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[Bills Directory]
H.B. 384 Enrolled
1
EMPLOYEE OBLIGATIONS RELATED TO
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WORKERS' COMPENSATION
3
2008 GENERAL SESSION
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STATE OF UTAH
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Chief Sponsor: Michael T. Morley
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Senate Sponsor:
Curtis S. Bramble
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8
LONG TITLE
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General Description:
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This bill modifies the Workers' Compensation Act to address an employee's duties
11
related to workers' compensation.
12
Highlighted Provisions:
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This bill:
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. defines terms;
15
. addresses reductions in disability compensation under certain circumstances;
16
. provides for adjudication;
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. addresses application of certain provisions to a local governmental entity or state
18
institution of higher education;
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. addresses the scope of the provisions;
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. provides for rulemaking;
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. addresses incarceration or unlawful employment related to permanent total
22
disabilities; and
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. makes technical changes.
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Monies Appropriated in this Bill:
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None
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Other Special Clauses:
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This bill takes effect on July 1, 2008.
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Utah Code Sections Affected:
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AMENDS:
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34A-2-410, as last amended by Laws of Utah 2005, Chapter 81
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34A-2-413, as last amended by Laws of Utah 2006, Chapter 295
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ENACTS:
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34A-2-410.5, Utah Code Annotated 1953
34
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Be it enacted by the Legislature of the state of Utah:
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Section 1.
Section
34A-2-410
is amended to read:
37
34A-2-410. Temporary disability -- Amount of payments -- State average weekly
38
wage defined.
39
(1) (a) [In] Subject to Subsections (1)(b) and (5), in case of temporary disability, so
40
long as the disability is total, the employee shall receive 66-2/3% of that employee's average
41
weekly wages at the time of the injury but:
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(i) not more than a maximum of 100% of the state average weekly wage at the time of
43
the injury per week; and
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(ii) (A) subject to Subsections (1)(a)(ii)(B) and (C), not less than a minimum of $45 per
45
week plus:
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(I) $5 for a dependent spouse; and
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(II) $5 for each dependent child under the age of 18 years, up to a maximum of four
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dependent children[,];
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(B) not to exceed the average weekly wage of the employee at the time of the injury[,
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but]; and
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(C) not to exceed 100% of the state average weekly wage at the time of the injury per
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week.
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(b) In no case shall the compensation benefits exceed 312 weeks at the rate of 100% of
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the state average weekly wage at the time of the injury over a period of 12 years from the date
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of the injury.
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(2) [In the event] If a light duty medical release is obtained [prior to] before the
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employee [reaching] reaches a fixed state of recovery[,] and [when] no light duty employment is
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available to the employee from the employer, temporary disability benefits shall continue to be
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paid.
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(3) The "state average weekly wage" as referred to in this chapter and Chapter 3, Utah
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Occupational Disease Act, shall be determined by the commission as follows:
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(a) On or before June 1 of each year, the total wages reported on contribution reports
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to the Unemployment Insurance Division for the preceding calendar year shall be divided by the
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average monthly number of insured workers determined by dividing the total insured workers
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reported for the preceding year by 12.
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(b) The average annual wage obtained under Subsection (3)(a) shall be divided by 52.
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(c) The average weekly wage determined under Subsection (3)(b) is rounded to the
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nearest dollar.
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(4) The state average weekly wage determined under Subsection (3) shall be used as the
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basis for computing the maximum compensation rate for:
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(a) injuries or disabilities arising from occupational disease that occurred during the
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[twelve-month] 12-month period commencing July 1 following the June 1 determination; and
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(b) any death resulting from the injuries or disabilities arising from occupational disease.
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(5) The commission may reduce or terminate temporary disability compensation in
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accordance with Section
34-2-410.5
.
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Section 2.
Section
34A-2-410.5
is enacted to read:
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34A-2-410.5. Employee cooperation with reemployment.
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(1) As used in this section:
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(a) "Controlled substance" is as defined in Section
58-37-2
.
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(b) "Correctional facility" means:
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(i) a correctional facility as defined in Section
76-8-311.3
; or
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(ii) a facility operated by or contracting with the federal government to house a criminal
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offender in either a secure or nonsecure setting.
