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H.B. 150

             1     

WORKERS' COMPENSATION REVISIONS

             2     
2006 GENERAL SESSION

             3     
STATE OF UTAH

             4     
Chief Sponsor: Michael T. Morley

             5     
Senate Sponsor: Curtis S. Bramble

             6     
             7      LONG TITLE
             8      General Description:
             9          This bill modifies provisions related to the Workers' Compensation Act and the Utah
             10      Occupational Disease Act.
             11      Highlighted Provisions:
             12          This bill:
             13          .    clarifies language related to when an employer is an employer of a contractor,
             14      subcontractor, or their employees for purposes of workers' compensation;
             15          .    addresses when an employer of a contractor, subcontractor, or their employees is
             16      protected by the exclusive remedy of workers' compensation;
             17          .    defines terms related to managed health care programs and provides for consistent
             18      use of terms;
             19          .    expands the persons with whom and purposes for which contracts may be made in a
             20      managed health care workers' compensation setting;
             21          .    expands requirements for a workers' compensation carrier's designated agent;
             22          .    gives the commission the exclusive jurisdiction and authority to determine the
             23      reasonableness and to adjudicate the collection of certain amounts related to
             24      workers' compensation benefits;
             25          .    addresses treatment of hospital services for purposes of workers' compensation;
             26          .    addresses reporting requirements;
             27          .    addresses contracts with providers of health services relating to the pricing of goods


             28      and services;
             29          .    clarifies burden of proof in permanent total disability claims;
             30          .    addresses who may file an application for a hearing;
             31          .    deletes out-of-date language;
             32          .    makes technical changes; and
             33          .     provides for legislative intent.
             34      Monies Appropriated in this Bill:
             35          None
             36      Other Special Clauses:
             37          None
             38      Utah Code Sections Affected:
             39      AMENDS:
             40          34A-2-103, as last amended by Chapter 71, Laws of Utah 2005
             41          34A-2-111, as renumbered and amended by Chapter 375, Laws of Utah 1997
             42          34A-2-407, as last amended by Chapter 113, Laws of Utah 2004
             43          34A-2-413, as last amended by Chapter 261, Laws of Utah 2005
             44          34A-2-801, as last amended by Chapter 67, Laws of Utah 2003
             45          34A-3-108, as last amended by Chapter 205 and renumbered and amended by Chapter
             46      375, Laws of Utah 1997
             47      ENACTS:
             48          34A-2-113, Utah Code Annotated 1953
             49      Uncodified Material Affected:
             50      ENACTS UNCODIFIED MATERIAL
             51     
             52      Be it enacted by the Legislature of the state of Utah:
             53          Section 1. Section 34A-2-103 is amended to read:
             54           34A-2-103. Employers enumerated and defined -- Regularly employed --
             55      Statutory employers.
             56          (1) (a) The state, and each county, city, town, and school district in the state are
             57      considered employers under this chapter and Chapter 3, Utah Occupational Disease Act.
             58          (b) For the purposes of the exclusive remedy in this chapter and Chapter 3, Utah


             59      Occupational Disease Act prescribed in Sections 34A-2-105 and 34A-3-102 , the state is
             60      considered to be a single employer and includes any office, department, agency, authority,
             61      commission, board, institution, hospital, college, university, or other instrumentality of the
             62      state.
             63          (2) (a) Except as provided in Subsection (4), each person, including each public utility
             64      and each independent contractor, who regularly employs one or more workers or operatives in
             65      the same business, or in or about the same establishment, under any contract of hire, express or
             66      implied, oral or written, is considered an employer under this chapter and Chapter 3, Utah
             67      Occupational Disease Act.
             68          (b) As used in this Subsection (2):
             69          [(a)] (i) "Independent contractor" means any person engaged in the performance of any
             70      work for another who, while so engaged, is:
             71          [(i)] (A) independent of the employer in all that pertains to the execution of the work;
             72          [(ii)] (B) not subject to the routine rule or control of the employer;
             73          [(iii)] (C) engaged only in the performance of a definite job or piece of work; and
             74          [(iv)] (D) subordinate to the employer only in effecting a result in accordance with the
             75      employer's design.
             76          [(b)] (ii) "Regularly" includes all employments in the usual course of the trade,
             77      business, profession, or occupation of the employer, whether continuous throughout the year or
             78      for only a portion of the year.
             79          (3) (a) The client company in an employee leasing arrangement under Title 58, Chapter
             80      59, Professional Employer Organization Registration Act, is considered the employer of leased
             81      employees and shall secure workers' compensation benefits for them by complying with
             82      Subsection 34A-2-201 (1) or (2) and commission rules.
             83          (b) [Insurance carriers] An insurance carrier may underwrite workers' compensation
             84      secured in accordance with Subsection (3)(a) showing the leasing company as the named
             85      insured and each client company as an additional insured by means of individual endorsements.
             86          (c) Endorsements shall be filed with the division as directed by commission rule.
             87          (d) The division shall promptly inform the Division of Occupation and Professional
             88      Licensing within the Department of Commerce if the division has reason to believe that an
             89      employee leasing company is not in compliance with Subsection 34A-2-201 (1) or (2) and


             90      commission rules.
             91          (4) A domestic employer who does not employ one employee or more than one
             92      employee at least 40 hours per week is not considered an employer under this chapter and
             93      Chapter 3, Utah Occupational Disease Act.
             94          (5) (a) As used in this Subsection (5):
             95          (i) (A) "agricultural employer" means a person who employs agricultural labor as
             96      defined in Subsections 35A-4-206 (1) and (2) and does not include employment as provided in
             97      Subsection 35A-4-206 (3); and
             98          (B) notwithstanding Subsection (5)(a)(i)(A), only for purposes of determining who is a
             99      member of the employer's immediate family under Subsection (5)(a)(ii), if the agricultural
             100      employer is a corporation, partnership, or other business entity, "agricultural employer" means
             101      an officer, director, or partner of the business entity;
             102          (ii) "employer's immediate family" means:
             103          (A) an agricultural employer's:
             104          (I) spouse;
             105          (II) grandparent;
             106          (III) parent;
             107          (IV) sibling;
             108          (V) child;
             109          (VI) grandchild;
             110          (VII) nephew; or
             111          (VIII) niece;
             112          (B) a spouse of any person provided in Subsection (5)(a)(ii)(A)(II) through (VIII); or
             113          (C) an individual who is similar to those listed in Subsections (5)(a)(ii)(A) or (B) as
             114      defined by rules of the commission; and
             115          (iii) "nonimmediate family" means a person who is not a member of the employer's
             116      immediate family.
             117          (b) For purposes of this chapter and Chapter 3, Utah Occupational Disease Act, an
             118      agricultural employer is not considered an employer of a member of the employer's immediate
             119      family.
             120          (c) For purposes of this chapter and Chapter 3, Utah Occupational Disease Act, an


