly as follows: | |
1 | SECTION 1. Section 28-53-7 of the General Laws in Chapter 28-53 entitled "Rhode Island |
2 | Uninsured Protection Fund" is hereby amended to read as follows: |
3 | 28-53-7. Payments to employees of uninsured employers. |
4 | (a) Where it is determined that the employee was injured in the course of employment |
5 | while working for an employer who fails to maintain a policy of workers' compensation insurance |
6 | as required by § 28-36-1 et seq., in accordance with the provisions of this chapter, the uninsured |
7 | protection fund is authorized to pay the benefits to which the injured employee would be entitled |
8 | pursuant to chapters 29 to 38 of this title subject to the limitations set forth herein. |
9 | (b) The workers' compensation court shall hear all petitions for payment from the fund |
10 | pursuant to § 28-30-1 et seq.; provided, however, that any petition for the commencement of |
11 | compensation benefits filed against the uninsured protection fund shall be accompanied or preceded |
12 | by a separate petition for the commencement of compensation benefits timely filed against the |
13 | uninsured unless the petition to be filed against the uninsured employer is otherwise enjoined or |
14 | prevented by law and the employer shall be named as parties to any petition seeking payment of |
15 | benefits from the fund. |
16 | (c) Where an employee is deemed to be entitled to benefits from the uninsured protection |
17 | fund, the fund shall pay benefits for incapacity as provided pursuant to chapters 29 to 38 of this |
18 | title except that the employee shall not be entitled to receive benefits for medical expenses pursuant |
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1 | to the provisions of § 28-33-5 or loss of function and disfigurement pursuant to the provisions of § |
2 | 28-33-19 from the uninsured protection fund. Nothing herein shall affect an employee's right to |
3 | otherwise recover such benefits for medical expenses, loss of function and disfigurement from an |
4 | uninsured employer. |
5 | (d) The fund shall pay costs, counsel, and witness fees, as provided in § 28-35-32, to any |
6 | employee who successfully prosecutes any petitions for payment; petitions to amend a pretrial |
7 | order; and all other employee petitions; and to employees who successfully defend, in whole or in |
8 | part, proceedings seeking to reduce or terminate any and all payments; provided, however, that the |
9 | attorney's fees awarded to counsel who represent the employee in petitions for lump-sum |
10 | commutation filed pursuant to § 28-33-25, or in the settlement of disputed cases pursuant to § 28- |
11 | 33-25.1, shall be limited to the maximum amount paid to counsel who serve as court-appointed |
12 | attorneys in workers' compensation proceedings as established by rule or order of the Rhode Island |
13 | supreme court. Any payment ordered by the court or due under this section shall not be subject to |
14 | liens set forth in § 28-33-27(b), nor shall such payments be assignable or subject to assignment in |
15 | any way. |
16 | (e) In the event that the uninsured employer makes payment of any monies to the employee |
17 | to compensate the employee in any way for the alleged work injury lost wages or medical expenses, |
18 | the fund shall may be entitled to a credit for all such monies received by, or on behalf of, the |
19 | employee, including, but not limited to, monies paid to the employee by any other party for the |
20 | employee's lost wages against any future benefits payable directly to the employee. The fund shall |
21 | be entitled to full reimbursement from the uninsured employer for any and all payments made by |
22 | the fund to the employee, as well as all costs, counsel, and witness fees paid out by the fund in |
23 | connection with any claim and/or petition, plus any and all costs and attorney's fees associated with |
24 | collection and reimbursement of the fund. |
25 | (f) This section shall apply to injuries that occur on or after September 1, 2019. |
26 | SECTION 2. Section 28-33-8 of the General Laws in Chapter 28-33 entitled "Workers' |
27 | Compensation - Benefits" is hereby amended to read as follows: |
28 | 28-33-8. Employee's choice of physician, dentist, or hospital -- Payment of charges -- |
29 | Physician reporting schedule. |
30 | (a)(1) An injured employee shall initially have freedom of choice to obtain health care, |
31 | diagnosis, and treatment from any qualified health care provider. The initial health care provider of |
32 | record may, without prior approval, refer the injured employee to any qualified specialist for |