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(c) "Disability claim" means a claim for compensation for:
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(i) a temporary total disability benefit; or
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(ii) a temporary partial disability benefit.
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(d) "Local governmental entity" is as defined in Section
34-41-101
.
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(e) "Reemployment" means employment that:
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(i) is after an accident or occupational disease that is the basis for a disability claim; and
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(ii) in a manner consistent with Subsection (2)(b), offers to an employee an opportunity
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for earnings, considering the employee's:
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(A) education;
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(B) experience; and
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(C) physical and mental impairment or condition.
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(f) "State institution of higher education" means an institution listed in Section
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53B-3-102
.
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(g) "Valid prescription" is a prescription, as defined in Section
58-37-2
, that is:
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(i) prescribed for a controlled substance for use by the employee for whom it is
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prescribed; and
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(ii) not altered or forged.
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(2) In accordance with this section, the commission may reduce or terminate an
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employee's disability compensation for a disability claim for good cause shown by the employer
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including if:
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(a) the employer terminates the employee from the reemployment and the termination
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is:
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(i) reasonable;
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(ii) for cause; and
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(iii) as a result, in whole or in part, of:
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(A) criminal conduct;
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(B) violent conduct; or
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(C) a violation of a reasonable, written workplace health, safety, licensure, or
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nondiscrimination rule that is applied in a manner that is reasonable and nondiscriminatory;
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(b) the employee is incarcerated in a correctional facility for a period of time that would
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result in the termination of the employee's reemployment in accordance with a reasonable,
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written workplace rule that is applied in a manner that is reasonable and nondiscriminatory; or
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(c) subject to Subsection (6), the employee is terminated from the reemployment:
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(i) (A) for use of a controlled substance that the employee did not obtain under a valid
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prescription;
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(B) for intentional abuse of a controlled substance that the employee obtained under a
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valid prescription, if the employee uses the controlled substance intentionally:
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(I) in excess of a prescribed therapeutic amount; or
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(II) in an otherwise abusive manner; or
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(C) for the use of alcohol that results in intoxication from alcohol with a blood or breath
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alcohol concentration of .08 grams or greater; and
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(ii) in accordance with a reasonable, written workplace rule that is applied in a manner
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that is reasonable and nondiscriminatory.
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(3) Notwithstanding the other provisions of this section, the employee described in
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Subsection (2) is eligible for medical benefits to the extent otherwise allowed under this title.
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(4) (a) An employer or the employer's insurance carrier may file an application for a
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hearing with the Division of Adjudication to request that an employee's disability compensation
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for a disability claim be reduced or terminated under this section.
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(b) An action under this Subsection (4) is barred if an application for a hearing is not
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filed within one year from the day on which the employer terminates the employee from
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reemployment as described in Subsection (2).
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(c) An employer or the employer's insurance carrier shall notify the employee that the
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employer or employer's insurance carrier has filed a request for a hearing under this section
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within three business days of the day on which the filing is made.
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(5) (a) The commission may reduce or terminate the disability compensation of an
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employee for a disability claim if after a hearing requested under Subsection (4), the commission
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determines that the conditions of Subsection (2) are met.
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(b) The commission shall issue an order as to whether or not an employee's disability
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compensation is reduced or terminated under this section by no later than 45 days from the day
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on which an application for a hearing is filed.
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(c) A reduction or termination of disability compensation under this Subsection (5)
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takes effect on the day determined by the commission.
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(d) If the disability compensation is ordered terminated or reduced, the employer or
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employer's insurance carrier shall treat a resulting overpayment as an offset against the
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employer's or employer's insurance carrier's future obligations to pay disability compensation to
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the employee.
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(6) (a) For purposes of Subsection (2)(c), the commission may consider a chemical test
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that conforms to scientifically accepted analytical methods and procedures and includes
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verification or confirmation of any positive test result by gas chromatography, gas
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chromatography-mass spectroscopy, or other comparably reliable analytical method showing
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that the employee has:
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(i) in the employee's system during employment:
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(A) any amount of a controlled substance or its metabolites if the employee did not
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obtain the controlled substance under a valid prescription; or
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(B) a controlled substance the employee obtained under a valid prescription or the
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metabolites of the controlled substance if the amount in the employee's system is consistent with
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the employee using the controlled substance intentionally:
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(I) in excess of prescribed therapeutic amounts; or
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(II) in an otherwise abusive manner; or
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(ii) a blood or breath alcohol concentration of .08 grams or greater during employment.