             121      agricultural employer is not considered an employer of a nonimmediate family employee if:
             122          (i) for the previous calendar year the agricultural employer's total annual payroll for all
             123      nonimmediate family employees was less than $8,000; or
             124          (ii) (A) for the previous calendar year the agricultural employer's total annual payroll
             125      for all nonimmediate family employees was equal to or greater than $8,000 but less than
             126      $50,000; and
             127          (B) the agricultural employer maintains insurance that covers job-related injuries of the
             128      employer's nonimmediate family employees in at least the following amounts:
             129          (I) $300,000 liability insurance, as defined in Section 31A-1-301 ; and
             130          (II) $5,000 for health care benefits similar to benefits under health care insurance as
             131      defined in Section 31A-1-301 .
             132          (d) For purposes of this chapter and Chapter 3, Utah Occupational Disease Act, an
             133      agricultural employer is considered an employer of a nonimmediate family employee if:
             134          (i) for the previous calendar year the agricultural employer's total annual payroll for all
             135      nonimmediate family employees is equal to or greater than $50,000; or
             136          (ii) (A) for the previous year the agricultural employer's total payroll for nonimmediate
             137      family employees was equal to or exceeds $8,000 but is less than $50,000; and
             138          (B) the agricultural employer fails to maintain the insurance required under Subsection
             139      (5)(c)(ii)(B).
             140          (6) An employer of agricultural laborers or domestic servants who is not considered an
             141      employer under this chapter and Chapter 3, Utah Occupational Disease Act, may come under
             142      this chapter and Chapter 3, Utah Occupational Disease Act, by complying with:
             143          (a) this chapter and Chapter 3, Utah Occupational Disease Act; and
             144          (b) the rules of the commission.
             145          (7) (a) If any person who is an employer procures any work to be done wholly or in
             146      part for the employer by a contractor over whose work the employer retains a right of
             147      supervision or control, and this work is a part or process in the trade or business of the
             148      employer, the contractor, all persons employed by the contractor, all subcontractors under the
             149      contractor, and all persons employed by any of these subcontractors, are considered employees
             150      of the original employer for the purposes of this chapter and Chapter 3, Utah Occupational
             151      Disease Act.


             152          (b) Any person who is engaged in constructing, improving, repairing, or remodelling a
             153      residence that the person owns or is in the process of acquiring as the person's personal
             154      residence may not be considered an employee or employer solely by operation of Subsection
             155      (7)(a).
             156          (c) A partner in a partnership or an owner of a sole proprietorship [may] is not [be]
             157      considered an employee under Subsection (7)(a) if the employer who procures work to be done
             158      by the partnership or sole proprietorship obtains and relies on either:
             159          (i) a valid certification of the partnership's or sole proprietorship's compliance with
             160      Section 34A-2-201 indicating that the partnership or sole proprietorship secured the payment of
             161      workers' compensation benefits pursuant to Section 34A-2-201 ; or
             162          (ii) if a partnership or sole proprietorship with no employees other than a partner of the
             163      partnership or owner of the sole proprietorship, a workers' compensation policy issued by an
             164      insurer pursuant to Subsection 31A-21-104 (8) stating that:
             165          (A) the partnership or sole proprietorship is customarily engaged in an independently
             166      established trade, occupation, profession, or business; and
             167          (B) the partner or owner personally waives the partner's or owner's entitlement to the
             168      benefits of this chapter and Chapter 3, Utah Occupational Disease Act, in the operation of the
             169      partnership or sole proprietorship.
             170          (d) A director or officer of a corporation [may] is not [be] considered an employee
             171      under Subsection (7)(a) if the director or officer is excluded from coverage under Subsection
             172      34A-2-104 (4).
             173          (e) A contractor or subcontractor is not an employee of the employer under Subsection
             174      (7)(a), if the employer who procures work to be done by the contractor or subcontractor obtains
             175      and relies on either:
             176          (i) a valid certification of the contractor's or subcontractor's compliance with Section
             177      34A-2-201 ; or
             178          (ii) if a partnership, corporation, or sole proprietorship with no employees other than a
             179      partner of the partnership, officer of the corporation, or owner of the sole proprietorship, a
             180      workers' compensation policy issued by an insurer pursuant to Subsection 31A-21-104 (8)
             181      stating that:
             182          (A) the partnership, corporation, or sole proprietorship is customarily engaged in an


             183      independently established trade, occupation, profession, or business; and
             184          (B) the partner, corporate officer, or owner personally waives the partner's, corporate
             185      officer's, or owner's entitlement to the benefits of this chapter and Chapter 3, Utah
             186      Occupational Disease Act, in the operation of the partnership's, corporation's, or sole
             187      proprietorship's enterprise under a contract of hire for services.
             188          (f) (i) Notwithstanding the other provisions in this Subsection (7), if the conditions of
             189      Subsection (7)(f)(ii) are met, a contractor, all persons employed by the contractor, all
             190      subcontractors under the contractor, and all persons employed by any of these subcontractors,
             191      are all considered employees of the original employer for purposes of Section 34A-2-105 .
             192          (ii) Subsection (7)(f)(i) applies if the employer who procures work to be done in whole
             193      or in part by the contractor, the subcontractor, and all persons employed by the contractor or
             194      subcontractor:
             195          (A) under Subsection (7)(a) is liable for and pays workers' compensation benefits
             196      because the contractor or subcontractor fails to comply with Section 34A-2-201 ;
             197          (B) secures the payment of workers' compensation benefits for the contractor or
             198      subcontractor pursuant to Section 34A-2-201 ; or
             199          (C) (I) obtains and relies on:
             200          (Aa) a valid certification described in Subsection (7)(c)(i) or (7)(e)(i);
             201          (Bb) a workers' compensation policy described in Subsection (7)(c)(ii) or (7)(e)(ii); or
             202          (Cc) proof that a director or officer is excluded from coverage under Subsection
             203      34A-2-104 (4);
             204          (II) is liable under Subsection (7)(a) for the payment of workers' compensation benefits
             205      if the contractor or subcontractor fails to comply with Section 34A-2-201 ;
             206          (III) procures work to be done that is part or process in the trade or business of the
             207      employer; and
             208          (IV) exercises supervision or control over the means by which the work is
             209      accomplished through the implementation of a written workplace accident and injury reduction
             210      program meeting the standards of Subsection 34A-2-111 (3).
             211          Section 2. Section 34A-2-111 is amended to read:
             212           34A-2-111. Managed health care programs -- Other safety programs.
             213          (1) As used in this section:


