HF 86 (LSB 1415YH (3) 88)

HOUSE FILE 86

BY  HUNTER, STAED, MASCHER, KURTZ, LENSING, and McCONKEY

A BILL FOR

An Act relating to the choice of doctor to treat an injured employee under workers’ compensation laws and including applicability date provisions.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  Section 85.27, subsection 4, Code 2019, is amended to read as follows:
   4.  a.  (1)  For purposes of this section, the employer is obliged to furnish reasonable services and supplies to treat an injured employee, and has the right to choose the care unless the employee has predesignated a physician as provided in paragraph “b”. If the employer chooses the care, the employer shall hold the employee harmless for the cost of care until the employer notifies the employee that the employer is no longer authorizing all or any part of the care and the reason for the change in authorization. An employer is not liable for the cost of care that the employer arranges in response to a sudden emergency if the employee’s condition, for which care was arranged, is not related to the employment. The treatment must be offered promptly and be reasonably suited to treat the injury without undue inconvenience to the employee.
   (2)  If the employee has reason to be dissatisfied with the care offered, the employee should communicate the basis of such dissatisfaction to the employer, in writing if requested, following which the employer and the employee may agree to alternate care reasonably suited to treat the injury. If the employer and employee cannot agree on such alternate care, the commissioner may, upon application and reasonable proofs proof of the necessity therefor, allow and order other care. In an emergency, the employee may choose the employee’s care at the employer’s expense, provided the employer or the employer’s agent cannot be reached immediately.
   (3)  An application made under this subsection paragraph “a” shall be considered an original proceeding for purposes of commencement and contested case proceedings under section 85.26. The hearing shall be conducted pursuant to chapter 17A. Before a hearing is scheduled, the parties may choose a telephone hearing, an audio-video conference hearing, or an in-person hearing. A request for an in-person hearing shall be approved unless the in-person hearing would be impractical because of the distance between the parties to the hearing. The workers’ compensation commissioner shall issue a decision within ten working days of receipt of an application for alternate care made pursuant to a telephone hearing or audio-video conference hearing or within fourteen working days of receipt of an application for alternate care made pursuant to an in-person hearing. The employer shall notify an injured employee of the employee’s ability to contest the employer’s choice of care pursuant to this subsection paragraph “a”.
   b.  (1)  An injured employee has the right to choose care, unless care needs to be provided at the job site in response to a life-threatening emergency, if the employee has predesignated a physician who is a primary care provider, who has previously provided medical treatment to the employee and has retained the employee’s medical records, to provide treatment for the injury. Upon hire and periodically during employment, an employer shall provide written notice to all employees who have not yet predesignated a physician, of their rights under this paragraph “b” to predesignate such a physician for treatment of an injury, in a manner prescribed by the workers’ compensation commissioner by rule. The employer or the employer’s insurer shall not coerce or otherwise attempt to influence an injured employee’s choice of a physician to provide care. An employee shall, as soon as practicable, notify the employer of an injury, and upon receiving such notice of an injury from an employee, the employer shall again provide written notice to that employee of the employee’s rights under this paragraph “b” in a manner prescribed by the workers’ compensation commissioner by rule. If an employer fails to notify employees of their right to choose a physician as provided in this paragraph “b”, the employee has the right to choose any physician to provide treatment for the injury and the treatment shall be considered care authorized under this section.
   (2)  For the purposes of this paragraph “b”, “physician” includes an individual physician, a group of physicians, or a clinic. For the purposes of this paragraph “b”, “primary care provider” means an employee’s personal physician who is licensed to practice medicine and surgery, osteopathic medicine and surgery, or osteopathy in this state or in another state and provides primary care and who is a family or general practitioner, a pediatrician, an internist, an obstetrician, or a gynecologist. A physician who practices in another state shall not be predesignated by an employee unless the physician’s office is located within sixty miles of where the employee is employed or was injured unless the workers’ compensation commissioner allows otherwise. A physician chosen by an injured employee to provide treatment is authorized to arrange for any consultation, surgical consultation, referral, emergency care, or other specialized medical services as the physician deems necessary to treat the injury. The employer shall pay for all such care, unless the workers’ compensation commissioner determines otherwise.