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(b) A local governmental entity or state institution of higher education shall comply
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with Title 34, Chapter 41, Local Governmental Entity Drug-Free Workplace Policies, in
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engaging in a test for a controlled substance that is the basis of a presumption under this
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section.
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(7) In accordance with Title 63, Chapter 46a, Utah Administrative Rulemaking Act, the
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commission may make rules:
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(a) describing factors to be considered under Subsection (2); and
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(b) related to the procedures for a request for a hearing under this section.
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(8) The adjudication of a dispute arising under this section is governed by Part 8,
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Adjudication.
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(9) An issue related to an employee's cooperation with regard to a claim for
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compensation for permanent total disability benefits is governed by Section
34A-2-413
.
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Section 3.
Section
34A-2-413
is amended to read:
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34A-2-413. Permanent total disability -- Amount of payments -- Rehabilitation.
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(1) (a) In [cases] the case of a permanent total disability resulting from an industrial
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accident or occupational disease, the employee shall receive compensation as outlined in this
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section.
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(b) To establish entitlement to permanent total disability compensation, the employee
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must prove by a preponderance of evidence that:
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(i) the employee sustained a significant impairment or combination of impairments as a
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result of the industrial accident or occupational disease that gives rise to the permanent total
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disability entitlement;
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(ii) the employee is permanently totally disabled; and
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(iii) the industrial accident or occupational disease [was] is the direct cause of the
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employee's permanent total disability.
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(c) To establish that an employee is permanently totally disabled the employee must
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prove by a preponderance of the evidence that:
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(i) the employee is not gainfully employed;
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(ii) the employee has an impairment or combination of impairments that limit the
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employee's ability to do basic work activities;
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(iii) the industrial or occupationally caused impairment or combination of impairments
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prevent the employee from performing the essential functions of the work activities for which
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the employee has been qualified until the time of the industrial accident or occupational disease
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that is the basis for the employee's permanent total disability claim; and
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(iv) the employee cannot perform other work reasonably available, taking into
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consideration the employee's:
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(A) age;
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(B) education;
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(C) past work experience;
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(D) medical capacity; and
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(E) residual functional capacity.
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(d) Evidence of an employee's entitlement to disability benefits other than those
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provided under this chapter and Chapter 3, Utah Occupational Disease Act, if relevant:
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(i) may be presented to the commission;
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(ii) is not binding; and
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(iii) creates no presumption of an entitlement under this chapter and Chapter 3, Utah
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Occupational Disease Act.
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(e) In determining under Subsections (1)(b) and (c) whether an employee cannot
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perform other work reasonably available, the following may not be considered:
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(i) whether the employee is incarcerated in a facility operated by or contracting with a
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federal, state, county, or municipal government to house a criminal offender in either a secure or
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nonsecure setting; or
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(ii) whether the employee is not legally eligible to be employed because of a reason
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unrelated to the impairment or combination of impairments.
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(2) For permanent total disability compensation during the initial 312-week entitlement,
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compensation [shall be] is 66-2/3% of the employee's average weekly wage at the time of the
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injury, limited as follows:
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(a) compensation per week may not be more than 85% of the state average weekly
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wage at the time of the injury;
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(b) (i) subject to Subsection (2)(b)(ii), compensation per week may not be less than the
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sum of $45 per week[, plus] and:
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(A) $5 for a dependent spouse[, plus]; and
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(B) $5 for each dependent child under the age of 18 years, up to a maximum of four
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dependent minor children[, but not exceeding]; and
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(ii) the amount calculated under Subsection (2)(b)(i) may not exceed:
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(A) the maximum established in Subsection (2)(a) [nor exceeding]; or
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(B) the average weekly wage of the employee at the time of the injury; and
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(c) after the initial 312 weeks, the minimum weekly compensation rate under
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Subsection (2)(b) [shall be] is 36% of the current state average weekly wage, rounded to the
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nearest dollar.
