House File 97 - Introduced HOUSE FILE 97 BY HUNTER , ABDUL-SAMAD , BENNETT , T. TAYLOR , KACENA , KEARNS , GASKILL , STAED , RUNNING-MARQUARDT , OLDSON , BROWN-POWERS , and GAINES A BILL FOR An Act relating to the choice of doctor to treat an injured 1 employee under workers’ compensation laws and including 2 applicability date provisions. 3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 4 TLSB 1938YH (4) 87 av/nh
H.F. 97 Section 1. Section 85.27, subsection 4, Code 2017, is 1 amended to read as follows: 2 4. a. (1) For purposes of this section , the employer is 3 obliged to furnish reasonable services and supplies to treat an 4 injured employee, and has the right to choose the care unless 5 the employee has predesignated a physician as provided in 6 paragraph “b” . If the employer chooses the care, the employer 7 shall hold the employee harmless for the cost of care until the 8 employer notifies the employee that the employer is no longer 9 authorizing all or any part of the care and the reason for 10 the change in authorization. An employer is not liable for 11 the cost of care that the employer arranges in response to a 12 sudden emergency if the employee’s condition, for which care 13 was arranged, is not related to the employment. The treatment 14 must be offered promptly and be reasonably suited to treat the 15 injury without undue inconvenience to the employee. 16 (2) If the employee has reason to be dissatisfied with the 17 care offered, the employee should communicate the basis of 18 such dissatisfaction to the employer, in writing if requested, 19 following which the employer and the employee may agree to 20 alternate care reasonably suited to treat the injury. If the 21 employer and employee cannot agree on such alternate care, the 22 commissioner may, upon application and reasonable proofs proof 23 of the necessity therefor, allow and order other care. In an 24 emergency, the employee may choose the employee’s care at the 25 employer’s expense, provided the employer or the employer’s 26 agent cannot be reached immediately. 27 (3) An application made under this subsection paragraph 28 “a” shall be considered an original proceeding for purposes 29 of commencement and contested case proceedings under section 30 85.26 . The hearing shall be conducted pursuant to chapter 31 17A . Before a hearing is scheduled, the parties may choose 32 a telephone hearing , an audio-video conference hearing, or 33 an in-person hearing. A request for an in-person hearing 34 shall be approved unless the in-person hearing would be 35 -1- LSB 1938YH (4) 87 av/nh 1/ 7
H.F. 97 impractical because of the distance between the parties to the 1 hearing. The workers’ compensation commissioner shall issue a 2 decision within ten working days of receipt of an application 3 for alternate care made pursuant to a telephone hearing or 4 audio-video conference hearing or within fourteen working days 5 of receipt of an application for alternate care made pursuant 6 to an in-person hearing. The employer shall notify an injured 7 employee of the employee’s ability to contest the employer’s 8 choice of care pursuant to this subsection paragraph “a” . 9 b. (1) An injured employee has the right to choose care, 10 unless care needs to be provided at the job site in response to 11 a life-threatening emergency, if the employee has predesignated 12 a physician who is a primary care provider, who has previously 13 provided medical treatment to the employee and has retained 14 the employee’s medical records, to provide treatment for the 15 injury. Upon hire and periodically during employment, an 16 employer shall provide written notice to all employees who have 17 not yet predesignated a physician, of their rights under this 18 paragraph “b” to predesignate such a physician for treatment of 19 an injury, in a manner prescribed by the workers’ compensation 20 commissioner by rule. The employer or the employer’s insurer 21 shall not coerce or otherwise attempt to influence an injured 22 employee’s choice of a physician to provide care. An employee 23 shall, as soon as practicable, notify the employer of an 24 injury, and upon receiving such notice of an injury from an 25 employee, the employer shall again provide written notice to 26 that employee of the employee’s rights under this paragraph 27 “b” in a manner prescribed by the workers’ compensation 28 commissioner by rule. If an employer fails to notify employees 29 of their right to choose a physician as provided in this 30 paragraph “b” , the employee has the right to choose any 31 physician to provide treatment for the injury and the treatment 32 shall be considered care authorized under this section. 33 (2) For the purposes of this paragraph “b” , “physician” 34 includes an individual physician, a group of physicians, or 35 -2- LSB 1938YH (4) 87 av/nh 2/ 7