             214          (a) (i) "Health care provider" means a person who furnishes treatment or care to
             215      persons who have suffered bodily injury.
             216          (ii) "Health care provider" includes:
             217          (A) a hospital;
             218          (B) a clinic;
             219          (C) an emergency care center;
             220          (D) a physician;
             221          (E) a nurse;
             222          (F) a nurse practitioner;
             223          (G) a physicians' assistant;
             224          (H) a paramedic; or
             225          (I) an emergency medical technician.
             226          (b) "Physician" means any health care provider licensed under:
             227          (i) Title 58, Chapter 5a, Podiatric Physician Licensing Act;
             228          (ii) Title 58, Chapter 24a, Physical Therapist Practice Act;
             229          (iii) Title 58, Chapter 67, Utah Medical Practice Act;
             230          (iv) Title 58, Chapter 68, Utah Osteopathic Medical Practice Act;
             231          (v) Title 58, Chapter 69, Dentist and Dental Hygienist Practice Act;
             232          (vi) Title 58, Chapter 70a, Physician Assistant Act;
             233          (vii) Title 58, Chapter 71, Naturopathic Physician Practice Act;
             234          (viii) Title 58, Chapter 72, Acupuncture Licensing Act; and
             235          (ix) Title 58, Chapter 73, Chiropractic Physician Practice Act.
             236          (c) "Preferred health care facility" means a facility:
             237          (i) that is a health care facility as defined in Section 26-21-2 ; and
             238          (ii) designated under a managed health care program.
             239          (d) "Preferred provider physician" means a physician designated under a managed
             240      health care program.
             241          (e) "Self-insured employer" is as defined in Section 34A-2-201.5 .
             242          [(1)] (2) (a) [Self-insured employers] A self-insured employer and [workers'
             243      compensation carriers] insurance carrier may adopt a managed health care program to provide
             244      employees the benefits of this chapter or Chapter 3, Utah Occupational Disease Act, beginning


             245      January 1, 1993. The plan [may include one or more of the following:] shall comply with this
             246      Subsection (2).
             247          [(a)] (b) (i) A preferred provider program may be developed [so long as] if the
             248      preferred provider program allows a selection by the employee of more than one physician in
             249      the health care specialty required for treating the specific problem of an industrial patient. [If]
             250          (ii) (A) Subject to the requirements of this section, if a preferred provider program is
             251      developed by an [employer,] insurance carrier[,] or self-insured [entity] employer, [employees
             252      are] an employee is required to use:
             253          (I) preferred provider physicians; and
             254          (II) [medical] preferred health care facilities.
             255          (B) If a preferred provider program is not developed, an [industrial claimant] employee
             256      may have free choice of health care providers. [Failure of an industrial claimant to use a
             257      preferred health care facility as defined in Section 26-21-2 as part of a preferred provider
             258      program, or failure to initially receive treatment from a preferred physician,]
             259          (iii) The failure to do the following may, if the [claimant] employee has been notified
             260      of the preferred provider program, result in the [claimant] employee being obligated for any
             261      charges in excess of the preferred provider allowances[.]:
             262          (A) use a preferred health care facility; or
             263          (B) initially receive treatment from a preferred provider physician.
             264          [(ii)] (iv) Notwithstanding the requirements of [Subsection (1)(a)(i)] Subsections
             265      (2)(b)(i) through (iii), a self-insured [entity] employer or other employer may:
             266          (A) (I) (Aa) have its own health care facility on or near its worksite or premises; and
             267          (Bb) continue to contract with other health care providers; or
             268          [(B)] (II) operate a health care facility; and
             269          (B) require employees to first seek treatment at the provided health care or contracted
             270      facility.
             271          [(iii)] (v) An employee [of an employer using] subject to a preferred provider program
             272      or employed by an employer having its own health care facility may procure the services of any
             273      qualified [practitioner] health care provider:
             274          (A) for emergency treatment, if a physician employed in the preferred provider
             275      program or at the health care facility is not available for any reason;


             276          (B) for conditions the employee in good faith believes are nonindustrial; or
             277          (C) when an employee living in a rural area would be unduly burdened by traveling to:
             278          (I) a preferred provider physician; or
             279          (II) preferred health care facility.
             280          [(b)] (c) (i) [Other] (A) An employer, insurance carrier, or self-insured employer may
             281      enter into contracts with [medical] the following for the purposes listed in Subsection
             282      (2)(c)(i)(B):
             283          (I) health care providers [or];
             284          (II) medical review organizations; or
             285          (III) vendors of medical goods, services, and supplies including medicines.
             286          (B) A contract described in Subsection (1)(c)(i)(A) may be made for the following
             287      purposes:
             288          [(A)] (I) insurance carriers or self-insured employers may form groups in contracting
             289      for managed health care services with [medical] health care providers;
             290          [(B)] (II) peer review;
             291          [(C)] (III) methods of utilization review;
             292          [(D)] (IV) use of case management; [and]
             293          [(E)] (V) bill audit[.];
             294          (VI) discounted purchasing; and
             295          (VII) the establishment of a reasonable health care cost containment program including
             296      the implementation of medical treatment and quality care guidelines that are:
             297          (Aa) scientifically based;
             298          (Bb) peer reviewed; and
             299          (Cc) consistent with standards for health care cost containment programs that the
             300      commission shall establish by rules made in accordance with Title 63, Chapter 46a, Utah
             301      Administrative Rulemaking Act, including the authority of the commission to approve a health
             302      care cost containment program before it is used or disapprove a health care cost containment
             303      program that does not comply with this Subsection (2)(c)(i)(B)(VII).
             304          (ii) [Insurance carriers] An insurance carrier may make any or all of the factors in
             305      Subsection [(1)(b)] (2)(c)(i) a condition of insuring [entities in their] an entity in its insurance
             306      contract.


