Bill Text: MN HF1799 | 2013-2014 | 88th Legislature | Introduced
Bill Title: Workers' Compensation Advisory Council recommendations adopted.
Sponsorship: Partisan Bill (Democrat 1)
Status: (Introduced - Dead) 2013-04-22 - Introduction and first reading, referred to Labor, Workplace and Regulated Industries [HF1799 Detail]
Download: Minnesota-2013-HF1799-Introduced.html
1.2relating to workers' compensation; adopting recommendations of the Workers'
1.3Compensation Advisory Council;amending Minnesota Statutes 2012, sections
1.4176.011, subdivisions 15, 16; 176.081, subdivisions 1, 7; 176.101, subdivision 1;
1.5176.102, subdivisions 5, 10; 176.106, subdivision 3; 176.136, subdivision 1b;
1.6176.191, subdivision 3; 176.645; 176.83, subdivision 5.
1.7BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.8 Section 1. Minnesota Statutes 2012, section 176.011, subdivision 15, is amended to read:
1.9 Subd. 15. Occupational disease. (a) "Occupational disease" means a mental
1.10impairment as defined in paragraph (d) or physical disease arising out of and in the course
1.11of employment peculiar to the occupation in which the employee is engaged and due
1.12to causes in excess of the hazards ordinary of employment and shall include undulant
1.13fever. Physical stimulus resulting in mental injury and mental stimulus resulting in
1.14physical injury shall remain compensable. Mental impairment is not considered a disease
1.15if it results from a disciplinary action work evaluation, job transfer, layoff, demotion,
1.16promotion, termination, retirement, or similar action taken in good faith by the employer.
1.17Ordinary diseases of life to which the general public is equally exposed outside of
1.18employment are not compensable, except where the diseases follow as an incident of an
1.19occupational disease, or where the exposure peculiar to the occupation makes the disease
1.20an occupational disease hazard. A disease arises out of the employment only if there be a
1.21direct causal connection between the conditions under which the work is performed and
1.22if the occupational disease follows as a natural incident of the work as a result of the
1.23exposure occasioned by the nature of the employment. An employer is not liable for
1.24compensation for any occupational disease which cannot be traced to the employment as a
1.25direct and proximate cause and is not recognized as a hazard characteristic of and peculiar
2.1to the trade, occupation, process, or employment or which results from a hazard to which
2.2the worker would have been equally exposed outside of the employment.
2.3(b) If immediately preceding the date of disablement or death, an employee was
2.4employed on active duty with an organized fire or police department of any municipality,
2.5as a member of the Minnesota State Patrol, conservation officer service, state crime bureau,
2.6as a forest officer by the Department of Natural Resources, state correctional officer, or
2.7sheriff or full-time deputy sheriff of any county, and the disease is that of myocarditis,
2.8coronary sclerosis, pneumonia or its sequel, and at the time of employment such employee
2.9was given a thorough physical examination by a licensed doctor of medicine, and a written
2.10report thereof has been made and filed with such organized fire or police department, with
2.11the Minnesota State Patrol, conservation officer service, state crime bureau, Department
2.12of Natural Resources, Department of Corrections, or sheriff's department of any county,
2.13which examination and report negatived any evidence of myocarditis, coronary sclerosis,
2.14pneumonia or its sequel, the disease is presumptively an occupational disease and shall
2.15be presumed to have been due to the nature of employment. If immediately preceding
2.16the date of disablement or death, any individual who by nature of their position provides
2.17emergency medical care, or an employee who was employed as a licensed police officer
2.18under section626.84, subdivision 1 ; firefighter; paramedic; state correctional officer;
2.19emergency medical technician; or licensed nurse providing emergency medical care; and
2.20who contracts an infectious or communicable disease to which the employee was exposed
2.21in the course of employment outside of a hospital, then the disease is presumptively an
2.22occupational disease and shall be presumed to have been due to the nature of employment
2.23and the presumption may be rebutted by substantial factors brought by the employer
2.24or insurer. Any substantial factors which shall be used to rebut this presumption and
2.25which are known to the employer or insurer at the time of the denial of liability shall be
2.26communicated to the employee on the denial of liability.
2.27(c) A firefighter on active duty with an organized fire department who is unable
2.28to perform duties in the department by reason of a disabling cancer of a type caused
2.29by exposure to heat, radiation, or a known or suspected carcinogen, as defined by the
2.30International Agency for Research on Cancer, and the carcinogen is reasonably linked to
2.31the disabling cancer, is presumed to have an occupational disease under paragraph (a). If a
2.32firefighter who enters the service after August 1, 1988, is examined by a physician prior to
2.33being hired and the examination discloses the existence of a cancer of a type described
2.34in this paragraph, the firefighter is not entitled to the presumption unless a subsequent
2.35medical determination is made that the firefighter no longer has the cancer.
3.1(d) For the purposes of this chapter, "mental impairment" means a diagnosis of
3.2post-traumatic stress disorder by a licensed physician or psychologist. For the purpose of
3.3this chapter, "post-traumatic stress disorder" means the condition as described in the most
3.4recent edition of the Diagnostic and Statistical Manual of Mental Disorders published
3.5by the American Psychiatric Association.
3.6 Sec. 2. Minnesota Statutes 2012, section 176.011, subdivision 16, is amended to read:
3.7 Subd. 16. Personal injury. "Personal injury" means any mental impairment as
3.8defined in subdivision 15, paragraph (d), or physical injury arising out of and in the course
3.9of employment and includes personal injury caused by occupational disease; but does
3.10not cover an employee except while engaged in, on, or about the premises where the
3.11employee's services require the employee's presence as a part of that service at the time of
3.12the injury and during the hours of that service. Where the employer regularly furnished
3.13transportation to employees to and from the place of employment, those employees are
3.14subject to this chapter while being so transported. Physical stimulus resulting in mental
3.15injury and mental stimulus resulting in physical injury shall remain compensable. Mental
3.16impairment is not considered a personal injury if it results from a disciplinary action work
3.17evaluation, job transfer, layoff, demotion, promotion, termination, retirement, or similar
3.18action taken in good faith by the employer. Personal injury does not include an injury
3.19caused by the act of a third person or fellow employee intended to injure the employee
3.20because of personal reasons, and not directed against the employee as an employee, or
3.21because of the employment. An injury or disease resulting from a vaccine in response
3.22to a declaration by the Secretary of the United States Department of Health and Human
3.23Services under the Public Health Service Act to address an actual or potential health
3.24risk related to the employee's employment is an injury or disease arising out of and in
3.25the course of employment.
3.26 Sec. 3. Minnesota Statutes 2012, section 176.081, subdivision 1, is amended to read:
3.27 Subdivision 1. Limitation of fees. (a) A fee for legal services of25 20 percent of
3.28the first$4,000 of compensation awarded to the employee and 20 percent of the next
3.29$60,000 $130,000 of compensation awarded to the employee is the maximum permissible
3.30fee and does not require approval by the commissioner, compensation judge, or any other
3.31party. All fees, including fees for obtaining medical or rehabilitation benefits, must be
3.32calculated according to the formula under this subdivision, except as otherwise provided
3.33in clause (1) or (2).
4.1(1) The contingent attorney fee for recovery of monetary benefits according to the
4.2formula in this section is presumed to be adequate to cover recovery of medical and
4.3rehabilitation benefit or services concurrently in dispute. Attorney fees for recovery of
4.4medical or rehabilitation benefits or services shall be assessed against the employer or
4.5insurer only if the attorney establishes that the contingent fee is inadequate to reasonably
4.6compensate the attorney for representing the employee in the medical or rehabilitation
4.7dispute. In cases where the contingent fee is inadequate the employer or insurer is liable
4.8for attorney fees based on the formula in this subdivision or in clause (2).