33 | independent consultation or assessment, or specified treatment. If the insurer or self-insured |
34 | employer has a preferred-provider network approved and kept on record by the medical advisory |
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1 | board, any change by the employee from the initial health care provider of record shall only be to |
2 | a health care provider listed in the approved preferred-provider network; provided, however, that |
3 | any contract proffered or maintained that restricts or limits the health care provider's ability to make |
4 | referrals pursuant to the provisions of this section; restricts the injured employee's first choice of |
5 | health care provider; substitutes or overrules the treatment protocols maintained by the medical |
6 | advisory board; or attempts to evade or limit the jurisdiction of the workers' compensation court |
7 | shall be void as against public policy. If the employee seeks to change to a health care provider not |
8 | in the approved preferred-provider network, the employee must obtain the approval of the insurer |
9 | or self-insured employer. Nothing contained in this section shall prevent the treatment, care, or |
10 | rehabilitation of an employee by more than one physician, dentist, or hospital. The employee's first |
11 | visit to any facility providing emergency care or to a physician or medical facility under contract |
12 | with or agreement with the employer or insurer to provide priority care, shall not constitute the |
13 | employee's initial choice to obtain health care, diagnosis, or treatment. |
14 | (2) In addition to the treatment of qualified health care providers, the employee shall have |
15 | the freedom to obtain a rehabilitation evaluation by a rehabilitation counselor certified by the |
16 | director pursuant to § 28-33-41 in cases where the employee has received compensation for a period |
17 | of more than three (3) months, and the employer shall pay the reasonable fees incurred by the |
18 | rehabilitation counselor for the initial assessment. |
19 | (b) Within three (3) days of an initial visit following an injury, the health care provider |
20 | shall provide to the insurer or self-insured employer, and the employee and his or her attorney, a |
21 | notification of compensable injury form to be approved by the administrator of the medical |
22 | advisory board. Within three (3) days of the injured employee's release or discharge, return to work, |
23 | and/or recovery from an injury covered by chapters 29 -- 38 of this title, the health care provider |
24 | shall provide a notice of release to the insurer or self-insured employer, and the employee and his |
25 | or her attorney, on a form approved by the division. A twenty thirty dollar ($20.00) ($30.00) fee |
26 | may be charged by the health care provider to the insurer or self-insured employer for the |
27 | notification of compensable injury forms or notice of release forms or for affidavits filed pursuant |
28 | to subsection (c) of this section, but only if filed in a timely manner. No claim for care or treatment |
29 | by a physician, dentist, or hospital chosen by an employee shall be valid and enforceable as against |
30 | his or her employer, the employer's insurer, or the employee, unless the physician, dentist, or |
31 | hospital gives written notice of the employee's choice to the employer/insurance carrier within |
32 | fifteen (15) days after the beginning of the services or treatment. The health care provider shall, in |
33 | writing, submit to the employer or insurance carrier an itemized bill and report for the services or |
34 | treatment and a final itemized bill for all unpaid services or treatment within three (3) months after |
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1 | the conclusion of the treatment. The employee shall not be personally liable to pay any physician, |
2 | dentist, or hospital bills in cases where the physician, dentist, or hospital has forfeited the right to |
3 | be paid by the employer or insurance carrier because of noncompliance with this section. |
4 | (c)(1) At six (6) ten (10) weeks from the date of injury, then every twelve (12) ten (10) |
5 | weeks thereafter until maximum medical improvement, any qualified physician or other health care |
6 | professional providing medical care or treatment to any person for an injury covered by chapters |
7 | 29 -- 38 of this title shall file an itemized bill and an affidavit with the insurer, the employee and |
8 | his or her attorney, and the medical advisory board. A ten percent (10%) discount may be taken on |
