Bill Text: HI SB2364 | 2018 | Regular Session | Amended

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Bill Title: Relating To Workers' Compensation.

Spectrum: Partisan Bill (Democrat 6-0)

Status: (Engrossed - Dead) 2018-04-27 - Conference committee meeting to reconvene on 04-27-18 3:00 pm in conference room 329. [SB2364 Detail]

Download: Hawaii-2018-SB2364-Amended.html

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THE SENATE	S.B. NO.	2364
TWENTY-NINTH LEGISLATURE, 2018		S.D. 2
STATE OF HAWAII		H.D. 1

A BILL FOR AN ACT

 

 

RELATING TO WORKERS' COMPENSATION.

 

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 

SECTION 1.  The legislature finds that Hawaii's existing workers' compensation system has been plagued by delays and denials, and in many of those cases, insurers seem to automatically deny the claim pending investigation.  These investigations may include reviewing reports from independent medical examiners, interviewing other employees, looking at videotapes, or combing through old medical records for evidence as to whether the workplace injury was related to a preexisting condition.  While insurers consider, sometimes for months, how to proceed on claims, patients are at times unable to receive compensation.

     The purpose of this Act is to prevent the non-payment of workers compensation claims by employers while the claim is pending investigation by:

     (1)  Requiring the employer to pay for all medical services required for the employee for the compensable injury and the process of recovery;

     (2)  Establishing negotiation, notice, and review procedures for disputed claims for medical services rendered;

     (3)  Imposing fines and penalties on parties who fail to negotiate in good faith; and

     (4)  Permitting service providers to charge interest on late bill payments.

     SECTION 2.  Chapter 386, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

     "§386-    Payment by employer; duty to service provider; disagreement with service provider; resolution procedures.  (a)  Notwithstanding any other law to the contrary, the employer shall pay for all medical services required by the employee for the compensable injury and the process of recovery.  The employer shall not be required to pay for care unrelated to the compensable injury.

     (b)  The employer shall retain the right to investigate the claim, but shall not use the investigation to determine compensability as the basis of denial of medical services for the employee.

     (c)  If an employer disputes a claim for services rendered or a bill received, the employer shall notify the provider of services of that fact within thirty calendar days of receipt of the claim for services or bill.  Failure by the employer to submit timely notice to the provider of services shall render the employer liable for the services provided or bill received until the employer satisfies the notice requirement and except as provided in subsection (d).

     (d)  Any employer who has received a claim for services rendered or a bill from a provider of services shall be liable for the claim or bill and, within sixty calendar days of receipt of the claim or bill, shall pay all charges listed in the claim for services rendered or the bill, except for items for which there is reasonable disagreement.  After expiration of the sixty-calendar-day time period for payment, the provider of services may increase the total outstanding balance owed for undisputed services or charges by one per cent per month.

     (e)  If reasonable disagreement occurs, the employer shall:

     (1)  Pay all undisputed charges;

     (2)  Notify the provider of services of the denial of payment of any disputed charges and the reason for the denial within thirty calendar days of receipt of the bill or claim for services rendered; and

     (3)  Provide a copy of the denial to the employee.

The employer's denial shall include a statement as follows:

"IF THE PROVIDER OF SERVICES DOES NOT AGREE WITH THE EMPLOYER'S STATED REASON FOR DENIAL OF PAYMENT, THE PROVIDER OF SERVICES MAY FILE A BILL DISPUTE REQUEST WITH THE DIRECTOR OF THE HAWAII DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS.  THE BILL DISPUTE REQUEST SHALL BE CLEARLY IDENTIFIED AS 'BILL DISPUTE REQUEST' IN CAPITAL LETTERS AND IN NO LESS THAN TEN POINT FONT ON THE FRONT OF THE FIRST PAGE OF THE REQUEST AND ON THE FRONT OF THE ENVELOPE IN WHICH THE REQUEST IS SENT.  ANY BILL DISPUTE REQUEST SHALL BE FILED WITHIN THIRTY CALENDAR DAYS AFTER THE POSTMARK DATE OF THE EMPLOYER'S DENIAL OF PAYMENT.  IF THE PROVIDER OF SERVICES FAILS TO SUBMIT A TIMELY BILL DISPUTE REQUEST, THE PROVIDER SHALL FORFEIT THE RIGHT TO DISPUTE THE EMPLOYER'S DENIAL OF PAYMENT."

     (f)  Upon receipt of a bill dispute request, the director shall send notice to the parties and the parties shall negotiate to resolve the disputed services or charges during the thirty-one calendar days following the date of the notice from the director.  If the parties fail to enter into an agreement within the thirty-one calendar days, then within fourteen calendar days thereafter, either party may file a request in writing to the director to review the bill dispute request; provided that the requesting party shall send a notice of the request to the non-requesting party.  Upon receipt of the request for review, the director shall send the parties a second notice requesting each party to file a position statement with the director, including substantiating documentation that describes the services and amounts in dispute and all actions taken to resolve the dispute during the thirty-one calendar day period of negotiation under this subsection.  The director shall review the positions of the parties and render an administrative decision without a hearing.  The director may assess a fine of up to $1,000 payable to the general fund against any party if the director finds that the party has failed to negotiate in good faith.  Denial of payment without reasonable cause shall be considered a failure to negotiate in good faith.

     (g)  An employee shall be liable for reimbursement of benefits or payments received under this section for any disputed claim that is found to be not compensable, whether received from an employer, insurer, or the special compensation fund.  Reimbursement shall be made to the source from which the compensation was received, and may include recoupment by the insurer of all payments made for medical care, medical services, vocational rehabilitation services, and all other services rendered for payment under this section."

     SECTION 3.  New statutory material is underscored.

     SECTION 4.  This Act shall take effect on January 1, 2050.

 

Report Title:

Workers' Compensation; Compensable Claims; Employer Payment

 

Description:

Requires employers to pay for all medical services required for the employee for the compensable injury and the process of recovery, even when claims are disputed.  Establishes negotiation, notice, and review procedures for disputed claims.  Imposes fines and penalties for failure to negotiate in good faith.  Permits service providers to charge interest on late bill payments.  (SB2364 HD1)

 

 

 

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.