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

     

     Introduced By: Senator Frank A. Ciccone

     Date Introduced: June 18, 2020

     Referred To: Senate Labor

     It is enacted by the General Assembly as follows:

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     SECTION 1. Section 28-53-7 of the General Laws in Chapter 28-53 entitled "Rhode Island

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Uninsured Protection Fund" is hereby amended to read as follows:

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     28-53-7. Payments to employees of uninsured employers.

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     (a) Where it is determined that the employee was injured in the course of employment

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while working for an employer who fails to maintain a policy of workers' compensation insurance

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as required by § 28-36-1 et seq., in accordance with the provisions of this chapter, the uninsured

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protection fund is authorized to pay the benefits to which the injured employee would be entitled

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pursuant to chapters 29 to 38 of this title subject to the limitations set forth herein.

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     (b) The workers' compensation court shall hear all petitions for payment from the fund

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pursuant to § 28-30-1 et seq.; provided, however, that any petition for the commencement of

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compensation benefits filed against the uninsured protection fund shall be accompanied or preceded

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by a separate petition for the commencement of compensation benefits timely filed against the

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uninsured unless the petition to be filed against the uninsured employer is otherwise enjoined or

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prevented by law and the employer shall be named as parties to any petition seeking payment of

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benefits from the fund.

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     (c) Where an employee is deemed to be entitled to benefits from the uninsured protection

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fund, the fund shall pay benefits for incapacity as provided pursuant to chapters 29 to 38 of this

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title except that the employee shall not be entitled to receive benefits for medical expenses pursuant

 

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to the provisions of § 28-33-5 or loss of function and disfigurement pursuant to the provisions of §

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28-33-19 from the uninsured protection fund. Nothing herein shall affect an employee's right to

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otherwise recover such benefits for medical expenses, loss of function and disfigurement from an

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uninsured employer.

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     (d) The fund shall pay costs, counsel, and witness fees, as provided in § 28-35-32, to any

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employee who successfully prosecutes any petitions for payment; petitions to amend a pretrial

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order; and all other employee petitions; and to employees who successfully defend, in whole or in

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part, proceedings seeking to reduce or terminate any and all payments; provided, however, that the

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attorney's fees awarded to counsel who represent the employee in petitions for lump-sum

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commutation filed pursuant to § 28-33-25, or in the settlement of disputed cases pursuant to § 28-

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33-25.1, shall be limited to the maximum amount paid to counsel who serve as court-appointed

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attorneys in workers' compensation proceedings as established by rule or order of the Rhode Island

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supreme court. Any payment ordered by the court or due under this section shall not be subject to

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liens set forth in § 28-33-27(b), nor shall such payments be assignable or subject to assignment in

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any way.

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     (e) In the event that the uninsured employer makes payment of any monies to the employee

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to compensate the employee in any way for the alleged work injury lost wages or medical expenses,

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the fund shall may be entitled to a credit for all such monies received by, or on behalf of, the

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employee, including, but not limited to, monies paid to the employee by any other party for the

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employee's lost wages against any future benefits payable directly to the employee. The fund shall

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be entitled to full reimbursement from the uninsured employer for any and all payments made by

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the fund to the employee, as well as all costs, counsel, and witness fees paid out by the fund in

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connection with any claim and/or petition, plus any and all costs and attorney's fees associated with

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collection and reimbursement of the fund.

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     (f) This section shall apply to injuries that occur on or after September 1, 2019.

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     SECTION 2. Section 28-33-8 of the General Laws in Chapter 28-33 entitled "Workers'

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Compensation - Benefits" is hereby amended to read as follows:

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     28-33-8. Employee's choice of physician, dentist, or hospital -- Payment of charges --

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Physician reporting schedule.

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     (a)(1) An injured employee shall initially have freedom of choice to obtain health care,

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diagnosis, and treatment from any qualified health care provider. The initial health care provider of

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record may, without prior approval, refer the injured employee to any qualified specialist for

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independent consultation or assessment, or specified treatment. If the insurer or self-insured

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employer has a preferred-provider network approved and kept on record by the medical advisory

 

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board, any change by the employee from the initial health care provider of record shall only be to

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a health care provider listed in the approved preferred-provider network; provided, however, that

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any contract proffered or maintained that restricts or limits the health care provider's ability to make

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referrals pursuant to the provisions of this section; restricts the injured employee's first choice of

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health care provider; substitutes or overrules the treatment protocols maintained by the medical

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advisory board; or attempts to evade or limit the jurisdiction of the workers' compensation court

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shall be void as against public policy. If the employee seeks to change to a health care provider not

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in the approved preferred-provider network, the employee must obtain the approval of the insurer

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or self-insured employer. Nothing contained in this section shall prevent the treatment, care, or

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rehabilitation of an employee by more than one physician, dentist, or hospital. The employee's first

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visit to any facility providing emergency care or to a physician or medical facility under contract

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with or agreement with the employer or insurer to provide priority care, shall not constitute the

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employee's initial choice to obtain health care, diagnosis, or treatment.

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     (2) In addition to the treatment of qualified health care providers, the employee shall have

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the freedom to obtain a rehabilitation evaluation by a rehabilitation counselor certified by the

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director pursuant to § 28-33-41 in cases where the employee has received compensation for a period

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of more than three (3) months, and the employer shall pay the reasonable fees incurred by the

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rehabilitation counselor for the initial assessment.