9 | the itemized bill affidavits not filed in a timely manner and received by the insurer one week or |
10 | more late. The affidavit shall be on a form designed and provided by the administrator of the |
11 | medical advisory board and shall state: |
12 | (i) The type of medical treatment provided to date, including type and frequency of |
13 | treatment(s); |
14 | (ii) Anticipated further treatment, including type, frequency, and duration of treatment(s), |
15 | whether or not maximum medical improvement has been reached, and the anticipated date of |
16 | discharge; |
17 | (iii) Whether the employee can return to the former position of employment, or is capable |
18 | of other work, specifying work restrictions and work capabilities of the employee; |
19 | (2) The affidavit shall be admissible as an exhibit of the workers' compensation court with |
20 | or without the appearance of the affiant. |
21 | (d) "Itemized bill", as referred to in this section, means a completed statement of charges, |
22 | on a form CMS HCFA 1500, UB 92/94 or other form suitable to the insurer, that includes, but is |
23 | not limited to, an enumeration of specific types of care provided; facilities or equipment used; |
24 | services rendered; and appliances or medicines prescribed, for purposes of identifying the treatment |
25 | given the employee with respect to his or her injury. |
26 | (e)(1) The treating physician shall furnish to the employee, or to his or her legal |
27 | representative, a copy of his or her medical report within ten (10) days of the examination date. |
28 | (2) The treating physician shall notify the employer, and the employee and his or her |
29 | attorney, immediately when an employee is able to return to full or modified work. |
30 | (3) There shall be no charge for a health record when that health record is necessary to |
31 | support any appeal or claim under the Workers' Compensation Act § 23-17-19.1(16). The treating |
32 | physician shall furnish to the employee, or to his or her legal representative, a medical report, within |
33 | ten (10) days of the request, stating the diagnosis, disability, loss of use, end result and/or causal |
34 | relationship of the employee's condition associated with the work related injury. The physician |
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1 | shall be entitled to charge for these services only as enunciated in the State of Rhode Island workers |
2 | compensation medical fee schedule. |
3 | (f)(1) Compensation for medical expenses and other services under §§ 28-33-5, 28-33-7, |
4 | or 28-33-8 is due and payable within twenty-one (21) days from the date a request is made for |
5 | payment of these expenses by the provider of the medical services. In the event payment is not |
6 | made within twenty-one (21) days from the date a request is made for payment, the provider of |
7 | medical services may add, and the insurer or self-insurer shall pay, interest at the per annum rate |
8 | as provided in § 9-21-10 on the amount due. The employee or the medical provider may file a |
9 | petition with the administrator of the workers' compensation court which petition shall follow the |
10 | procedure as authorized in chapter 35 of this title. |
11 | (2) The twenty-one day (21) period in subdivision (1) of this subsection and in § 28-35-12 |
12 | shall begin on the date the insurer receives a request with appropriate documentation required to |
13 | determine whether the claim is compensable and the payment requested is due. |
14 | SECTION 3. This act shall take effect upon passage. |
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LC005419 | |
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EXPLANATION | |
BY THE LEGISLATIVE COUNCIL | |
OF | |
A N A C T | |
RELATING TO LABOR AND LABOR AND LABOR RELATIONS -- WORKERS' | |
COMPENSATION | |
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1 | This is the annual workers' compensation omnibus bill. It would slightly alter the process |
2 | and type of benefits for which work-related injured employees of uninsured employers may seek |
3 | compensation. It would also reduce the frequency from every twelve (12) weeks, to every ten (10) |
4 | weeks, with which an employee's medical provider must render a status report, concerning his or |
5 | her actual and anticipated medical treatment plans, with an itemization of any of their work |
6 | restrictions and capabilities, and whether they have reached maximum medical improvement. |
7 | This act would take effect upon passage. |
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LC005419 | |
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