4.9 For the purposes of applying the formula where the employer or insurer is liable for
4.10attorney fees, the amount of compensation awarded for obtaining disputed medical and
4.11rehabilitation benefits under sections176.102 ,
176.135 , and
176.136 shall be the dollar
4.12value of the medical or rehabilitation benefit awarded, where ascertainable.
4.13(2) The maximum attorney fee for obtaining a change of doctor or qualified
4.14rehabilitation consultant, or any other disputed medical or rehabilitation benefit for which
4.15a dollar value is not reasonably ascertainable, is the amount charged in hourly fees for the
4.16representation or $500, whichever is less, to be paid by the employer or insurer.
4.17(3) The fees for obtaining disputed medical or rehabilitation benefits are included
4.18in the$13,000 $26,000 limit in paragraph (b). An attorney must concurrently file all
4.19outstanding disputed issues. An attorney is not entitled to attorney fees for representation
4.20in any issue which could reasonably have been addressed during the pendency of other
4.21issues for the same injury.
4.22(b) All fees for legal services related to the same injury are cumulative and may
4.23not exceed$13,000 $26,000. If multiple injuries are the subject of a dispute, the
4.24commissioner, compensation judge, or court of appeals shall specify the attorney fee
4.25attributable to each injury.
4.26(c) If the employer or the insurer or the defendant is given written notice of claims
4.27for legal services or disbursements, the claim shall be a lien against the amount paid or
4.28payable as compensation. Subject to the foregoing maximum amount for attorney fees,
4.29up to 25 percent of the first $4,000 of periodic compensation awarded to the employee
4.30and 20 percent of the next $60,000 of periodic compensation awarded to the employee
4.31may be withheld from the periodic payments for attorney fees or disbursements if the
4.32payor of the funds clearly indicates on the check or draft issued to the employee for
4.33payment the purpose of the withholding, the name of the attorney, the amount withheld,
4.34and the gross amount of the compensation payment before withholding. In no case
4.35shall fees be calculated on the basis of any undisputed portion of compensation awards.
4.36Allowable fees under this chapter shall be based solely upon genuinely disputed claims or
5.1portions of claims, including disputes related to the payment of rehabilitation benefits or
5.2to other aspects of a rehabilitation plan. The existence of a dispute is dependent upon a
5.3disagreement after the employer or insurer has had adequate time and information to take
5.4a position on liability. Neither the holding of a hearing nor the filing of an application for a
5.5hearing alone may determine the existence of a dispute. Except where the employee is
5.6represented by an attorney in other litigation pending at the department or at the Office
5.7of Administrative Hearings, a fee may not be charged after June 1, 1996, for services
5.8with respect to a medical or rehabilitation issue arising under section176.102 ,
176.135 ,
5.9or176.136 performed before the employee has consulted with the department and the
5.10department certifies that there is a dispute and that it has tried to resolve the dispute.
5.11(d) An attorney who is claiming legal fees for representing an employee in a workers'
5.12compensation matter shall file a statement of attorney fees with the commissioner,
5.13compensation judge before whom the matter was heard, or Workers' Compensation Court
5.14of Appeals on cases before the court. A copy of the signed retainer agreement shall also
5.15be filed. The employee and insurer shall receive a copy of the statement. The statement
5.16shall be on a form prescribed by the commissioner and shall report the number of hours
5.17spent on the case.
5.18(e) Employers and insurers may not pay attorney fees or wages for legal services
5.19of more than $13,000 per case.
5.20(f) An attorney must file a statement of attorney fees within 12 months of the date
5.21the attorney has submitted the written notice specified in paragraph (c). If the attorney
5.22has not filed a statement of attorney fees within the 12 months, the attorney must send a
5.23renewed notice of lien to the insurer. If 12 months have elapsed since the last notice of
5.24lien has been received by the insurer and no statement of attorney fees has been filed, the
5.25insurer must release the withheld money to the employee, except that before releasing the
5.26money to the employee, the insurer must give the attorney 30 days' written notice of the
5.27pending release. The insurer must not release the money if the attorney files a statement of
5.28attorney fees within the 30 days.
5.29 Sec. 4. Minnesota Statutes 2012, section 176.081, subdivision 7, is amended to read:
5.30 Subd. 7. Award; additional amount. If the employer or insurer files a denial of
5.31liability, notice of discontinuance, or fails to make payment of compensation or medical
5.32expenses within the statutory period after notice of injury or occupational disease, or
5.33otherwise unsuccessfully resists the payment of compensation or medical expenses,
5.34or unsuccessfully disputes the payment of rehabilitation benefits or other aspects of
5.35a rehabilitation plan, and the injured person has employed an attorney at law, who
6.1successfully procures payment on behalf of the employee or who enables the resolution of
6.2a dispute with respect to a rehabilitation plan, the compensation judge, commissioner, or
6.3the Workers' Compensation Court of Appeals upon appeal, upon application, shall award
6.4to the employee against the insurer or self-insured employer or uninsured employer, in
6.5addition to the compensation benefits paid or awarded to the employee, an amount equal
6.6to 30 percent of that portion of the attorney's fee which has been awarded pursuant to this
6.7section that is in excess of $250. This subdivision shall apply only to contingent fees
6.8payable from the employee's compensation benefits, and not to other fees paid by the
6.9employer and insurer, including but not limited to those fees payable for resolution of a
6.10medical dispute or rehabilitation dispute, or pursuant to section 176.191.
6.11 Sec. 5. Minnesota Statutes 2012, section 176.101, subdivision 1, is amended to read:
6.12 Subdivision 1. Temporary total disability. (a) For injury producing temporary total
6.13disability, the compensation is 66-2/3 percent of the weekly wage at the time of injury.
6.14(b)(1) Commencing on October 1,2008 2013, and each October 1 thereafter, the
6.15maximum weekly compensation payable is$850 per week 102 percent of the statewide
6.16average weekly wage for the period ending December 31 of the preceding year.
6.17(2) The Workers' Compensation Advisory Council may consider adjustment
6.18increases and make recommendations to the legislature.
6.19(c) The minimum weekly compensation payable is $130 per week or the injured
6.20employee's actual weekly wage, whichever is less.
6.21(d) Temporary total compensation shall be paid during the period of disability
6.22subject to the cessation and recommencement conditions in paragraphs (e) to (l).
6.23(e) Temporary total disability compensation shall cease when the employee returns
6.24to work. Except as otherwise provided in section176.102, subdivision 11 , temporary
6.25total disability compensation may only be recommenced following cessation under this
6.26paragraph, paragraph (h), or paragraph (j) prior to payment of 130 weeks of temporary
6.27total disability compensation and only as follows:
6.28(1) if temporary total disability compensation ceased because the employee returned
6.29to work, it may be recommenced if the employee is laid off or terminated for reasons other
6.30than misconduct if the layoff or termination occurs prior to 90 days after the employee
6.31has reached maximum medical improvement. Recommenced temporary total disability
6.32compensation under this clause ceases when any of the cessation events in paragraphs
6.33(e) to (l) occurs; or
6.34(2) if temporary total disability compensation ceased because the employee returned
6.35to work or ceased under paragraph (h) or (j), it may be recommenced if the employee is
7.1medically unable to continue at a job due to the injury. Where the employee is medically
7.2unable to continue working due to the injury, temporary total disability compensation
7.3may continue until any of the cessation events in paragraphs (e) to (l) occurs following
7.4recommencement. If an employee who has not yet received temporary total disability
7.5compensation becomes medically unable to continue working due to the injury after
7.6reaching maximum medical improvement, temporary total disability compensation shall
7.7commence and shall continue until any of the events in paragraphs (e) to (l) occurs
7.8following commencement. For purposes of commencement or recommencement under
7.9this clause only, a new period of maximum medical improvement under paragraph
7.10(j) begins when the employee becomes medically unable to continue working due to
7.11the injury. Temporary total disability compensation may not be recommenced under
7.12this clause and a new period of maximum medical improvement does not begin if the
7.13employee is not actively employed when the employee becomes medically unable to
7.14work. All periods of initial and recommenced temporary total disability compensation are
7.15included in the 130-week limitation specified in paragraph (k).