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(3) This Subsection (3) applies to claims resulting from an accident or disease arising
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out of and in the course of the employee's employment on or before June 30, 1994.
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(a) The employer or its insurance carrier is liable for the initial 312 weeks of permanent
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total disability compensation except as outlined in Section
34A-2-703
as in effect on the date of
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injury.
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(b) The employer or its insurance carrier may not be required to pay compensation for
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any combination of disabilities of any kind, as provided in this section and Sections
34A-2-410
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through
34A-2-412
and Part 5, Industrial Noise, in excess of the amount of compensation
242
payable over the initial 312 weeks at the applicable permanent total disability compensation rate
243
under Subsection (2).
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(c) [Any] The Employers' Reinsurance Fund shall for an overpayment of [this]
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compensation [shall be reimbursed] described in Subsection (3)(b), reimburse the overpayment:
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(i) to the employer or its insurance carrier [by the Employers' Reinsurance Fund]; and
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[shall be paid]
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(ii) out of the Employers' Reinsurance Fund's liability to the employee.
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(d) After an employee [has received] receives compensation from the employee's
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employer, its insurance carrier, or the Employers' Reinsurance Fund for any combination of
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disabilities amounting to 312 weeks of compensation at the applicable permanent total disability
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compensation rate, the Employers' Reinsurance Fund shall pay all remaining permanent total
253
disability compensation.
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(e) Employers' Reinsurance Fund payments shall commence immediately after the
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employer or its insurance carrier [has satisfied] satisfies its liability under this Subsection (3) or
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Section
34A-2-703
.
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(4) This Subsection (4) applies to claims resulting from an accident or disease arising
258
out of and in the course of the employee's employment on or after July 1, 1994.
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(a) The employer or its insurance carrier is liable for permanent total disability
260
compensation.
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(b) The employer or its insurance carrier may not be required to pay compensation for
262
any combination of disabilities of any kind, as provided in this section and Sections
34A-2-410
263
through
34A-2-412
and Part 5, Industrial Noise, in excess of the amount of compensation
264
payable over the initial 312 weeks at the applicable permanent total disability compensation rate
265
under Subsection (2).
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(c) [Any overpayment of this compensation shall be recouped by the] The employer or
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its insurance carrier may recoup the overpayment of compensation described in Subsection (4)
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by reasonably offsetting the overpayment against future liability paid before or after the initial
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312 weeks.
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(5) Notwithstanding the minimum rate established in Subsection (2), [the compensation
271
payable by the] an employer, its insurance carrier, or the Employers' Reinsurance Fund, after an
272
employee [has received] receives compensation from the employer or the employer's insurance
273
carrier for any combination of disabilities amounting to 312 weeks of compensation at the
274
applicable total disability compensation rate, shall [be reduced,] reduce the compensation
275
payable:
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(a) to the extent allowable by law[,]; and
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(b) by the dollar amount of 50% of the Social Security retirement benefits received by
278
the employee during the same period.
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(6) (a) A finding by the commission of permanent total disability is not final, unless
280
otherwise agreed to by the parties, until:
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(i) an administrative law judge reviews a summary of reemployment activities
282
undertaken pursuant to Chapter 8, Utah Injured Worker Reemployment Act;
283
(ii) the employer or its insurance carrier submits to the administrative law judge:
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(A) a reemployment plan as prepared by a qualified rehabilitation provider reasonably
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designed to return the employee to gainful employment; or
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(B) notice that the employer or its insurance carrier will not submit a plan; and
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(iii) the administrative law judge, after notice to the parties, holds a hearing, unless
288
otherwise stipulated, to:
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(A) consider evidence regarding rehabilitation; and
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(B) review any reemployment plan submitted by the employer or its insurance carrier
291
under Subsection (6)(a)(ii).
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(b) Before commencing the procedure required by Subsection (6)(a), the administrative
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law judge shall order:
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(i) the initiation of permanent total disability compensation payments to provide for the
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employee's subsistence; and
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(ii) the payment of any undisputed disability or medical benefits due the employee.
297
(c) Notwithstanding Subsection (6)(a), an order for payment of benefits described in
298
Subsection (6)(b) is considered a final order for purposes of Section
34A-2-212
.