             307          [(2) As used in Subsection (1), "physician" means any health care provider licensed
             308      under:]
             309          [(a) Title 58, Chapter 5a, Podiatric Physician Licensing Act;]
             310          [(b) Title 58, Chapter 24a, Physical Therapist Practice Act;]
             311          [(c) Title 58, Chapter 67, Utah Medical Practice Act;]
             312          [(d) Title 58, Chapter 68, Utah Osteopathic Medical Practice Act;]
             313          [(e) Title 58, Chapter 69, Dentist and Dental Hygienist Practice Act;]
             314          [(f) Title 58, Chapter 70, Physician Assistant Practice Act;]
             315          [(g) Title 58, Chapter 71, Naturopathic Physician Practice Act;]
             316          [(h) Title 58, Chapter 72, Acupuncture Licensing Act; and]
             317          [(i) Title 58, Chapter 73, Chiropractic Physician Practice Act.]
             318          [(3) Each workers' compensation insurance carrier writing insurance in this state shall
             319      maintain a designated agent in this state registered with the division.]
             320          [(4)] (3) (a) In addition to a managed health care [plans] program, an insurance carrier
             321      may require an employer to establish a work place safety program if the employer:
             322          (i) has an experience modification factor of 1.00 or higher, as determined by the
             323      National Council on Compensation Insurance; or
             324          (ii) is determined by the insurance carrier to have a three-year loss ratio of 100% or
             325      higher.
             326          (b) A workplace safety program may include:
             327          (i) a written workplace accident and injury reduction program that:
             328          (A) promotes safe and healthful working conditions[, which]; and
             329          (B) is based on clearly stated goals and objectives for meeting those goals; and
             330          (ii) a documented review of the workplace accident and injury reduction program each
             331      calendar year delineating how procedures set forth in the program are met.
             332          [(5)] (c) A written workplace accident and injury reduction program permitted under
             333      Subsection [(4)] (3)(b)(i) should describe:
             334          [(a)] (i) how managers, supervisors, and employees are responsible for implementing
             335      the program;
             336          [(b)] (ii) how continued participation of management will be established, measured,
             337      and maintained;


             338          [(c)] (iii) the methods used to identify, analyze, and control new or existing hazards,
             339      conditions, and operations;
             340          [(d)] (iv) how the program will be communicated to all employees so that the
             341      employees are informed of work-related hazards and controls;
             342          [(e)] (v) how workplace accidents will be investigated and corrective action
             343      implemented; and
             344          [(f)] (vi) how safe work practices and rules will be enforced.
             345          [(6)] (4) The premiums charged to any employer who fails or refuses to establish a
             346      workplace safety program pursuant to Subsection [(4)] (3)(b)(i) or (ii) may be increased by 5%
             347      over any existing current rates and premium modifications charged that employer.
             348          Section 3. Section 34A-2-113 is enacted to read:
             349          34A-2-113. Designated agent required.
             350          Each workers' compensation insurance carrier writing insurance in this state shall
             351      maintain a designated agent in this state that is:
             352          (1) registered with the division; and
             353          (2) authorized to receive on behalf of the workers' compensation insurance carrier all
             354      notices or orders provided for under this chapter or Chapter 3, Utah Occupational Disease Act.
             355          Section 4. Section 34A-2-407 is amended to read:
             356           34A-2-407. Reporting of industrial injuries -- Regulation of health care providers
             357      -- Funeral expenses.
             358          (1) As used in this section, "physician" is as defined in Section 34A-2-111 .
             359          (2) (a) Any employee sustaining an injury arising out of and in the course of
             360      employment shall provide notification to the employee's employer promptly of the injury.
             361          (b) If the employee is unable to provide the notification required by Subsection (2)(a),
             362      the following may provide notification of the injury to the employee's employer:
             363          (i) the employee's next-of-kin; or
             364          (ii) the employee's attorney.
             365          (c) An employee claiming benefits under this chapter, or Chapter 3, Utah Occupational
             366      Disease Act, shall comply with rules adopted by the commission regarding disclosure of
             367      medical records of the employee medically relevant to the industrial accident or occupational
             368      disease claim.


             369          (3) (a) An employee is barred for any claim of benefits arising from an injury if the
             370      employee fails to notify within the time period described in Subsection (3)(b):
             371          (i) the employee's employer in accordance with Subsection (2); or
             372          (ii) the division.
             373          (b) The notice required by Subsection (3)(a) shall be made within:
             374          (i) 180 days of the day on which the injury occurs; or
             375          (ii) in the case of an occupational hearing loss, the time period specified in Section
             376      34A-2-506 .
             377          (4) The following constitute notification of injury required by Subsection (2):
             378          (a) an employer's or physician's injury report filed with:
             379          (i) the division;
             380          (ii) the employer; or
             381          (iii) the employer's insurance carrier; or
             382          (b) the payment of any medical or disability benefits by:
             383          (i) the employer; or
             384          (ii) the employer's insurance carrier.
             385          (5) (a) In the form prescribed by the division, each employer shall file a report with the
             386      division of any:
             387          (i) work-related fatality; or
             388          (ii) work-related injury resulting in:
             389          (A) medical treatment;
             390          (B) loss of consciousness;
             391          (C) loss of work;
             392          (D) restriction of work; or
             393          (E) transfer to another job.
             394          (b) The employer shall file the report required by Subsection (5)(a) within seven days
             395      after:
             396          (i) the occurrence of a fatality or injury;
             397          (ii) the employer's first knowledge of the fatality or injury; or
             398          (iii) the employee's notification of the fatality or injury.
             399          (c) (i) An employer shall file a subsequent report with the division of any previously