7.16(f) Temporary total disability compensation shall cease if the employee withdraws
7.17from the labor market. Temporary total disability compensation may be recommenced
7.18following cessation under this paragraph only if the employee reenters the labor market
7.19prior to 90 days after the employee reached maximum medical improvement and prior to
7.20payment of 130 weeks of temporary total disability compensation. Once recommenced,
7.21temporary total disability ceases when any of the cessation events in paragraphs (e) to
7.22(l) occurs.
7.23(g) Temporary total disability compensation shall cease if the total disability ends
7.24and the employee fails to diligently search for appropriate work within the employee's
7.25physical restrictions. Temporary total disability compensation may be recommenced
7.26following cessation under this paragraph only if the employee begins diligently searching
7.27for appropriate work within the employee's physical restrictions prior to 90 days after
7.28maximum medical improvement and prior to payment of 130 weeks of temporary total
7.29disability compensation. Once recommenced, temporary total disability compensation
7.30ceases when any of the cessation events in paragraphs (e) to (l) occurs.
7.31(h) Temporary total disability compensation shall cease if the employee has been
7.32released to work without any physical restrictions caused by the work injury.
7.33(i) Temporary total disability compensation shall cease if the employee refuses an
7.34offer of work that is consistent with a plan of rehabilitation filed with the commissioner
7.35which meets the requirements of section176.102, subdivision 4 , or, if no plan has been
7.36filed, the employee refuses an offer of gainful employment that the employee can do in the
8.1employee's physical condition. Once temporary total disability compensation has ceased
8.2under this paragraph, it may not be recommenced.
8.3(j) Temporary total disability compensation shall cease 90 days after the employee
8.4has reached maximum medical improvement, except as provided in section176.102,
8.5subdivision 11, paragraph (b) . For purposes of this subdivision, the 90-day period after
8.6maximum medical improvement commences on the earlier of: (1) the date that the
8.7employee receives a written medical report indicating that the employee has reached
8.8maximum medical improvement; or (2) the date that the employer or insurer serves the
8.9report on the employee and the employee's attorney, if any. Once temporary total disability
8.10compensation has ceased under this paragraph, it may not be recommenced except if the
8.11employee returns to work and is subsequently medically unable to continue working
8.12as provided in paragraph (e), clause (2).
8.13(k) Temporary total disability compensation shall cease entirely when 130 weeks
8.14of temporary total disability compensation have been paid, except as provided in section
8.15176.102, subdivision 11, paragraph (b)
. Notwithstanding anything in this section to the
8.16contrary, initial and recommenced temporary total disability compensation combined shall
8.17not be paid for more than 130 weeks, regardless of the number of weeks that have elapsed
8.18since the injury, except that if the employee is in a retraining plan approved under section
8.19176.102, subdivision 11
, the 130-week limitation shall not apply during the retraining, but
8.20is subject to the limitation before the plan begins and after the plan ends.
8.21(l) Paragraphs (e) to (k) do not limit other grounds under law to suspend or
8.22discontinue temporary total disability compensation provided under this chapter.
8.23(m) Once an employee has been paid 52 weeks of temporary total compensation,
8.24the employer or insurer must notify the employee in writing of the 130-week limitation
8.25on payment of temporary total compensation. A copy of this notice must also be filed
8.26with the department.
8.27 Sec. 6. Minnesota Statutes 2012, section 176.102, subdivision 5, is amended to read:
8.28 Subd. 5. On-the-job training; job placement and job development limitation.
8.29(a) On-the-job training is to be given consideration in developing a rehabilitation plan
8.30especially where it would produce an economic status similar to that enjoyed prior to
8.31disability.
8.32(b) For purposes of this subdivision, job placement includes job development
8.33services as defined in rules adopted by the commissioner. Job placement services provided
8.34by a qualified rehabilitation consultant firm or a registered rehabilitation vendor must
8.35not exceed 20 hours per month or 24 consecutive or intermittent weeks. When 12
9.1consecutive or intermittent weeks of job placement services have been provided, the
9.2qualified rehabilitation consultant must consult with the parties and either file a plan
9.3amendment reflecting an agreement by the parties to extend job placement services for up
9.4to an additional 12 consecutive or intermittent weeks, or file a request for a rehabilitation
9.5conference under section 176.106. The commissioner or compensation judge may issue an
9.6order modifying the rehabilitation plan or make other determinations about the employee's
9.7rehabilitation, but must not order more than 24 total consecutive or intermittent weeks of
9.8job placement services.
9.9 Sec. 7. Minnesota Statutes 2012, section 176.102, subdivision 10, is amended to read:
9.10 Subd. 10. Rehabilitation; consultants and vendors. (a) The commissioner shall
9.11approve rehabilitation consultants who may propose and implement plans if they satisfy
9.12rules adopted by the commissioner for rehabilitation consultants. A consultant may be an
9.13individual or public or private entity, and except for rehabilitation services, Department of
9.14Employment and Economic Development, a consultant may not be a vendor or the agent
9.15of a vendor of rehabilitation services. The commissioner shall also approve rehabilitation
9.16vendors if they satisfy rules adopted by the commissioner.
9.17(b) An individual qualified rehabilitation consultant registered by the commissioner
9.18must not provide any medical, rehabilitation, or disability case management services
9.19related to an injury that is compensable under this chapter unless the case management
9.20services are part of an approved rehabilitation plan.
9.21 Sec. 8. Minnesota Statutes 2012, section 176.106, subdivision 3, is amended to read:
9.22 Subd. 3. Conference. The matter shall be scheduled for an administrative
9.23conference within 60 days after receipt of the request for a conference, except that an
9.24administrative conference on a rehabilitation issue under section 176.102 must be held
9.25within 21 days, unless the issue involves only fees for rehabilitation services that have
9.26already been provided or there is good cause for holding the conference later than 21
9.27days. If there is a rehabilitation plan in effect, the qualified rehabilitation consultant must
9.28continue to provide reasonable services under the plan until the date the conference was
9.29initially scheduled to be held. Notice of the conference shall be served on all parties no
9.30later than 14 days prior to the conference, unless the commissioner or compensation judge
9.31determines that a conference shall not be held. The commissioner or compensation judge
9.32may order an administrative conference before the commissioner's designee whether or
9.33not a request for conference is filed.
10.1The commissioner or compensation judge may refuse to hold an administrative
10.2conference and refer the matter for a settlement or pretrial conference or may certify the
10.3matter to the Office of Administrative Hearings for a full hearing before a compensation
10.4judge.
10.5 Sec. 9. Minnesota Statutes 2012, section 176.136, subdivision 1b, is amended to read:
10.6 Subd. 1b. Limitation of liability. (a) The liability of the employer for treatment,
10.7articles, and supplies provided to an employee while an inpatient or outpatient at a small
10.8hospital shall be the hospital's usual and customary charge, unless the charge is determined
10.9by the commissioner or a compensation judge to be unreasonably excessive. A "small
10.10hospital," for purposes of this paragraph, is a hospital which has 100 or fewer licensed beds.
10.11(b) The liability of the employer for the treatment, articles, and supplies that are
10.12not limited by subdivision 1a or 1c or paragraph (a) shall be limited to 85 percent of
10.13the provider's usual and customary charge, or 85 percent of the prevailing charges for
10.14similar treatment, articles, and supplies furnished to an injured person when paid for by
10.15the injured person, whichever is lower. On this basis, the commissioner or compensation
10.16judge may determine the reasonable value of all treatment, services, and supplies, and
10.17the liability of the employer is limited to that amount. The commissioner may by rule
10.18establish the reasonable value of a service, article, or supply in lieu of the 85 percent
10.19limitation in this paragraph. A prevailing charge established under Minnesota Rules,
10.20part 5221.0500, subpart 2, must be based on no more than two years of billing data
10.21immediately preceding the date of the service.