299
(d) The employer or its insurance carrier shall be given credit for any disability
300
payments made under Subsection (6)(b) against its ultimate disability compensation liability
301
under this chapter or Chapter 3, Utah Occupational Disease Act.
302
(e) An employer or its insurance carrier may not be ordered to submit a reemployment
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plan. If the employer or its insurance carrier voluntarily submits a plan, the plan is subject to
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Subsections (6)(e)(i) through (iii).
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(i) The plan may include, but not require an employee to pay for:
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(A) retraining[,];
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(B) education[,];
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(C) medical and disability compensation benefits[,];
309
(D) job placement services[,]; or
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(E) incentives calculated to facilitate reemployment [funded by the employer or its
311
insurance carrier].
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(ii) The plan shall include payment of reasonable disability compensation to provide for
313
the employee's subsistence during the rehabilitation process.
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(iii) The employer or its insurance carrier shall diligently pursue the reemployment plan.
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The employer's or insurance carrier's failure to diligently pursue the reemployment plan [shall
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be] is cause for the administrative law judge on the administrative law judge's own motion to
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make a final decision of permanent total disability.
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(f) If a preponderance of the evidence shows that successful rehabilitation is not
319
possible, the administrative law judge shall order that the employee be paid weekly permanent
320
total disability compensation benefits.
321
(g) If a preponderance of the evidence shows that pursuant to a reemployment plan, as
322
prepared by a qualified rehabilitation provider and presented under Subsection (6)(e), an
323
employee could immediately or without unreasonable delay return to work but for the
324
following, an administrative law judge shall order that the employee be denied the payment of
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weekly permanent total disability compensation benefits:
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(i) incarceration in a facility operated by or contracting with a federal, state, county, or
327
municipal government to house a criminal offender in either a secure or nonsecure setting; or
328
(ii) not being legally eligible to be employed because of a reason unrelated to the
329
impairment or combination of impairments.
330
(7) (a) The period of benefits commences on the date the employee became
331
permanently totally disabled, as determined by a final order of the commission based on the
332
facts and evidence, and ends:
333
(i) with the death of the employee; or
334
(ii) when the employee is capable of returning to regular, steady work.
335
(b) An employer or its insurance carrier may provide or locate for a permanently totally
336
disabled employee reasonable, medically appropriate, part-time work in a job earning at least
337
minimum wage [provided that employment], except that the employee may not be required to
338
accept the work to the extent that it would disqualify the employee from Social Security
339
disability benefits.
340
(c) An employee shall:
341
(i) fully cooperate in the placement and employment process; and
342
(ii) accept the reasonable, medically appropriate, part-time work.
343
(d) In a consecutive four-week period when an employee's gross income from the work
344
provided under Subsection (7)(b) exceeds $500, the employer or insurance carrier may reduce
345
the employee's permanent total disability compensation by 50% of the employee's income in
346
excess of $500.
347
(e) If a work opportunity is not provided by the employer or its insurance carrier, a
348
permanently totally disabled employee may obtain medically appropriate, part-time work subject
349
to the offset provisions [contained in] of Subsection (7)(d).
350
(f) (i) The commission shall establish rules regarding the part-time work and offset.
351
(ii) The adjudication of disputes arising under this Subsection (7) is governed by Part 8,
352
Adjudication.
353
(g) The employer or its insurance carrier [shall have] has the burden of proof to show
354
that medically appropriate part-time work is available.
355
(h) The administrative law judge may:
356
(i) excuse an employee from participation in any [job] work:
357
(A) that would require the employee to undertake work exceeding the employee's:
358
(I) medical capacity [and]; or
359
(II) residual functional capacity; or
360
(B) for good cause; or
361
(ii) allow the employer or its insurance carrier to reduce permanent total disability
362
benefits as provided in Subsection (7)(d) when reasonable, medically appropriate, part-time
363
[employment has been] work is offered, but the employee [has failed] fails to fully cooperate.
364
(8) When an employee [has been] is rehabilitated or the employee's rehabilitation is
365
possible but the employee has some loss of bodily function, the award shall be for permanent
366
partial disability.