             400      reported injury that later results in death.
             401          (ii) The subsequent report required by this Subsection (5)(c) shall be filed with the
             402      division within seven days following:
             403          (A) the death; or
             404          (B) the employer's first knowledge or notification of the death.
             405          (d) A report is not required to be filed under this Subsection (5) for minor injuries,
             406      such as cuts or scratches that require first-aid treatment only, unless:
             407          (i) a treating physician files a report with the division in accordance with Subsection
             408      (9); or
             409          (ii) a treating physician is required to file a report with the division in accordance with
             410      Subsection (9).
             411          (6) An employer required to file a report under Subsection (5) shall provide the
             412      employee with:
             413          (a) a copy of the report submitted to the division; and
             414          (b) a statement, as prepared by the division, of the employee's rights and
             415      responsibilities related to the industrial injury.
             416          (7) Each employer shall maintain a record in a manner prescribed by the division of all:
             417          (a) work-related fatalities; or
             418          (b) work-related injuries resulting in:
             419          (i) medical treatment;
             420          (ii) loss of consciousness;
             421          (iii) loss of work;
             422          (iv) restriction of work; or
             423          (v) transfer to another job.
             424          (8) (a) Except as provided in Subsection (8)(b), an employer who refuses or neglects to
             425      make reports, to maintain records, or to file reports with the division as required by this section
             426      is:
             427          (i) guilty of a class C misdemeanor; and
             428          (ii) subject to a civil assessment:
             429          (A) imposed by the division, subject to the requirements of Title 63, Chapter 46b,
             430      Administrative Procedures Act; and


             431          (B) that may not exceed $500.
             432          (b) An employer is not subject to the civil assessment or guilty of a class C
             433      misdemeanor under this Subsection (8) if:
             434          (i) the employer submits a report later than required by this section; and
             435          (ii) the division finds that the employer has shown good cause for submitting a report
             436      later than required by this section.
             437          (c) A civil assessment collected under this Subsection (8) shall be deposited into the
             438      Uninsured Employers' Fund created in Section 34A-2-704 .
             439          (9) (a) [Except as provided in Subsection (9)(c), a] A physician attending an injured
             440      employee shall comply with rules established by the commission regarding:
             441          (i) fees for physician's services;
             442          (ii) disclosure of medical records of the employee medically relevant to the employee's
             443      industrial accident[,] or occupational disease claim; and
             444          (iii) reports to the division regarding:
             445          (A) the condition and treatment of an injured employee; or
             446          (B) any other matter concerning industrial cases that the physician is treating.
             447          (b) A physician who is associated with, employed by, or bills through a hospital is
             448      subject to Subsection (9)(a).
             449          (c) A hospital providing services for an injured employee is not subject to the
             450      requirements of Subsection (9)(a)[.] except for rules made by the commission that are
             451      described in Subsection (9)(a)(ii) or (iii).
             452          (d) The commission's schedule of fees may reasonably differentiate remuneration to be
             453      paid to providers of health services based on:
             454          (i) the severity of the employee's condition;
             455          (ii) the nature of the treatment necessary; and
             456          (iii) the facilities or equipment specially required to deliver that treatment.
             457          (e) This Subsection (9) does not [modify contracts with providers] prohibit a contract
             458      with a provider of health services relating to the pricing of goods and services [existing on May
             459      1, 1995].
             460          [(f) In accordance with Title 63, Chapter 46b, Administrative Procedures Act, a
             461      physician may file with the Division of Adjudication an application for hearing to appeal a


             462      decision or final order to the extent a decision or final order concerns the fees charged by the
             463      physician in accordance with this section.]
             464          (10) A copy of the initial report filed under Subsection (9)(a)(iii) shall be furnished to:
             465          (a) the division;
             466          (b) the employee; and
             467          (c) (i) the employer; or
             468          (ii) the employer's insurance carrier.
             469          (11) (a) Except as provided in Subsection (11)(b), a [physician, excluding any
             470      hospital,] person subject to Subsection (9)(a)(iii) who fails to comply with Subsection
             471      (9)(a)(iii) is guilty of a class C misdemeanor for each offense.
             472          (b) A [physician] person subject to Subsection (9)(a)(iii) is not guilty of a class C
             473      misdemeanor under this Subsection (11), if:
             474          (i) the [physician] person files a late report; and
             475          (ii) the division finds that there is good cause for submitting a late report.
             476          (12) (a) Subject to appellate review under Section 34A-1-303 , the commission has
             477      exclusive jurisdiction to hear and determine:
             478          (i) whether [the treatment] goods provided to or services rendered to an employee [by a
             479      physician are: (i) reasonably related to industrial injuries or occupational diseases; and (ii)] are
             480      compensable pursuant to this chapter or Chapter 3, Utah Occupational Disease Act[.],
             481      including:
             482          (A) medical, nurse, or hospital services;
             483          (B) medicines; and
             484          (C) artificial means, appliances, or prosthesis;
             485          (ii) the reasonableness of the amounts charged or paid for a good or service described
             486      in Subsection (12)(a)(i); and
             487          (iii) collection issues related to a good or service described in Subsection (12)(a)(i).
             488          (b) Except as provided in Subsection (12)(a), Subsection 34A-2-211 (7), or Section
             489      34A-2-212 , a person may not maintain a cause of action in any forum within this state other
             490      than the commission for collection or payment [of a physician's billing for treatment] for goods
             491      or services described in Subsection (12)(a) that are compensable under this chapter or Chapter
             492      3, Utah Occupational Disease Act.


             493          Section 5. Section 34A-2-413 is amended to read:
             494           34A-2-413. Permanent total disability -- Amount of payments -- Rehabilitation.
             495          (1) (a) In cases of permanent total disability resulting from an industrial accident or
             496      occupational disease, the employee shall receive compensation as outlined in this section.
             497          (b) To establish entitlement to permanent total disability compensation, the employee
             498      [has the burden of proof to show] must prove by a preponderance of evidence that:
             499          (i) the employee sustained a significant impairment or combination of impairments as a
             500      result of the industrial accident or occupational disease that gives rise to the permanent total
             501      disability entitlement;
             502          (ii) the employee is permanently totally disabled; and
             503          (iii) the industrial accident or occupational disease was the direct cause of the
             504      employee's permanent total disability.
             505          (c) To [find] establish that an employee is permanently totally disabled[, the
             506      commission shall conclude] the employee must prove by a preponderance of the evidence that:
             507          (i) the employee is not gainfully employed;
             508          (ii) the employee has an impairment or combination of impairments that limit the
             509      employee's ability to do basic work activities;
             510          (iii) the industrial or occupationally caused impairment or combination of impairments
             511      prevent the employee from performing the essential functions of the work activities for which
             512      the employee has been qualified until the time of the industrial accident or occupational disease
             513      that is the basis for the employee's permanent total disability claim; and
             514          (iv) the employee cannot perform other work reasonably available, taking into
             515      consideration the employee's:
             516          (A) age;
             517          (B) education;
             518          (C) past work experience;
             519          (D) medical capacity; and
             520          (E) residual functional capacity.
             521          (d) Evidence of an employee's entitlement to disability benefits other than those
             522      provided under this chapter and Chapter 3, Utah Occupational Disease Act, if relevant:
             523          (i) may be presented to the commission;