10.22(c) The limitation of liability for charges provided by paragraph (b) does not apply
10.23to a nursing home that participates in the medical assistance program and whose rates are
10.24established by the commissioner of human services.
10.25(d) An employer's liability for treatment, articles, and supplies provided under this
10.26chapter by a health care provider located outside of Minnesota is limited to the payment that
10.27the health care provider would receive if the treatment, article, or supply were paid under
10.28the workers' compensation law of the jurisdiction in which the treatment was provided.
10.29 Sec. 10. Minnesota Statutes 2012, section 176.191, subdivision 3, is amended to read:
10.30 Subd. 3. Insurer payment. If a dispute exists as to whether an employee's injury
10.31is compensable under this chapter and the employee is otherwise covered by an insurer
10.32or entity pursuant to chapters 62A, 62C, 62D, 62E, 62R, and 62T, that insurer or entity
10.33shall pay any medical costs incurred by the employee for the injury up to the limits of the
10.34applicable coverage and shall make any disability payments otherwise payable by that
11.1insurer or entity in the absence of or in addition to workers' compensation liability. If the
11.2injury is subsequently determined to be compensable pursuant to this chapter, the workers'
11.3compensation insurer shall be ordered to reimburse the insurer or entity that made the
11.4payments for all payments made under this subdivision by the insurer or entity, including
11.5interest at a rate of 12 percent a year. If the health care provider accepts payment for the
11.6services from the insurer or entity under chapter 62A, 62C, 62D, 62E, 62R, or 62T, the
11.7payment shall be deemed payment in full and the employer is not liable for additional
11.8payment under this chapter for the services. If a payment pursuant to this subdivision
11.9exceeds the reasonable value as permitted by sections176.135 and
176.136 , the provider
11.10shall reimburse the workers' compensation insurer for all the excess as provided by rules
11.11promulgated by the commissioner.
11.12 Sec. 11. Minnesota Statutes 2012, section 176.645, is amended to read:
11.13176.645 ADJUSTMENT OF BENEFITS.
11.14 Subdivision 1. Amount. For injuries occurring after October 1, 1975, for which
11.15benefits are payable under section176.101, subdivisions 1, 2 and 4 , and section
176.111,
11.16subdivision 5 , the total benefits due the employee or any dependents shall be adjusted in
11.17accordance with this section. On October 1, 1981, and thereafter on the anniversary of
11.18the date of the employee's injury the total benefits due shall be adjusted by multiplying
11.19the total benefits due prior to each adjustment by a fraction, the denominator of which
11.20is the statewide average weekly wage for December 31, of the year two years previous
11.21to the adjustment and the numerator of which is the statewide average weekly wage for
11.22December 31, of the year previous to the adjustment. For injuries occurring after October
11.231, 1975, all adjustments provided for in this section shall be included in computing
11.24any benefit due under this section. Any limitations of amounts due for daily or weekly
11.25compensation under this chapter shall not apply to adjustments made under this section.
11.26No adjustment increase made on or after October 1, 1977, but prior to October 1,
11.271992, under this section shall exceed six percent a year; in those instances where the
11.28adjustment under the formula of this section would exceed this maximum, the increase
11.29shall be deemed to be six percent. No adjustment increase made on or after October 1,
11.301992, under this section shall exceed four percent a year; in those instances where the
11.31adjustment under the formula of this section would exceed this maximum, the increase
11.32shall be deemed to be four percent. For injuries occurring on and after October 1, 1995, no
11.33adjustment increase made on or after October 1, 1995, shall exceed two percent a year;
11.34in those instances where the adjustment under the formula of this section would exceed
11.35this maximum, the increase shall be deemed to be two percent. For injuries occurring on
12.1and after October 1, 2013, no adjustment increase shall exceed three percent a year. If
12.2the adjustment under the formula of this section would exceed three percent, the increase
12.3shall be three percent. No adjustment under this section shall be less than zero percent.
12.4The Workers' Compensation Advisory Council may consider adjustment or other further
12.5increases and make recommendations to the legislature.
12.6 Subd. 2. Time of first adjustment. For injuries occurring on or after October 1,
12.71981, the initial adjustment made pursuant to subdivision 1 is deferred until the first
12.8anniversary of the date of the injury. For injuries occurring on or after October 1, 1992,
12.9the initial adjustment under subdivision 1 is deferred until the second anniversary of the
12.10date of the injury. The adjustment made at that time shall be that of the last year only. For
12.11injuries occurring on or after October 1, 1995, the initial adjustment under subdivision 1 is
12.12deferred until the fourth anniversary of the date of injury. The adjustment at that time shall
12.13be that of the last year only. For injuries occurring on or after October 1, 2013, the initial
12.14adjustment under subdivision 1 is deferred until the third anniversary of the date of injury.
12.15The adjustment made at that time shall be that of the last year only.
12.16 Sec. 12. Minnesota Statutes 2012, section 176.83, subdivision 5, is amended to read:
12.17 Subd. 5. Treatment standards for medical services. (a) In consultation with the
12.18Medical Services Review Board or the rehabilitation review panel, the commissioner shall
12.19adopt rules establishing standards and procedures for health care provider treatment. The
12.20rules shall apply uniformly to all providers including those providing managed care under
12.21section176.1351 . The rules shall be used to determine whether a provider of health
12.22care services and rehabilitation services, including a provider of medical, chiropractic,
12.23podiatric, surgical, hospital, or other services, is performing procedures or providing
12.24services at a level or with a frequency that is excessive, unnecessary, or inappropriate
12.25under section176.135, subdivision 1 , based upon accepted medical standards for quality
12.26health care and accepted rehabilitation standards.
12.27(b) The rules shall include, but are not limited to, the following:
12.28(1) criteria for diagnosis and treatment of the most common work-related injuries
12.29including, but not limited to, low back injuries and upper extremity repetitive trauma
12.30injuries;
12.31(2) criteria for surgical procedures including, but not limited to, diagnosis, prior
12.32conservative treatment, supporting diagnostic imaging and testing, and anticipated
12.33outcome criteria;
12.34(3) criteria for use of appliances, adaptive equipment, and use of health clubs or
12.35other exercise facilities;
13.1(4) criteria for diagnostic imaging procedures;
13.2(5) criteria for inpatient hospitalization;and
13.3(6) criteria for treatment of chronic pain; and
13.4(7) criteria for the long-term use of opioids or other scheduled medications to
13.5alleviate intractable pain and improve function, including the use of written contracts
13.6between the injured worker and the health care provider who prescribes the medication.
13.7(c) If it is determined by the payer that the level, frequency, or cost of a procedure or
13.8service of a provider is excessive, unnecessary, or inappropriate according to the standards
13.9established by the rules, the provider shall not be paid for the procedure, service, or cost
13.10by an insurer, self-insurer, or group self-insurer, and the provider shall not be reimbursed
13.11or attempt to collect reimbursement for the procedure, service, or cost from any other
13.12source, including the employee, another insurer, the special compensation fund, or any
13.13government program unless the commissioner or compensation judge determines at a
13.14hearing or administrative conference that the level, frequency, or cost was not excessive
13.15under the rules in which case the insurer, self-insurer, or group self-insurer shall make
13.16the payment deemed reasonable.
