Bill Text: HI SB857 | 2018 | Regular Session | Amended
Bill Title: Relating To Workers' Compensation.
Spectrum: Partisan Bill (Democrat 2-0)
Status: (Engrossed - Dead) 2017-11-30 - Carried over to 2018 Regular Session. [SB857 Detail]
Download: Hawaii-2018-SB857-Amended.html
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THE SENATE |
S.B. NO. |
857 |
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TWENTY-NINTH LEGISLATURE, 2017 |
S.D. 1 |
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STATE OF HAWAII |
H.D. 2 |
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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 that 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.
Accordingly, the purpose of this Act is to prevent employers from denying a claim without reasonable cause or while the claim is pending investigation and impose fines and penalties on those 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 controvert 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 controverts a claim for services rendered or a bill received pursuant to subsection (a), the employer shall notify the provider of services of that fact within calendar days of receipt of the notification or bill. Failure by the employer to submit timely notice to the provider of services shall render the employer liable for services provided until the employer satisfies the notice requirement and except as provided in subsection (d).
(d) Any employer who has received a notification of services rendered or a bill from a provider of services shall be liable for those services and shall pay all charges listed in the notification of services rendered or the bill within sixty calendar days of receipt of the notification or bill, except for items where 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 pay all undisputed charges, shall notify the provider 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 notification of services rendered, and shall provide a copy of the denial to the employee. The employer's denial shall include a statement as follows:
"If the provider of service does not agree with the employer's stated reason for denial of payment, the provider of service 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 a 'BILLING 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 service's 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 during 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 such request to the non-requesting party. Upon receipt of the request for review, the director shall send the parties a second notice requesting that each party 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 fourteen-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 controverted claim that is found to be uncompensable, 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 7, 2059.
Report Title:
Workers' Compensation; Employers; Service Providers; Payment; Disagreement; Resolution Procedures
Description:
Establishes that employers shall pay all workers' compensation claims for compensable injuries and shall not deny claims without reasonable cause or during a pending investigation. Creates a presumption of compensability for claims submitted by employees excluded from coverage under the Hawaii Prepaid Health Care Act. Establishes that employers shall notify providers of service of any billing disagreements and allows providers to charge an additional rate to employers for outstanding balances owed for undisputed services or charges. Establishes resolution procedures for employers and providers who have a reasonable disagreement over liability for services rendered. Requires an employee whose claim is found to be uncompensable to submit reimbursements for services rendered. (SB857 HD2)
The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.
