Bill Text: CT SB00907 | 2013 | General Assembly | Comm Sub

Connecticut Senate Bill 907 (Prior Session Legislation)

Bill Title: An Act Concerning Additional Requirements For An Employer's Notice To Dispute Certain Care Deemed Reasonable For An Employee Under The Workers' Compensation Act.

Spectrum: Committee Bill

Status: (Introduced - Dead) 2013-06-04 - Senate Recommitted to Labor and Public Employees [SB00907 Detail]

Download: Connecticut-2013-SB00907-Comm_Sub.html

General Assembly		*Substitute Bill No. 907*
*January Session, 2013*		_____SB00907LAB___031913____

AN ACT CONCERNING ADDITIONAL REQUIREMENTS FOR AN EMPLOYER'S NOTICE TO DISPUTE CERTAIN CARE DEEMED REASONABLE FOR AN EMPLOYEE UNDER THE WORKERS' COMPENSATION ACT.

Be it enacted by the Senate and House of Representatives in General Assembly convened:

Section 1. (NEW) (Effective October 1, 2013) (a) No employer or an employer's insurer shall discontinue, reduce or deny a course of treatment which a physician or surgeon deems reasonable or necessary unless the employer notifies the commissioner, physician or surgeon and the employee of the proposed discontinuance, reduction or denial of the course of medical care and the commissioner approves such discontinuance, reduction or denial of such care in writing. Such notice shall specify the reason maintained by the employer or the employer's insurer that the course of medical care deemed reasonable by the physician or surgeon is not reasonable and be in substantially the following form:

IMPORTANT

STATE OF CONNECTICUT WORKERS' COMPENSATION COMMISSION

YOU ARE HEREBY NOTIFIED THAT THE EMPLOYER OR INSURER INTENDS TO DISCONTINUE, REDUCE OR DENY TREATMENT .... (date) FOR THE FOLLOWING REASONS:

If you object to the discontinuance, reduction, or denial of treatment as stated in this notice, YOU MUST REQUEST A HEARING NOT LATER THAN FIFTEEN DAYS after your receipt of this notice, or this notice will automatically be approved.

To request an Informal Hearing, call the Workers' Compensation Commission District Office in which your case is pending.

Be prepared to provide medical and other documentation to support your objection. For your protection, note the date when you received this notice.

(b) No discontinuance or reduction of an ongoing course of treatment shall be effective unless approved in writing by the commissioner upon a determination that the proposed care is not reasonable. The parties may request a hearing on any such proposed discontinuance, reduction or denial not later than fifteen days after receipt of such notice. Such notice of intention to discontinue, reduce or deny medical treatment shall be issued not later than ten days after a notice of need for treatment is received by the employer, employer's insurer, employer's claim administrator or Second Injury Fund. The commissioner shall not approve such discontinuance, reduction or denial prior to expiration of the period for requesting a hearing or the completion of the hearing, whichever is later. Either party may request a formal hearing on the commissioner's decision to grant or deny the discontinuance, reduction or denial. The employer shall have the burden of proof that the medical care or treatment is unreasonable. Failure to issue such notice of intention to discontinue, reduce or deny medical treatment shall preclude the employer and the employer's insurer from discontinuing, reducing or denying the request for medical treatment.

(c) The notice required in subsection (a) of this section shall include an opinion from a physician or surgeon licensed to practice medicine in this state that the course of treatment recommended by the attending physician or surgeon is not reasonable or necessary and the basis for such opinion. If the employer intends to rely on the opinion of a physician or surgeon who performs an examination pursuant to section 31-294f of the general statutes, and such examination has not yet taken place, then the name of the physician or surgeon, date, time and location of the examination, which shall be held not more than thirty calendar days after the employee's receipt of the notice, shall be attached to the notice in lieu of an opinion that the treatment is not reasonable or necessary. Failure to conduct the examination not later than thirty days after receipt of such notice shall preclude the employer or employer's insurer from disputing, discontinuing or reducing the requested treatment. The treatment recommended by the attending physician or surgeon may not be discontinued, reduced or denied until the results of the examination pursuant to section 31-294f of the general statutes is considered at an informal hearing.

(d) If the employer or employer's insurer seeks to discontinue, reduce or deny the course of medical care found reasonable by a physician or surgeon based upon a dispute between physicians or surgeons not as to the reasonableness of the course of care, but as to the better course of care, the patient shall be entitled to choose the course of care after informed consent.

(e) An employer or an employer's insurer is not required to comply with the notice provisions set forth in subsections (a), (b) and (c) of this section for an ongoing course of medical treatment of limited duration.

Sec. 2. (NEW) (Effective October 1, 2013) An employer and the employer's insurer are exempt from the notice provisions of subsections (a) to (c), inclusive, of section 1 of this act if the employer provides the injured employee with accident and health insurance pursuant to section 31-284b of the general statutes.