13.17(d) A rehabilitation provider who is determined by the rehabilitation review panel
13.18board, after hearing, to be consistently performing procedures or providing services at an
13.19excessive level or cost may be prohibited from receiving any further reimbursement for
13.20procedures or services provided under this chapter. A prohibition imposed on a provider
13.21under this subdivision may be grounds for revocation or suspension of the provider's
13.22license or certificate of registration to provide health care or rehabilitation service in
13.23Minnesota by the appropriate licensing or certifying body. The commissioner and Medical
13.24Services Review Board shall review excessive, inappropriate, or unnecessary health care
13.25provider treatment under section176.103 .
13.26 Sec. 13. PATIENT ADVOCATE PILOT PROGRAM.
13.27The commissioner of labor and industry shall implement a two-year patient
13.28advocate program for employees with back injuries who are considering back fusion
13.29surgery. The purpose of the program is to ensure that injured workers understand their
13.30treatment options and receive treatment for their work injuries according to accepted
13.31medical standards. The services provided by the patient advocate shall be paid for from
13.32the special compensation fund.
1.3Compensation Advisory Council;amending Minnesota Statutes 2012, sections
1.4176.011, subdivisions 15, 16; 176.081, subdivisions 1, 7; 176.101, subdivision 1;
1.5176.102, subdivisions 5, 10; 176.106, subdivision 3; 176.136, subdivision 1b;
1.6176.191, subdivision 3; 176.645; 176.83, subdivision 5.
1.7BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.8 Section 1. Minnesota Statutes 2012, section 176.011, subdivision 15, is amended to read:
1.9 Subd. 15. Occupational disease. (a) "Occupational disease" means a mental
1.10impairment as defined in paragraph (d) or physical disease arising out of and in the course
1.11of employment peculiar to the occupation in which the employee is engaged and due
1.12to causes in excess of the hazards ordinary of employment and shall include undulant
1.13fever. Physical stimulus resulting in mental injury and mental stimulus resulting in
1.14physical injury shall remain compensable. Mental impairment is not considered a disease
1.15if it results from a disciplinary action work evaluation, job transfer, layoff, demotion,
1.16promotion, termination, retirement, or similar action taken in good faith by the employer.
1.17Ordinary diseases of life to which the general public is equally exposed outside of
1.18employment are not compensable, except where the diseases follow as an incident of an
1.19occupational disease, or where the exposure peculiar to the occupation makes the disease
1.20an occupational disease hazard. A disease arises out of the employment only if there be a
1.21direct causal connection between the conditions under which the work is performed and
1.22if the occupational disease follows as a natural incident of the work as a result of the
1.23exposure occasioned by the nature of the employment. An employer is not liable for
1.24compensation for any occupational disease which cannot be traced to the employment as a
1.25direct and proximate cause and is not recognized as a hazard characteristic of and peculiar
2.1to the trade, occupation, process, or employment or which results from a hazard to which
2.2the worker would have been equally exposed outside of the employment.
2.3(b) If immediately preceding the date of disablement or death, an employee was
2.4employed on active duty with an organized fire or police department of any municipality,
2.5as a member of the Minnesota State Patrol, conservation officer service, state crime bureau,
2.6as a forest officer by the Department of Natural Resources, state correctional officer, or
2.7sheriff or full-time deputy sheriff of any county, and the disease is that of myocarditis,
2.8coronary sclerosis, pneumonia or its sequel, and at the time of employment such employee
2.9was given a thorough physical examination by a licensed doctor of medicine, and a written
2.10report thereof has been made and filed with such organized fire or police department, with
2.11the Minnesota State Patrol, conservation officer service, state crime bureau, Department
2.12of Natural Resources, Department of Corrections, or sheriff's department of any county,
2.13which examination and report negatived any evidence of myocarditis, coronary sclerosis,
2.14pneumonia or its sequel, the disease is presumptively an occupational disease and shall
2.15be presumed to have been due to the nature of employment. If immediately preceding
2.16the date of disablement or death, any individual who by nature of their position provides
2.17emergency medical care, or an employee who was employed as a licensed police officer
2.18under section
2.19emergency medical technician; or licensed nurse providing emergency medical care; and
2.20who contracts an infectious or communicable disease to which the employee was exposed
2.21in the course of employment outside of a hospital, then the disease is presumptively an
2.22occupational disease and shall be presumed to have been due to the nature of employment
2.23and the presumption may be rebutted by substantial factors brought by the employer
2.24or insurer. Any substantial factors which shall be used to rebut this presumption and
2.25which are known to the employer or insurer at the time of the denial of liability shall be
2.26communicated to the employee on the denial of liability.
2.27(c) A firefighter on active duty with an organized fire department who is unable
2.28to perform duties in the department by reason of a disabling cancer of a type caused
2.29by exposure to heat, radiation, or a known or suspected carcinogen, as defined by the
2.30International Agency for Research on Cancer, and the carcinogen is reasonably linked to
2.31the disabling cancer, is presumed to have an occupational disease under paragraph (a). If a
2.32firefighter who enters the service after August 1, 1988, is examined by a physician prior to
2.33being hired and the examination discloses the existence of a cancer of a type described
2.34in this paragraph, the firefighter is not entitled to the presumption unless a subsequent
2.35medical determination is made that the firefighter no longer has the cancer.
3.1(d) For the purposes of this chapter, "mental impairment" means a diagnosis of
3.2post-traumatic stress disorder by a licensed physician or psychologist. For the purpose of
3.3this chapter, "post-traumatic stress disorder" means the condition as described in the most
3.4recent edition of the Diagnostic and Statistical Manual of Mental Disorders published
3.5by the American Psychiatric Association.
3.6 Sec. 2. Minnesota Statutes 2012, section 176.011, subdivision 16, is amended to read:
3.7 Subd. 16. Personal injury. "Personal injury" means any mental impairment as
3.8defined in subdivision 15, paragraph (d), or physical injury arising out of and in the course
3.9of employment and includes personal injury caused by occupational disease; but does
3.10not cover an employee except while engaged in, on, or about the premises where the
3.11employee's services require the employee's presence as a part of that service at the time of
3.12the injury and during the hours of that service. Where the employer regularly furnished
3.13transportation to employees to and from the place of employment, those employees are
3.14subject to this chapter while being so transported. Physical stimulus resulting in mental
3.15injury and mental stimulus resulting in physical injury shall remain compensable. Mental
3.16impairment is not considered a personal injury if it results from a disciplinary action work
3.17evaluation, job transfer, layoff, demotion, promotion, termination, retirement, or similar
3.18action taken in good faith by the employer. Personal injury does not include an injury
3.19caused by the act of a third person or fellow employee intended to injure the employee
3.20because of personal reasons, and not directed against the employee as an employee, or
3.21because of the employment. An injury or disease resulting from a vaccine in response
3.22to a declaration by the Secretary of the United States Department of Health and Human
3.23Services under the Public Health Service Act to address an actual or potential health
3.24risk related to the employee's employment is an injury or disease arising out of and in
3.25the course of employment.
3.26 Sec. 3. Minnesota Statutes 2012, section 176.081, subdivision 1, is amended to read:
3.27 Subdivision 1. Limitation of fees. (a) A fee for legal services of
3.28the first
3.29
3.30fee and does not require approval by the commissioner, compensation judge, or any other
3.31party. All fees, including fees for obtaining medical or rehabilitation benefits, must be
3.32calculated according to the formula under this subdivision, except as otherwise provided
3.33in clause (1) or (2).
4.1(1) The contingent attorney fee for recovery of monetary benefits according to the
4.2formula in this section is presumed to be adequate to cover recovery of medical and
4.3rehabilitation benefit or services concurrently in dispute. Attorney fees for recovery of
4.4medical or rehabilitation benefits or services shall be assessed against the employer or
4.5insurer only if the attorney establishes that the contingent fee is inadequate to reasonably
4.6compensate the attorney for representing the employee in the medical or rehabilitation
4.7dispute. In cases where the contingent fee is inadequate the employer or insurer is liable
4.8for attorney fees based on the formula in this subdivision or in clause (2).