H.F. 97 a clinic. For the purposes of this paragraph “b” , “primary 1 care provider” means an employee’s personal physician who is 2 licensed to practice medicine and surgery, osteopathic medicine 3 and surgery, or osteopathy in this state or in another state 4 and provides primary care and who is a family or general 5 practitioner, a pediatrician, an internist, an obstetrician, 6 or a gynecologist. A physician who practices in another 7 state shall not be predesignated by an employee unless the 8 physician’s office is located within sixty miles of where 9 the employee is employed or was injured unless the workers’ 10 compensation commissioner allows otherwise. A physician chosen 11 by an injured employee to provide treatment is authorized to 12 arrange for any consultation, surgical consultation, referral, 13 emergency care, or other specialized medical services as the 14 physician deems necessary to treat the injury. The employer 15 shall pay for all such care, unless the workers’ compensation 16 commissioner determines otherwise. 17 (3) If the employer has reason to be dissatisfied with the 18 care chosen by the employee, the employer should communicate 19 the basis of such dissatisfaction to the employee, in writing 20 if requested, following which the employee and the employer may 21 agree to alternate care reasonably suited to treat the injury. 22 If the employee and employer cannot agree on such alternate 23 care, the commissioner may, upon application and reasonable 24 proof of the necessity therefor, allow and order other care. 25 (4) An application made under this paragraph “b” shall be 26 considered an original proceeding for purposes of commencement 27 and contested case proceedings under section 85.26. The 28 hearing shall be conducted pursuant to chapter 17A. Before 29 a hearing is scheduled, the parties may choose a telephone 30 hearing, an audio-video conference hearing, or an in-person 31 hearing. A request for an in-person hearing shall be approved 32 unless the in-person hearing would be impractical because of 33 the distance between the parties to the hearing. The workers’ 34 compensation commissioner shall issue a decision within ten 35 -3- LSB 1938YH (4) 87 av/nh 3/ 7
H.F. 97 working days of receipt of an application for alternate care 1 made pursuant to a telephone hearing or audio-video conference 2 hearing or within fourteen working days of receipt of an 3 application for alternate care made pursuant to an in-person 4 hearing. 5 Sec. 2. Section 85.39, Code 2017, is amended to read as 6 follows: 7 85.39 Examination of injured employees. 8 1. a. After an injury, the employee, if requested by the 9 employer, shall submit for examination at some reasonable 10 time and place and as often as reasonably requested, to a 11 physician or physicians authorized to practice under the laws 12 of this state or another state, without cost to the employee; 13 but if the employee requests, the employee, at the employee’s 14 own cost, is entitled to have a physician or physicians 15 of the employee’s own selection present to participate in 16 the examination. If an employee is required to leave work 17 for which the employee is being paid wages to attend the 18 requested examination, the employee shall be compensated at 19 the employee’s regular rate for the time the employee is 20 required to leave work, and the employee shall be furnished 21 transportation to and from the place of examination, or the 22 employer may elect to pay the employee the reasonable cost of 23 the transportation. The refusal of the employee to submit 24 to the examination shall suspend the employee’s right to any 25 compensation for the period of the refusal. Compensation shall 26 not be payable for the period of suspension. 27 b. If an evaluation of permanent disability has been made by 28 a physician retained by the employer and the employee believes 29 this evaluation to be too low, the employee shall, upon 30 application to the commissioner and upon delivery of a copy of 31 the application to the employer and its insurance carrier, be 32 reimbursed by the employer the reasonable fee for a subsequent 33 examination by a physician of the employee’s own choice, and 34 reasonably necessary transportation expenses incurred for the 35 -4- LSB 1938YH (4) 87 av/nh 4/ 7
