Bill Text: HI SB2364 | 2018 | Regular Session | Amended
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 |
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TWENTY-NINTH LEGISLATURE, 2018 |
S.D. 1 |
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STATE OF HAWAII |
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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 an independent medical examiner, interviewing other employees, looking at videotapes, or combing through old medical records for evidence as to whether the workplace injury was related to a pre-existing condition. While the insurer considers, sometimes for months, how to proceed on a claim, the patient is at times unable to receive compensation.
The purpose of this Act is to prevent employers from denying a workers' compensation claim without reasonable cause or while the claim is pending investigation and to impose fines and penalties on employers who continue doing so without reasonable cause.
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 not dispute a claim for
services:
(1) Without reasonable cause; or
(2) While the claim is pending investigation;
provided that a claim shall be presumed
compensable when submitted by an employee who is excluded from health care
coverage under the Hawaii Prepaid Health Care Act.
(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 shall, within sixty calendar days of receipt of the claim or
bill, 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) In the event of reasonable disagreement, 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 POSTMARK OF THE EMPLOYER'S DENIAL OF PAYMENT. THE PROVIDER OF SERVICES' FAILURE TO SUBMIT A
TIMELY BILL DISPUTE REQUEST SHALL BE CONSIDERED AS ACCEPTANCE OF 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 sends
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 service fee of up to $1,000 payable to the general fund against one or
more parties who the director finds 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, 2045.
Report Title:
Workers' Compensation; Compensable Claims; Employer Payment
Description:
Prohibits
employer disputes of workers' compensation claims without reasonable cause or
while the claim is pending investigation.
Establishes negotiation, notice, and review procedures for disputed
claims. Establishes penalty for failure
to negotiate in good faith. Permits
service providers to charge interest on late bill payments. Takes effect 1/1/2045. (SD1)
The summary description
of legislation appearing on this page is for informational purposes only and is
not legislation or evidence of legislative intent.