             524          (ii) is not binding; and
             525          (iii) creates no presumption of an entitlement under this chapter and Chapter 3, Utah
             526      Occupational Disease Act.
             527          (2) For permanent total disability compensation during the initial 312-week
             528      entitlement, compensation shall be 66-2/3% of the employee's average weekly wage at the time
             529      of the injury, limited as follows:
             530          (a) compensation per week may not be more than 85% of the state average weekly
             531      wage at the time of the injury;
             532          (b) compensation per week may not be less than the sum of $45 per week, plus $5 for a
             533      dependent spouse, plus $5 for each dependent child under the age of 18 years, up to a
             534      maximum of four dependent minor children, but not exceeding the maximum established in
             535      Subsection (2)(a) nor exceeding the average weekly wage of the employee at the time of the
             536      injury; and
             537          (c) after the initial 312 weeks, the minimum weekly compensation rate under
             538      Subsection (2)(b) shall be 36% of the current state average weekly wage, rounded to the nearest
             539      dollar.
             540          (3) This Subsection (3) applies to claims resulting from an accident or disease arising
             541      out of and in the course of the employee's employment on or before June 30, 1994.
             542          (a) The employer or its insurance carrier is liable for the initial 312 weeks of permanent
             543      total disability compensation except as outlined in Section 34A-2-703 as in effect on the date
             544      of injury.
             545          (b) The employer or its insurance carrier may not be required to pay compensation for
             546      any combination of disabilities of any kind, as provided in this section and Sections 34A-2-410
             547      through 34A-2-412 and Part 5, Industrial Noise, in excess of the amount of compensation
             548      payable over the initial 312 weeks at the applicable permanent total disability compensation
             549      rate under Subsection (2).
             550          (c) Any overpayment of this compensation shall be reimbursed to the employer or its
             551      insurance carrier by the Employers' Reinsurance Fund and shall be paid out of the Employers'
             552      Reinsurance Fund's liability to the employee.
             553          (d) After an employee has received compensation from the employee's employer, its
             554      insurance carrier, or the Employers' Reinsurance Fund for any combination of disabilities


             555      amounting to 312 weeks of compensation at the applicable permanent total disability
             556      compensation rate, the Employers' Reinsurance Fund shall pay all remaining permanent total
             557      disability compensation.
             558          (e) Employers' Reinsurance Fund payments shall commence immediately after the
             559      employer or its insurance carrier has satisfied its liability under this Subsection (3) or Section
             560      34A-2-703 .
             561          (4) This Subsection (4) applies to claims resulting from an accident or disease arising
             562      out of and in the course of the employee's employment on or after July 1, 1994.
             563          (a) The employer or its insurance carrier is liable for permanent total disability
             564      compensation.
             565          (b) The employer or its insurance carrier may not be required to pay compensation for
             566      any combination of disabilities of any kind, as provided in this section and Sections 34A-2-410
             567      through 34A-2-412 and Part 5, Industrial Noise, in excess of the amount of compensation
             568      payable over the initial 312 weeks at the applicable permanent total disability compensation
             569      rate under Subsection (2).
             570          (c) Any overpayment of this compensation shall be recouped by the employer or its
             571      insurance carrier by reasonably offsetting the overpayment against future liability paid before
             572      or after the initial 312 weeks.
             573          (5) Notwithstanding the minimum rate established in Subsection (2), the compensation
             574      payable by the employer, its insurance carrier, or the Employers' Reinsurance Fund, after an
             575      employee has received compensation from the employer or the employer's insurance carrier for
             576      any combination of disabilities amounting to 312 weeks of compensation at the applicable total
             577      disability compensation rate, shall be reduced, to the extent allowable by law, by the dollar
             578      amount of 50% of the Social Security retirement benefits received by the employee during the
             579      same period.
             580          (6) (a) A finding by the commission of permanent total disability is not final, unless
             581      otherwise agreed to by the parties, until:
             582          (i) an administrative law judge reviews a summary of reemployment activities
             583      undertaken pursuant to Chapter 8, Utah Injured Worker Reemployment Act;
             584          (ii) the employer or its insurance carrier submits to the administrative law judge:
             585          (A) a reemployment plan as prepared by a qualified rehabilitation provider reasonably


             586      designed to return the employee to gainful employment; or
             587          (B) notice that the employer or its insurance carrier will not submit a plan; and
             588          (iii) the administrative law judge, after notice to the parties, holds a hearing, unless
             589      otherwise stipulated, to:
             590          (A) consider evidence regarding rehabilitation; and
             591          (B) review any reemployment plan submitted by the employer or its insurance carrier
             592      under Subsection (6)(a)(ii).
             593          (b) Before commencing the procedure required by Subsection (6)(a), the administrative
             594      law judge shall order:
             595          (i) the initiation of permanent total disability compensation payments to provide for the
             596      employee's subsistence; and
             597          (ii) the payment of any undisputed disability or medical benefits due the employee.
             598          (c) Notwithstanding Subsection (6)(a), an order for payment of benefits described in
             599      Subsection (6)(b) is considered a final order for purposes of Section 34A-2-212 .
             600          (d) The employer or its insurance carrier shall be given credit for any disability
             601      payments made under Subsection (6)(b) against its ultimate disability compensation liability
             602      under this chapter or Chapter 3, Utah Occupational Disease Act.
             603          (e) An employer or its insurance carrier may not be ordered to submit a reemployment
             604      plan. If the employer or its insurance carrier voluntarily submits a plan, the plan is subject to
             605      Subsections (6)(e)(i) through (iii).
             606          (i) The plan may include retraining, education, medical and disability compensation
             607      benefits, job placement services, or incentives calculated to facilitate reemployment funded by
             608      the employer or its insurance carrier.
             609          (ii) The plan shall include payment of reasonable disability compensation to provide
             610      for the employee's subsistence during the rehabilitation process.
             611          (iii) The employer or its insurance carrier shall diligently pursue the reemployment
             612      plan. The employer's or insurance carrier's failure to diligently pursue the reemployment plan
             613      shall be cause for the administrative law judge on the administrative law judge's own motion to
             614      make a final decision of permanent total disability.
             615          (f) If a preponderance of the evidence shows that successful rehabilitation is not
             616      possible, the administrative law judge shall order that the employee be paid weekly permanent