H.F. 97 examination. The physician chosen by the employee has the 1 right to confer with and obtain from the employer-retained 2 physician sufficient history of the injury to make a proper 3 examination. 4 2. If the employee has chosen a physician to provide care 5 as provided in section 85.27, subsection 4, paragraph “b” , when 6 it is medically indicated that no significant improvement from 7 an injury is anticipated, the employee may obtain a medical 8 opinion from the employee’s physician, at the employer’s 9 expense, regarding the extent of the employee’s permanent 10 disability. If the employee obtains such an evaluation and the 11 employer believes this evaluation of permanent disability to be 12 too high, the employer may arrange for a medical examination of 13 the injured employee by a physician of the employer’s choice 14 for the purpose of obtaining a medical opinion regarding the 15 extent of the employee’s permanent disability. If an employee 16 is required to leave work for which the employee is being paid 17 wages to attend an examination under this subsection, the 18 employee shall be compensated at the employee’s regular rate 19 for the time the employee is required to leave work, and the 20 employee shall be furnished transportation to and from the 21 place of examination, or the employer may elect to pay the 22 employee the reasonable cost of transportation. The physician 23 chosen by the employer to conduct the examination has the right 24 to confer with and obtain from any physician who has treated 25 the injured employee sufficient history of the injury to make 26 a proper examination. The refusal by the employee to submit 27 to the examination shall suspend the employee’s right to any 28 compensation for the period of the refusal. Compensation shall 29 not be payable for the period of suspension. 30 Sec. 3. APPLICABILITY. This Act applies to injuries 31 occurring on or after January 1, 2018. 32 EXPLANATION 33 The inclusion of this explanation does not constitute agreement with 34 the explanation’s substance by the members of the general assembly. 35 -5- LSB 1938YH (4) 87 av/nh 5/ 7
H.F. 97 This bill relates to the choice of a physician to treat an 1 injured employee under the state’s workers’ compensation laws. 2 The bill allows the employer to choose care unless the employee 3 has predesignated a physician as provided in the bill. 4 The bill gives an employee the right to predesignate a 5 physician who is a primary care provider, who has previously 6 provided treatment to the employee and has retained the 7 employee’s medical records, to provide treatment for a 8 work-related injury. The employer is required to provide 9 written notice to employees of this right upon hire, and 10 periodically during employment, and upon receiving notice of 11 an injury from an employee who has not yet predesignated a 12 physician of their right to do so, in a manner prescribed by 13 the workers’ compensation commissioner. An employer or an 14 employer’s insurer shall not coerce or otherwise attempt to 15 influence an injured employee’s choice of a physician. 16 If the employer fails to provide such notification, an 17 injured employee has the right to choose any physician to 18 provide treatment for the work-related injury and that 19 treatment shall be considered authorized care. 20 If the employer or employee is dissatisfied with the care 21 chosen by the other party, the dissatisfied party is required 22 to communicate the basis of dissatisfaction to the other 23 party in writing and the parties may agree to alternate care 24 reasonably suited to treat the injury. If the parties cannot 25 agree to such alternate care, the dissatisfied party may make 26 an application for alternate care to the commissioner. 27 An application for alternate care is an original proceeding 28 and is treated as a contested case. A party may request that 29 the hearing be held in person, by telephone, or by audio-video 30 conference. The commissioner is required to issue a decision 31 within 10 working days of receipt of an application made 32 pursuant to a telephone hearing or audio-video conference 33 hearing and within 14 days of an in-person hearing. 34 Code section 85.39 is amended to provide that if the 35 -6- LSB 1938YH (4) 87 av/nh 6/ 7
H.F. 97 employee has chosen care, when it is medically indicated that 1 no significant improvement from an injury is anticipated, the 2 employee may obtain a medical opinion regarding the extent 3 of the employee’s permanent disability from the employee’s 4 physician. If the employer believes that the evaluation of 5 permanent disability obtained by the employee is too high, the 6 employer has the right to obtain another medical opinion from a 7 physician of the employer’s choosing. 8 The bill applies to injuries occurring on or after January 9 1, 2018. 10 -7- LSB 1938YH (4) 87 av/nh 7/ 7