367
(9) As determined by an administrative law judge, an employee is not entitled to
368
disability compensation, unless the employee fully cooperates with any evaluation or
369
reemployment plan under this chapter or Chapter 3, Utah Occupational Disease Act. The
370
administrative law judge shall dismiss without prejudice the claim for benefits of an employee if
371
the administrative law judge finds that the employee fails to fully cooperate, unless the
372
administrative law judge states specific findings on the record justifying dismissal with prejudice.
373
(10) (a) The loss or permanent and complete loss of the use of the following constitutes
374
total and permanent disability that is compensated according to this section:
375
(i) both hands[,];
376
(ii) both arms[,];
377
(iii) both feet[,];
378
(iv) both legs[,];
379
(v) both eyes[,]; or
380
(vi) any combination of two [such] body members [constitutes total and permanent
381
disability, to be compensated according to this section] described in this Subsection (10)(a).
382
(b) A finding of permanent total disability pursuant to Subsection (10)(a) is final.
383
(11) (a) An insurer or self-insured employer may periodically reexamine a permanent
384
total disability claim, except those based on Subsection (10), for which the insurer or
385
self-insured employer had or has payment responsibility to determine whether the [worker]
386
employee remains permanently totally disabled.
387
(b) Reexamination may be conducted no more than once every three years after an
388
award is final, unless good cause is shown by the employer or its insurance carrier to allow
389
more frequent reexaminations.
390
(c) The reexamination may include:
391
(i) the review of medical records;
392
(ii) employee submission to one or more reasonable medical evaluations;
393
(iii) employee submission to one or more reasonable rehabilitation evaluations and
394
retraining efforts;
395
(iv) employee disclosure of Federal Income Tax Returns;
396
(v) employee certification of compliance with Section
34A-2-110
; and
397
(vi) employee completion of one or more sworn affidavits or questionnaires approved
398
by the division.
399
(d) The insurer or self-insured employer shall pay for the cost of a reexamination with
400
appropriate employee reimbursement pursuant to rule for reasonable travel allowance and per
401
diem as well as reasonable expert witness fees incurred by the employee in supporting the
402
employee's claim for permanent total disability benefits at the time of reexamination.
403
(e) If an employee fails to fully cooperate in the reasonable reexamination of a
404
permanent total disability finding, an administrative law judge may order the suspension of the
405
employee's permanent total disability benefits until the employee cooperates with the
406
reexamination.
407
(f) (i) [Should] If the reexamination of a permanent total disability finding [reveal]
408
reveals evidence that reasonably raises the issue of an employee's continued entitlement to
409
permanent total disability compensation benefits, an insurer or self-insured employer may
410
petition the Division of Adjudication for a rehearing on that issue. The [petition] insurer or
411
self-insured employer shall [be accompanied by] include with the petition, documentation
412
supporting the insurer's or self-insured employer's belief that the employee is no longer
413
permanently totally disabled.
414
(ii) If the petition under Subsection (11)(f)(i) demonstrates good cause, as determined
415
by the Division of Adjudication, an administrative law judge shall adjudicate the issue at a
416
hearing.
417
(iii) Evidence of an employee's participation in medically appropriate, part-time work
418
may not be the sole basis for termination of an employee's permanent total disability entitlement,
419
but the evidence of the employee's participation in medically appropriate, part-time work under
420
Subsection (7) may be considered in the reexamination or hearing with other evidence relating
421
to the employee's status and condition.
422
(g) In accordance with Section
34A-1-309
, the administrative law judge may award
423
reasonable [attorneys] attorney fees to an attorney retained by an employee to represent the
424
employee's interests with respect to reexamination of the permanent total disability finding,
425
except if the employee does not prevail, the [attorneys] attorney fees shall be set at $1,000. The
426
[attorneys] attorney fees awarded shall be paid by the employer or its insurance carrier in
427
addition to the permanent total disability compensation benefits due.
428
(h) During the period of reexamination or adjudication if the employee fully cooperates,
429
each insurer, self-insured employer, or the Employers' Reinsurance Fund shall continue to pay
430
the permanent total disability compensation benefits due the employee.
431
(12) If any provision of this section, or the application of any provision to any person or
432
circumstance, is held invalid, the remainder of this section [shall be] is given effect without the
433
invalid provision or application.
434
Section 4. Effective date.
435
This bill takes effect on July 1, 2008.
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