             617      total disability compensation benefits.
             618          (7) (a) The period of benefits commences on the date the employee became
             619      permanently totally disabled, as determined by a final order of the commission based on the
             620      facts and evidence, and ends:
             621          (i) with the death of the employee; or
             622          (ii) when the employee is capable of returning to regular, steady work.
             623          (b) An employer or its insurance carrier may provide or locate for a permanently totally
             624      disabled employee reasonable, medically appropriate, part-time work in a job earning at least
             625      minimum wage provided that employment may not be required to the extent that it would
             626      disqualify the employee from Social Security disability benefits.
             627          (c) An employee shall fully cooperate in the placement and employment process and
             628      accept the reasonable, medically appropriate, part-time work.
             629          (d) In a consecutive four-week period when an employee's gross income from the work
             630      provided under Subsection (7)(b) exceeds $500, the employer or insurance carrier may reduce
             631      the employee's permanent total disability compensation by 50% of the employee's income in
             632      excess of $500.
             633          (e) If a work opportunity is not provided by the employer or its insurance carrier, a
             634      permanently totally disabled employee may obtain medically appropriate, part-time work
             635      subject to the offset provisions contained in Subsection (7)(d).
             636          (f) (i) The commission shall establish rules regarding the part-time work and offset.
             637          (ii) The adjudication of disputes arising under this Subsection (7) is governed by Part
             638      8, Adjudication.
             639          (g) The employer or its insurance carrier shall have the burden of proof to show that
             640      medically appropriate part-time work is available.
             641          (h) The administrative law judge may:
             642          (i) excuse an employee from participation in any job that would require the employee
             643      to undertake work exceeding the employee's medical capacity and residual functional capacity
             644      or for good cause; or
             645          (ii) allow the employer or its insurance carrier to reduce permanent total disability
             646      benefits as provided in Subsection (7)(d) when reasonable, medically appropriate, part-time
             647      employment has been offered but the employee has failed to fully cooperate.


             648          (8) When an employee has been rehabilitated or the employee's rehabilitation is
             649      possible but the employee has some loss of bodily function, the award shall be for permanent
             650      partial disability.
             651          (9) As determined by an administrative law judge, an employee is not entitled to
             652      disability compensation, unless the employee fully cooperates with any evaluation or
             653      reemployment plan under this chapter or Chapter 3, Utah Occupational Disease Act. The
             654      administrative law judge shall dismiss without prejudice the claim for benefits of an employee
             655      if the administrative law judge finds that the employee fails to fully cooperate, unless the
             656      administrative law judge states specific findings on the record justifying dismissal with
             657      prejudice.
             658          (10) (a) The loss or permanent and complete loss of the use of both hands, both arms,
             659      both feet, both legs, both eyes, or any combination of two such body members constitutes total
             660      and permanent disability, to be compensated according to this section.
             661          (b) A finding of permanent total disability pursuant to Subsection (10)(a) is final.
             662          (11) (a) An insurer or self-insured employer may periodically reexamine a permanent
             663      total disability claim, except those based on Subsection (10), for which the insurer or
             664      self-insured employer had or has payment responsibility to determine whether the worker
             665      remains permanently totally disabled.
             666          (b) Reexamination may be conducted no more than once every three years after an
             667      award is final, unless good cause is shown by the employer or its insurance carrier to allow
             668      more frequent reexaminations.
             669          (c) The reexamination may include:
             670          (i) the review of medical records;
             671          (ii) employee submission to reasonable medical evaluations;
             672          (iii) employee submission to reasonable rehabilitation evaluations and retraining
             673      efforts;
             674          (iv) employee disclosure of Federal Income Tax Returns;
             675          (v) employee certification of compliance with Section 34A-2-110 ; and
             676          (vi) employee completion of sworn affidavits or questionnaires approved by the
             677      division.
             678          (d) The insurer or self-insured employer shall pay for the cost of a reexamination with


             679      appropriate employee reimbursement pursuant to rule for reasonable travel allowance and per
             680      diem as well as reasonable expert witness fees incurred by the employee in supporting the
             681      employee's claim for permanent total disability benefits at the time of reexamination.
             682          (e) If an employee fails to fully cooperate in the reasonable reexamination of a
             683      permanent total disability finding, an administrative law judge may order the suspension of the
             684      employee's permanent total disability benefits until the employee cooperates with the
             685      reexamination.
             686          (f) (i) Should the reexamination of a permanent total disability finding reveal evidence
             687      that reasonably raises the issue of an employee's continued entitlement to permanent total
             688      disability compensation benefits, an insurer or self-insured employer may petition the Division
             689      of Adjudication for a rehearing on that issue. The petition shall be accompanied by
             690      documentation supporting the insurer's or self-insured employer's belief that the employee is no
             691      longer permanently totally disabled.
             692          (ii) If the petition under Subsection (11)(f)(i) demonstrates good cause, as determined
             693      by the Division of Adjudication, an administrative law judge shall adjudicate the issue at a
             694      hearing.
             695          (iii) Evidence of an employee's participation in medically appropriate, part-time work
             696      may not be the sole basis for termination of an employee's permanent total disability
             697      entitlement, but the evidence of the employee's participation in medically appropriate, part-time
             698      work under Subsection (7) may be considered in the reexamination or hearing with other
             699      evidence relating to the employee's status and condition.
             700          (g) In accordance with Section 34A-1-309 , the administrative law judge may award
             701      reasonable attorneys fees to an attorney retained by an employee to represent the employee's
             702      interests with respect to reexamination of the permanent total disability finding, except if the
             703      employee does not prevail, the attorneys fees shall be set at $1,000. The attorneys fees shall be
             704      paid by the employer or its insurance carrier in addition to the permanent total disability
             705      compensation benefits due.
             706          (h) During the period of reexamination or adjudication if the employee fully
             707      cooperates, each insurer, self-insured employer, or the Employers' Reinsurance Fund shall
             708      continue to pay the permanent total disability compensation benefits due the employee.
             709          (12) If any provision of this section, or the application of any provision to any person