4.9 For the purposes of applying the formula where the employer or insurer is liable for
4.10attorney fees, the amount of compensation awarded for obtaining disputed medical and
4.11rehabilitation benefits under sections
4.12value of the medical or rehabilitation benefit awarded, where ascertainable.
4.13(2) The maximum attorney fee for obtaining a change of doctor or qualified
4.14rehabilitation consultant, or any other disputed medical or rehabilitation benefit for which
4.15a dollar value is not reasonably ascertainable, is the amount charged in hourly fees for the
4.16representation or $500, whichever is less, to be paid by the employer or insurer.
4.17(3) The fees for obtaining disputed medical or rehabilitation benefits are included
4.18in the
4.19outstanding disputed issues. An attorney is not entitled to attorney fees for representation
4.20in any issue which could reasonably have been addressed during the pendency of other
4.21issues for the same injury.
4.22(b) All fees for legal services related to the same injury are cumulative and may
4.23not exceed
4.24commissioner, compensation judge, or court of appeals shall specify the attorney fee
4.25attributable to each injury.
4.26(c) If the employer or the insurer or the defendant is given written notice of claims
4.27for legal services or disbursements, the claim shall be a lien against the amount paid or
4.28payable as compensation. Subject to the foregoing maximum amount for attorney fees,
4.29up to 25 percent of the first $4,000 of periodic compensation awarded to the employee
4.30and 20 percent of the next $60,000 of periodic compensation awarded to the employee
4.31may be withheld from the periodic payments for attorney fees or disbursements if the
4.32payor of the funds clearly indicates on the check or draft issued to the employee for
4.33payment the purpose of the withholding, the name of the attorney, the amount withheld,
4.34and the gross amount of the compensation payment before withholding. In no case
4.35shall fees be calculated on the basis of any undisputed portion of compensation awards.
4.36Allowable fees under this chapter shall be based solely upon genuinely disputed claims or
5.1portions of claims, including disputes related to the payment of rehabilitation benefits or
5.2to other aspects of a rehabilitation plan. The existence of a dispute is dependent upon a
5.3disagreement after the employer or insurer has had adequate time and information to take
5.4a position on liability. Neither the holding of a hearing nor the filing of an application for a
5.5hearing alone may determine the existence of a dispute. Except where the employee is
5.6represented by an attorney in other litigation pending at the department or at the Office
5.7of Administrative Hearings, a fee may not be charged after June 1, 1996, for services
5.8with respect to a medical or rehabilitation issue arising under section
5.9or
5.10department certifies that there is a dispute and that it has tried to resolve the dispute.
5.11(d) An attorney who is claiming legal fees for representing an employee in a workers'
5.12compensation matter shall file a statement of attorney fees with the commissioner,
5.13compensation judge before whom the matter was heard, or Workers' Compensation Court
5.14of Appeals on cases before the court. A copy of the signed retainer agreement shall also
5.15be filed. The employee and insurer shall receive a copy of the statement. The statement
5.16shall be on a form prescribed by the commissioner and shall report the number of hours
5.17spent on the case.
5.18(e) Employers and insurers may not pay attorney fees or wages for legal services
5.19of more than $13,000 per case.
5.20(f) An attorney must file a statement of attorney fees within 12 months of the date
5.21the attorney has submitted the written notice specified in paragraph (c). If the attorney
5.22has not filed a statement of attorney fees within the 12 months, the attorney must send a
5.23renewed notice of lien to the insurer. If 12 months have elapsed since the last notice of
5.24lien has been received by the insurer and no statement of attorney fees has been filed, the
5.25insurer must release the withheld money to the employee, except that before releasing the
5.26money to the employee, the insurer must give the attorney 30 days' written notice of the
5.27pending release. The insurer must not release the money if the attorney files a statement of
5.28attorney fees within the 30 days.
5.29 Sec. 4. Minnesota Statutes 2012, section 176.081, subdivision 7, is amended to read:
5.30 Subd. 7. Award; additional amount. If the employer or insurer files a denial of
5.31liability, notice of discontinuance, or fails to make payment of compensation or medical
5.32expenses within the statutory period after notice of injury or occupational disease, or
5.33otherwise unsuccessfully resists the payment of compensation or medical expenses,
5.34or unsuccessfully disputes the payment of rehabilitation benefits or other aspects of
5.35a rehabilitation plan, and the injured person has employed an attorney at law, who
6.1successfully procures payment on behalf of the employee or who enables the resolution of
6.2a dispute with respect to a rehabilitation plan, the compensation judge, commissioner, or
6.3the Workers' Compensation Court of Appeals upon appeal, upon application, shall award
6.4to the employee against the insurer or self-insured employer or uninsured employer, in
6.5addition to the compensation benefits paid or awarded to the employee, an amount equal
6.6to 30 percent of that portion of the attorney's fee which has been awarded pursuant to this
6.7section that is in excess of $250. This subdivision shall apply only to contingent fees
6.8payable from the employee's compensation benefits, and not to other fees paid by the
6.9employer and insurer, including but not limited to those fees payable for resolution of a
6.10medical dispute or rehabilitation dispute, or pursuant to section 176.191.
6.11 Sec. 5. Minnesota Statutes 2012, section 176.101, subdivision 1, is amended to read:
6.12 Subdivision 1. Temporary total disability. (a) For injury producing temporary total
6.13disability, the compensation is 66-2/3 percent of the weekly wage at the time of injury.
6.14(b)(1) Commencing on October 1,
6.15maximum weekly compensation payable is
6.16average weekly wage for the period ending December 31 of the preceding year.
6.17(2) The Workers' Compensation Advisory Council may consider adjustment
6.18increases and make recommendations to the legislature.
6.19(c) The minimum weekly compensation payable is $130 per week or the injured
6.20employee's actual weekly wage, whichever is less.
6.21(d) Temporary total compensation shall be paid during the period of disability
6.22subject to the cessation and recommencement conditions in paragraphs (e) to (l).
6.23(e) Temporary total disability compensation shall cease when the employee returns
6.24to work. Except as otherwise provided in section
6.25total disability compensation may only be recommenced following cessation under this
6.26paragraph, paragraph (h), or paragraph (j) prior to payment of 130 weeks of temporary
6.27total disability compensation and only as follows:
6.28(1) if temporary total disability compensation ceased because the employee returned
6.29to work, it may be recommenced if the employee is laid off or terminated for reasons other
6.30than misconduct if the layoff or termination occurs prior to 90 days after the employee
6.31has reached maximum medical improvement. Recommenced temporary total disability
6.32compensation under this clause ceases when any of the cessation events in paragraphs
6.33(e) to (l) occurs; or
6.34(2) if temporary total disability compensation ceased because the employee returned
6.35to work or ceased under paragraph (h) or (j), it may be recommenced if the employee is
7.1medically unable to continue at a job due to the injury. Where the employee is medically
7.2unable to continue working due to the injury, temporary total disability compensation
7.3may continue until any of the cessation events in paragraphs (e) to (l) occurs following
7.4recommencement. If an employee who has not yet received temporary total disability
7.5compensation becomes medically unable to continue working due to the injury after
7.6reaching maximum medical improvement, temporary total disability compensation shall
7.7commence and shall continue until any of the events in paragraphs (e) to (l) occurs
7.8following commencement. For purposes of commencement or recommencement under
7.9this clause only, a new period of maximum medical improvement under paragraph
7.10(j) begins when the employee becomes medically unable to continue working due to
7.11the injury. Temporary total disability compensation may not be recommenced under
7.12this clause and a new period of maximum medical improvement does not begin if the
7.13employee is not actively employed when the employee becomes medically unable to
7.14work. All periods of initial and recommenced temporary total disability compensation are
7.15included in the 130-week limitation specified in paragraph (k).