   (3)  If the employer has reason to be dissatisfied with the care chosen by the employee, the employer should communicate the basis of such dissatisfaction to the employee, in writing if requested, following which the employee and the employer may agree to alternate care reasonably suited to treat the injury. If the employee and employer cannot agree on such alternate care, the commissioner may, upon application and reasonable proof of the necessity therefor, allow and order other care.
   (4)  An application made under this paragraph “b” shall be considered an original proceeding for purposes of commencement and contested case proceedings under section 85.26. The hearing shall be conducted pursuant to chapter 17A. Before a hearing is scheduled, the parties may choose a telephone hearing, an audio-video conference hearing, or an in-person hearing. A request for an in-person hearing shall be approved unless the in-person hearing would be impractical because of the distance between the parties to the hearing. The workers’ compensation commissioner shall issue a decision within ten working days of receipt of an application for alternate care made pursuant to a telephone hearing or audio-video conference hearing or within fourteen working days of receipt of an application for alternate care made pursuant to an in-person hearing.
    Sec. 2.  Section 85.39, Code 2019, is amended by adding the following new subsection:
   NEW SUBSECTION.  3.  If the employee has chosen a physician to provide care as provided in section 85.27, subsection 4, paragraph “b”, when it is medically indicated that no significant improvement from an injury is anticipated, the employee may obtain a medical opinion from the employee’s physician, at the employer’s expense, regarding the extent of the employee’s permanent disability. If the employee obtains such an evaluation and the employer believes this evaluation of permanent disability to be too high, the employer may arrange for a medical examination of the injured employee by a physician of the employer’s choice for the purpose of obtaining a medical opinion regarding the extent of the employee’s permanent disability. If an employee is required to leave work for which the employee is being paid wages to attend an examination under this subsection, the employee shall be compensated at the employee’s regular rate for the time the employee is required to leave work, and the employee shall be furnished transportation to and from the place of examination, or the employer may elect to pay the employee the reasonable cost of transportation. The physician chosen by the employer to conduct the examination has the right to confer with and obtain from any physician who has treated the injured employee sufficient history of the injury to make a proper examination. The refusal by the employee to submit to the examination shall suspend the employee’s right to any compensation for the period of the refusal. Compensation shall not be payable for the period of suspension.
    Sec. 3.  APPLICABILITY.  This Act applies to injuries occurring on or after January 1, 2020.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill relates to the choice of a physician to treat an injured employee under the state’s workers’ compensation laws. The bill allows the employer to choose care unless the employee has predesignated a physician as provided in the bill.
   The bill gives an employee the right to predesignate a physician who is a primary care provider, who has previously provided treatment to the employee and has retained the employee’s medical records, to provide treatment for a work-related injury. The employer is required to provide written notice to employees of this right upon hire, and periodically during employment, and upon receiving notice of an injury from an employee who has not yet predesignated a physician of their right to do so, in a manner prescribed by the workers’ compensation commissioner. An employer or an employer’s insurer shall not coerce or otherwise attempt to influence an injured employee’s choice of a physician.
   If the employer fails to provide such notification, an injured employee has the right to choose any physician to provide treatment for the work-related injury and that treatment shall be considered authorized care.
   If the employer or employee is dissatisfied with the care chosen by the other party, the dissatisfied party is required to communicate the basis of dissatisfaction to the other party in writing and the parties may agree to alternate care reasonably suited to treat the injury. If the parties cannot agree to such alternate care, the dissatisfied party may make an application for alternate care to the commissioner.
   An application for alternate care is an original proceeding and is treated as a contested case. A party may request that the hearing be held in person, by telephone, or by audio-video conference. The commissioner is required to issue a decision within 10 working days of receipt of an application made pursuant to a telephone hearing or audio-video conference hearing and within 14 days of an in-person hearing.
   Code section 85.39 is amended to provide that if the employee has chosen care, when it is medically indicated that no significant improvement from an injury is anticipated, the employee may obtain a medical opinion regarding the extent of the employee’s permanent disability from the employee’s physician. If the employer believes that the evaluation of permanent disability obtained by the employee is too high, the employer has the right to obtain another medical opinion from a physician of the employer’s choosing.
   The bill applies to injuries occurring on or after January 1, 2020.