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     (b) Within three (3) days of an initial visit following an injury, the health care provider

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shall provide to the insurer or self-insured employer, and the employee and his or her attorney, a

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notification of compensable injury form to be approved by the administrator of the medical

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advisory board. Within three (3) days of the injured employee's release or discharge, return to work,

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and/or recovery from an injury covered by chapters 29 -- 38 of this title, the health care provider

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shall provide a notice of release to the insurer or self-insured employer, and the employee and his

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or her attorney, on a form approved by the division. A twenty thirty dollar ($20.00) ($30.00) fee

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may be charged by the health care provider to the insurer or self-insured employer for the

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notification of compensable injury forms or notice of release forms or for affidavits filed pursuant

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to subsection (c) of this section, but only if filed in a timely manner. No claim for care or treatment

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by a physician, dentist, or hospital chosen by an employee shall be valid and enforceable as against

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his or her employer, the employer's insurer, or the employee, unless the physician, dentist, or

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hospital gives written notice of the employee's choice to the employer/insurance carrier within

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fifteen (15) days after the beginning of the services or treatment. The health care provider shall, in

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writing, submit to the employer or insurance carrier an itemized bill and report for the services or

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treatment and a final itemized bill for all unpaid services or treatment within three (3) months after

 

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the conclusion of the treatment. The employee shall not be personally liable to pay any physician,

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dentist, or hospital bills in cases where the physician, dentist, or hospital has forfeited the right to

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be paid by the employer or insurance carrier because of noncompliance with this section.

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     (c)(1) At six (6) ten (10) weeks from the date of injury, then every twelve (12) ten (10)

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weeks thereafter until maximum medical improvement, any qualified physician or other health care

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professional providing medical care or treatment to any person for an injury covered by chapters

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29 -- 38 of this title shall file an itemized bill and an affidavit with the insurer, the employee and

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his or her attorney, and the medical advisory board. A ten percent (10%) discount may be taken on

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the itemized bill affidavits not filed in a timely manner and received by the insurer one week or

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more late. The affidavit shall be on a form designed and provided by the administrator of the

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medical advisory board and shall state:

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     (i) The type of medical treatment provided to date, including type and frequency of

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treatment(s);

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     (ii) Anticipated further treatment, including type, frequency, and duration of treatment(s),

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whether or not maximum medical improvement has been reached, and the anticipated date of

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discharge;

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     (iii) Whether the employee can return to the former position of employment, or is capable

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of other work, specifying work restrictions and work capabilities of the employee;

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     (2) The affidavit shall be admissible as an exhibit of the workers' compensation court with

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or without the appearance of the affiant.

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     (d) "Itemized bill", as referred to in this section, means a completed statement of charges,

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on a form CMS HCFA 1500, UB 92/94 or other form suitable to the insurer, that includes, but is

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not limited to, an enumeration of specific types of care provided; facilities or equipment used;

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services rendered; and appliances or medicines prescribed, for purposes of identifying the treatment

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given the employee with respect to his or her injury.

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     (e)(1) The treating physician shall furnish to the employee, or to his or her legal

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representative, a copy of his or her medical report within ten (10) days of the examination date.

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     (2) The treating physician shall notify the employer, and the employee and his or her

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attorney, immediately when an employee is able to return to full or modified work.

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     (3) There shall be no charge for a health record when that health record is necessary to

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support any appeal or claim under the Workers' Compensation Act § 23-17-19.1(16). The treating

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physician shall furnish to the employee, or to his or her legal representative, a medical report, within

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ten (10) days of the request, stating the diagnosis, disability, loss of use, end result and/or causal

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relationship of the employee's condition associated with the work related injury. The physician

 

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shall be entitled to charge for these services only as enunciated in the State of Rhode Island workers

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compensation medical fee schedule.

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     (f)(1) Compensation for medical expenses and other services under §§ 28-33-5, 28-33-7,

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or 28-33-8 is due and payable within twenty-one (21) days from the date a request is made for

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payment of these expenses by the provider of the medical services. In the event payment is not

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made within twenty-one (21) days from the date a request is made for payment, the provider of

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medical services may add, and the insurer or self-insurer shall pay, interest at the per annum rate

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as provided in § 9-21-10 on the amount due. The employee or the medical provider may file a

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petition with the administrator of the workers' compensation court which petition shall follow the

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procedure as authorized in chapter 35 of this title.

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     (2) The twenty-one day (21) period in subdivision (1) of this subsection and in § 28-35-12

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shall begin on the date the insurer receives a request with appropriate documentation required to

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determine whether the claim is compensable and the payment requested is due.

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     SECTION 3. This act shall take effect upon passage.

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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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     This is the annual workers' compensation omnibus bill. It would slightly alter the process

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and type of benefits for which work-related injured employees of uninsured employers may seek

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compensation. It would also reduce the frequency from every twelve (12) weeks, to every ten (10)

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weeks, with which an employee's medical provider must render a status report, concerning his or

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her actual and anticipated medical treatment plans, with an itemization of any of their work

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restrictions and capabilities, and whether they have reached maximum medical improvement.

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     This act would take effect upon passage.

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