7.16(f) Temporary total disability compensation shall cease if the employee withdraws
7.17from the labor market. Temporary total disability compensation may be recommenced
7.18following cessation under this paragraph only if the employee reenters the labor market
7.19prior to 90 days after the employee reached maximum medical improvement and prior to
7.20payment of 130 weeks of temporary total disability compensation. Once recommenced,
7.21temporary total disability ceases when any of the cessation events in paragraphs (e) to
7.22(l) occurs.
7.23(g) Temporary total disability compensation shall cease if the total disability ends
7.24and the employee fails to diligently search for appropriate work within the employee's
7.25physical restrictions. Temporary total disability compensation may be recommenced
7.26following cessation under this paragraph only if the employee begins diligently searching
7.27for appropriate work within the employee's physical restrictions prior to 90 days after
7.28maximum medical improvement and prior to payment of 130 weeks of temporary total
7.29disability compensation. Once recommenced, temporary total disability compensation
7.30ceases when any of the cessation events in paragraphs (e) to (l) occurs.
7.31(h) Temporary total disability compensation shall cease if the employee has been
7.32released to work without any physical restrictions caused by the work injury.
7.33(i) Temporary total disability compensation shall cease if the employee refuses an
7.34offer of work that is consistent with a plan of rehabilitation filed with the commissioner
7.35which meets the requirements of section
7.36filed, the employee refuses an offer of gainful employment that the employee can do in the
8.1employee's physical condition. Once temporary total disability compensation has ceased
8.2under this paragraph, it may not be recommenced.
8.3(j) Temporary total disability compensation shall cease 90 days after the employee
8.4has reached maximum medical improvement, except as provided in section
8.5subdivision 11, paragraph (b)
8.6maximum medical improvement commences on the earlier of: (1) the date that the
8.7employee receives a written medical report indicating that the employee has reached
8.8maximum medical improvement; or (2) the date that the employer or insurer serves the
8.9report on the employee and the employee's attorney, if any. Once temporary total disability
8.10compensation has ceased under this paragraph, it may not be recommenced except if the
8.11employee returns to work and is subsequently medically unable to continue working
8.12as provided in paragraph (e), clause (2).
8.13(k) Temporary total disability compensation shall cease entirely when 130 weeks
8.14of temporary total disability compensation have been paid, except as provided in section
8.16contrary, initial and recommenced temporary total disability compensation combined shall
8.17not be paid for more than 130 weeks, regardless of the number of weeks that have elapsed
8.18since the injury, except that if the employee is in a retraining plan approved under section
8.20is subject to the limitation before the plan begins and after the plan ends.
8.21(l) Paragraphs (e) to (k) do not limit other grounds under law to suspend or
8.22discontinue temporary total disability compensation provided under this chapter.
8.23(m) Once an employee has been paid 52 weeks of temporary total compensation,
8.24the employer or insurer must notify the employee in writing of the 130-week limitation
8.25on payment of temporary total compensation. A copy of this notice must also be filed
8.26with the department.
8.27 Sec. 6. Minnesota Statutes 2012, section 176.102, subdivision 5, is amended to read:
8.28 Subd. 5. On-the-job training; job placement and job development limitation.
8.29(a) On-the-job training is to be given consideration in developing a rehabilitation plan
8.30especially where it would produce an economic status similar to that enjoyed prior to
8.31disability.
8.32(b) For purposes of this subdivision, job placement includes job development
8.33services as defined in rules adopted by the commissioner. Job placement services provided
8.34by a qualified rehabilitation consultant firm or a registered rehabilitation vendor must
8.35not exceed 20 hours per month or 24 consecutive or intermittent weeks. When 12
9.1consecutive or intermittent weeks of job placement services have been provided, the
9.2qualified rehabilitation consultant must consult with the parties and either file a plan
9.3amendment reflecting an agreement by the parties to extend job placement services for up
9.4to an additional 12 consecutive or intermittent weeks, or file a request for a rehabilitation
9.5conference under section 176.106. The commissioner or compensation judge may issue an
9.6order modifying the rehabilitation plan or make other determinations about the employee's
9.7rehabilitation, but must not order more than 24 total consecutive or intermittent weeks of
9.8job placement services.
9.9 Sec. 7. Minnesota Statutes 2012, section 176.102, subdivision 10, is amended to read:
9.10 Subd. 10. Rehabilitation; consultants and vendors. (a) The commissioner shall
9.11approve rehabilitation consultants who may propose and implement plans if they satisfy
9.12rules adopted by the commissioner for rehabilitation consultants. A consultant may be an
9.13individual or public or private entity, and except for rehabilitation services, Department of
9.14Employment and Economic Development, a consultant may not be a vendor or the agent
9.15of a vendor of rehabilitation services. The commissioner shall also approve rehabilitation
9.16vendors if they satisfy rules adopted by the commissioner.
9.17(b) An individual qualified rehabilitation consultant registered by the commissioner
9.18must not provide any medical, rehabilitation, or disability case management services
9.19related to an injury that is compensable under this chapter unless the case management
9.20services are part of an approved rehabilitation plan.
9.21 Sec. 8. Minnesota Statutes 2012, section 176.106, subdivision 3, is amended to read:
9.22 Subd. 3. Conference. The matter shall be scheduled for an administrative
9.23conference within 60 days after receipt of the request for a conference, except that an
9.24administrative conference on a rehabilitation issue under section 176.102 must be held
9.25within 21 days, unless the issue involves only fees for rehabilitation services that have
9.26already been provided or there is good cause for holding the conference later than 21
9.27days. If there is a rehabilitation plan in effect, the qualified rehabilitation consultant must
9.28continue to provide reasonable services under the plan until the date the conference was
9.29initially scheduled to be held. Notice of the conference shall be served on all parties no
9.30later than 14 days prior to the conference, unless the commissioner or compensation judge
9.31determines that a conference shall not be held. The commissioner or compensation judge
9.32may order an administrative conference before the commissioner's designee whether or
9.33not a request for conference is filed.
10.1The commissioner or compensation judge may refuse to hold an administrative
10.2conference and refer the matter for a settlement or pretrial conference or may certify the
10.3matter to the Office of Administrative Hearings for a full hearing before a compensation
10.4judge.
10.5 Sec. 9. Minnesota Statutes 2012, section 176.136, subdivision 1b, is amended to read:
10.6 Subd. 1b. Limitation of liability. (a) The liability of the employer for treatment,
10.7articles, and supplies provided to an employee while an inpatient or outpatient at a small
10.8hospital shall be the hospital's usual and customary charge, unless the charge is determined
10.9by the commissioner or a compensation judge to be unreasonably excessive. A "small
10.10hospital," for purposes of this paragraph, is a hospital which has 100 or fewer licensed beds.
10.11(b) The liability of the employer for the treatment, articles, and supplies that are
10.12not limited by subdivision 1a or 1c or paragraph (a) shall be limited to 85 percent of
10.13the provider's usual and customary charge, or 85 percent of the prevailing charges for
10.14similar treatment, articles, and supplies furnished to an injured person when paid for by
10.15the injured person, whichever is lower. On this basis, the commissioner or compensation
10.16judge may determine the reasonable value of all treatment, services, and supplies, and
10.17the liability of the employer is limited to that amount. The commissioner may by rule
10.18establish the reasonable value of a service, article, or supply in lieu of the 85 percent
10.19limitation in this paragraph. A prevailing charge established under Minnesota Rules,
10.20part 5221.0500, subpart 2, must be based on no more than two years of billing data
10.21immediately preceding the date of the service.
10.22(c) The limitation of liability for charges provided by paragraph (b) does not apply
10.23to a nursing home that participates in the medical assistance program and whose rates are
10.24established by the commissioner of human services.
