The Commonwealth of Massachusetts

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PRESENTED BY:

Tarr, Bruce (SEN)

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To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
                Court assembled:

                The undersigned legislators and/or citizens respectfully petition for the passage of the accompanying bill:

An Act to ensure fairness in the disability adjudication process

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PETITION OF:

The Commonwealth of Massachusetts

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In the Year Two Thousand and Nine

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An Act to ensure fairness in the disability adjudication process.

                Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:

SECTION 1. Section 14 of Chapter 152 of the General Laws is hereby amended by inserting after subsection (1)(b) the following additional new paragraph:

For the purposes of this section, if an insurer contests the total permanent disability of an employee after that decision has been fully and finally adjudicated in favor of the employee, without either evidence of improvement in the condition of the employee, evidence that the employee has been working or otherwise behaving in a manner inconsistent with a total and permanent disability, or evidence of a significant advancement in medical science that has a substantial likelihood of affecting the total and permanent disability of the employee, more than once in any five-year period, that contest shall be considered an action not based on reasonable grounds.

SECTION 2. Section 24 of Chapter 152 of the General Laws is hereby amended by inserting at the end thereof the following new subsection:-

“(11) All bills submitted pursuant to adjudication under this chapter shall be paid within 30 days unless good cause for delay is shown before 30 days has elapsed. Any payments made after the initial 30-day period shall include payment of the prevailing rate of interest”.

SECTION 3. Section 11 of Chapter 152 of the General Laws is hereby amended by inserting at the end the following paragraphs:-

“All such hearings shall be recorded either by tape-recorder or by video and copies or transcriptions made available to the parties for a reasonable fee not exceeding the costs of labor and materials.

On motion from the employee and when information of a personally sensitive nature is being discussed, the member may close the proceeding to the parties and family members of the employee.”

SECTION 4. Section 8 of Chapter 152 of the General Laws is hereby amended by striking subsection 2(D) in its entirety; and further, by striking in Section 2 the following words:- “For purposes of clause (d) of this section, any termination of an employee within one year of resumption of work with his prior employer will be presumed to be for the reason that the employee was physically or mentally incapable of performing the duties required by the job or that the job was unsuitable for the employee, unless the insurer demonstrates the contrary by a preponderance of evidence at a subsequent proceeding”.

SECTION 5. Section 30 of Chapter 152 of the General Laws is hereby amended by inserting at the end of the second paragraph the following sentence:- “No insurer shall participate in the medical judgments of any utilization review process established by said regulations, except to provide necessary information at the request of the utilization review agent or agents”.