10.25(d) An employer's liability for treatment, articles, and supplies provided under this
10.26chapter by a health care provider located outside of Minnesota is limited to the payment that
10.27the health care provider would receive if the treatment, article, or supply were paid under
10.28the workers' compensation law of the jurisdiction in which the treatment was provided.
10.29 Sec. 10. Minnesota Statutes 2012, section 176.191, subdivision 3, is amended to read:
10.30 Subd. 3. Insurer payment. If a dispute exists as to whether an employee's injury
10.31is compensable under this chapter and the employee is otherwise covered by an insurer
10.32or entity pursuant to chapters 62A, 62C, 62D, 62E, 62R, and 62T, that insurer or entity
10.33shall pay any medical costs incurred by the employee for the injury up to the limits of the
10.34applicable coverage and shall make any disability payments otherwise payable by that
11.1insurer or entity in the absence of or in addition to workers' compensation liability. If the
11.2injury is subsequently determined to be compensable pursuant to this chapter, the workers'
11.3compensation insurer shall be ordered to reimburse the insurer or entity that made the
11.4payments for all payments made under this subdivision by the insurer or entity, including
11.5interest at a rate of 12 percent a year. If the health care provider accepts payment for the
11.6services from the insurer or entity under chapter 62A, 62C, 62D, 62E, 62R, or 62T, the
11.7payment shall be deemed payment in full and the employer is not liable for additional
11.8payment under this chapter for the services. If a payment pursuant to this subdivision
11.9exceeds the reasonable value as permitted by sections
11.10shall reimburse the workers' compensation insurer for all the excess as provided by rules
11.11promulgated by the commissioner.
11.12 Sec. 11. Minnesota Statutes 2012, section 176.645, is amended to read:
11.13176.645 ADJUSTMENT OF BENEFITS.
11.14 Subdivision 1. Amount. For injuries occurring after October 1, 1975, for which
11.15benefits are payable under section
11.16subdivision 5
11.17accordance with this section. On October 1, 1981, and thereafter on the anniversary of
11.18the date of the employee's injury the total benefits due shall be adjusted by multiplying
11.19the total benefits due prior to each adjustment by a fraction, the denominator of which
11.20is the statewide average weekly wage for December 31, of the year two years previous
11.21to the adjustment and the numerator of which is the statewide average weekly wage for
11.22December 31, of the year previous to the adjustment. For injuries occurring after October
11.231, 1975, all adjustments provided for in this section shall be included in computing
11.24any benefit due under this section. Any limitations of amounts due for daily or weekly
11.25compensation under this chapter shall not apply to adjustments made under this section.
11.26No adjustment increase made on or after October 1, 1977, but prior to October 1,
11.271992, under this section shall exceed six percent a year; in those instances where the
11.28adjustment under the formula of this section would exceed this maximum, the increase
11.29shall be deemed to be six percent. No adjustment increase made on or after October 1,
11.301992, under this section shall exceed four percent a year; in those instances where the
11.31adjustment under the formula of this section would exceed this maximum, the increase
11.32shall be deemed to be four percent. For injuries occurring on and after October 1, 1995, no
11.33adjustment increase made on or after October 1, 1995, shall exceed two percent a year;
11.34in those instances where the adjustment under the formula of this section would exceed
11.35this maximum, the increase shall be deemed to be two percent. For injuries occurring on
12.1and after October 1, 2013, no adjustment increase shall exceed three percent a year. If
12.2the adjustment under the formula of this section would exceed three percent, the increase
12.3shall be three percent. No adjustment under this section shall be less than zero percent.
12.4The Workers' Compensation Advisory Council may consider adjustment or other further
12.5increases and make recommendations to the legislature.
12.6 Subd. 2. Time of first adjustment. For injuries occurring on or after October 1,
12.71981, the initial adjustment made pursuant to subdivision 1 is deferred until the first
12.8anniversary of the date of the injury. For injuries occurring on or after October 1, 1992,
12.9the initial adjustment under subdivision 1 is deferred until the second anniversary of the
12.10date of the injury. The adjustment made at that time shall be that of the last year only. For
12.11injuries occurring on or after October 1, 1995, the initial adjustment under subdivision 1 is
12.12deferred until the fourth anniversary of the date of injury. The adjustment at that time shall
12.13be that of the last year only. For injuries occurring on or after October 1, 2013, the initial
12.14adjustment under subdivision 1 is deferred until the third anniversary of the date of injury.
12.15The adjustment made at that time shall be that of the last year only.
12.16 Sec. 12. Minnesota Statutes 2012, section 176.83, subdivision 5, is amended to read:
12.17 Subd. 5. Treatment standards for medical services. (a) In consultation with the
12.18Medical Services Review Board or the rehabilitation review panel, the commissioner shall
12.19adopt rules establishing standards and procedures for health care provider treatment. The
12.20rules shall apply uniformly to all providers including those providing managed care under
12.21section
12.22care services and rehabilitation services, including a provider of medical, chiropractic,
12.23podiatric, surgical, hospital, or other services, is performing procedures or providing
12.24services at a level or with a frequency that is excessive, unnecessary, or inappropriate
12.25under section
12.26health care and accepted rehabilitation standards.
12.27(b) The rules shall include, but are not limited to, the following:
12.28(1) criteria for diagnosis and treatment of the most common work-related injuries
12.29including, but not limited to, low back injuries and upper extremity repetitive trauma
12.30injuries;
12.31(2) criteria for surgical procedures including, but not limited to, diagnosis, prior
12.32conservative treatment, supporting diagnostic imaging and testing, and anticipated
12.33outcome criteria;
12.34(3) criteria for use of appliances, adaptive equipment, and use of health clubs or
12.35other exercise facilities;
13.1(4) criteria for diagnostic imaging procedures;
13.2(5) criteria for inpatient hospitalization;
13.3(6) criteria for treatment of chronic pain; and
13.4(7) criteria for the long-term use of opioids or other scheduled medications to
13.5alleviate intractable pain and improve function, including the use of written contracts
13.6between the injured worker and the health care provider who prescribes the medication.
13.7(c) If it is determined by the payer that the level, frequency, or cost of a procedure or
13.8service of a provider is excessive, unnecessary, or inappropriate according to the standards
13.9established by the rules, the provider shall not be paid for the procedure, service, or cost
13.10by an insurer, self-insurer, or group self-insurer, and the provider shall not be reimbursed
13.11or attempt to collect reimbursement for the procedure, service, or cost from any other
13.12source, including the employee, another insurer, the special compensation fund, or any
13.13government program unless the commissioner or compensation judge determines at a
13.14hearing or administrative conference that the level, frequency, or cost was not excessive
13.15under the rules in which case the insurer, self-insurer, or group self-insurer shall make
13.16the payment deemed reasonable.
13.17(d) A rehabilitation provider who is determined by the rehabilitation review panel
13.18board, after hearing, to be consistently performing procedures or providing services at an
13.19excessive level or cost may be prohibited from receiving any further reimbursement for
13.20procedures or services provided under this chapter. A prohibition imposed on a provider
13.21under this subdivision may be grounds for revocation or suspension of the provider's
13.22license or certificate of registration to provide health care or rehabilitation service in
13.23Minnesota by the appropriate licensing or certifying body. The commissioner and Medical
13.24Services Review Board shall review excessive, inappropriate, or unnecessary health care
13.25provider treatment under section
13.26 Sec. 13. PATIENT ADVOCATE PILOT PROGRAM.
13.27The commissioner of labor and industry shall implement a two-year patient
13.28advocate program for employees with back injuries who are considering back fusion
13.29surgery. The purpose of the program is to ensure that injured workers understand their
13.30treatment options and receive treatment for their work injuries according to accepted
13.31medical standards. The services provided by the patient advocate shall be paid for from
13.32the special compensation fund.