             710      or circumstance, is held invalid, the remainder of this section shall be given effect without the
             711      invalid provision or application.
             712          Section 6. Section 34A-2-801 is amended to read:
             713           34A-2-801. Initiating adjudicative proceedings -- Procedure for review of
             714      administrative action.
             715          (1) (a) To contest an action of the employee's employer or its insurance carrier
             716      concerning a compensable industrial accident or occupational disease alleged by the employee,
             717      any of the following shall file an application for hearing with the Division of Adjudication:
             718          (i) the employee; or
             719          (ii) a representative of the employee, the qualifications of whom are defined in rule by
             720      the commission.
             721          (b) To appeal the imposition of a penalty or other administrative act imposed by the
             722      division on the employer or its insurance carrier for failure to comply with this chapter or
             723      Chapter 3, Utah Occupational Disease Act, any of the following shall file an application for
             724      hearing with the Division of Adjudication:
             725          (i) the employer;
             726          (ii) the insurance carrier; or
             727          (iii) a representative of either the employer or the insurance carrier, the qualifications
             728      of whom are defined in rule by the commission.
             729          (c) A [physician, as defined in Section 34A-2-111 ,] person providing goods or services
             730      described in Subsections 34A-2-407 (12) and 34A-3-108 (12) may file an application for hearing
             731      in accordance with Section 34A-2-407 or 34A-3-108 .
             732          (d) An attorney may file an application for hearing in accordance with Section
             733      34A-1-309 .
             734          (2) Unless a party in interest appeals the decision of an administrative law judge in
             735      accordance with Subsection (3), the decision of an administrative law judge on an application
             736      for hearing filed under Subsection (1) is a final order of the commission 30 days after the date
             737      the decision is issued.
             738          (3) (a) A party in interest may appeal the decision of an administrative law judge by
             739      filing a motion for review with the Division of Adjudication within 30 days of the date the
             740      decision is issued.


             741          (b) Unless a party in interest to the appeal requests under Subsection (3)(c) that the
             742      appeal be heard by the Appeals Board, the commissioner shall hear the review.
             743          (c) A party in interest may request that an appeal be heard by the Appeals Board by
             744      filing the request with the Division of Adjudication:
             745          (i) as part of the motion for review; or
             746          (ii) if requested by a party in interest who did not file a motion for review, within 20
             747      days of the date the motion for review is filed with the Division of Adjudication.
             748          (d) A case appealed to the Appeals Board shall be decided by the majority vote of the
             749      Appeals Board.
             750          (4) All records on appeals shall be maintained by the Division of Adjudication. Those
             751      records shall include an appeal docket showing the receipt and disposition of the appeals on
             752      review.
             753          (5) Upon appeal, the commissioner or Appeals Board shall make its decision in
             754      accordance with Section 34A-1-303 .
             755          (6) The commissioner or Appeals Board shall promptly notify the parties to any
             756      proceedings before it of its decision, including its findings and conclusions.
             757          (7) The decision of the commissioner or Appeals Board is final unless within 30 days
             758      after the date the decision is issued further appeal is initiated under the provisions of this
             759      section or Title 63, Chapter 46b, Administrative Procedures Act.
             760          (8) (a) Within 30 days after the date the decision of the commissioner or Appeals
             761      Board is issued, any aggrieved party may secure judicial review by commencing an action in
             762      the court of appeals against the commissioner or Appeals Board for the review of the decision
             763      of the commissioner or Appeals Board.
             764          (b) In an action filed under Subsection (8)(a):
             765          (i) any other party to the proceeding before the commissioner or Appeals Board shall
             766      be made a party; and
             767          (ii) the commission shall be made a party.
             768          (c) A party claiming to be aggrieved may seek judicial review only if the party has
             769      exhausted the party's remedies before the commission as provided by this section.
             770          (d) At the request of the court of appeals, the commission shall certify and file with the
             771      court all documents and papers and a transcript of all testimony taken in the matter together


             772      with the decision of the commissioner or Appeals Board.
             773          Section 7. Section 34A-3-108 is amended to read:
             774           34A-3-108. Reporting of occupational diseases -- Regulation of health care
             775      providers.
             776          (1) Any employee sustaining an occupational disease, as defined in this chapter, arising
             777      out of and in the course of employment shall provide notification to the employee's employer
             778      promptly of the occupational disease. If the employee is unable to provide notification, the
             779      employee's next-of-kin or attorney may provide notification of the occupational disease to the
             780      employee's employer.
             781          (2) (a) Any employee who fails to notify the employee's employer or the division
             782      within 180 days after the cause of action arises is barred from any claim of benefits arising
             783      from the occupational disease.
             784          (b) The cause of action is considered to arise on the date the employee first suffered
             785      disability from the occupational disease and knew, or in the exercise of reasonable diligence
             786      should have known, that the occupational disease was caused by employment.
             787          (3) The following constitute notification of an occupational disease:
             788          (a) an employer's or physician's injury report filed with the:
             789          (i) division;
             790          (ii) employer; or
             791          (iii) insurance carrier; or
             792          (b) the payment of any medical or disability benefits by the employer or the employer's
             793      insurance carrier.
             794          (4) (a) In the form prescribed by the division, each employer shall file a report with the
             795      division of any occupational disease resulting in:
             796          (i) medical treatment;
             797          (ii) loss of consciousness;
             798          (iii) loss of work;
             799          (iv) restriction of work; or
             800          (v) transfer to another job.
             801          (b) The report required under Subsection (4)(a), shall be filed within seven days after:
             802          (i) the occurrence of an occupational disease;


             803          (ii) the employer's first knowledge of the occupational disease; or
             804          (iii) the employee's notification of the occupational disease.
             805          (c) Each employer shall file a subsequent report with the division of any previously
             806      reported occupational disease that later resulted in death. The subsequent report shall be filed
             807      with the division within seven days following:
             808          (i) the death; or
             809          (ii) the employer's first knowledge or notification of the death.
             810          (d) A report is not required for:
             811          (i) minor injuries that require first-aid treatment only, unless a treating physician files,
             812      or is required to file, the Physician's Initial Report of Work Injury or Occupational Disease with
             813      the division;
             814          (ii) occupational diseases that manifest after the employee is no longer employed by the
             815      employer with which the exposure occurred; or
             816          (iii) when the employer is not aware of an exposure occasioned by the employment that
             817      results in an occupational disease as defined by Section 34A-3-103 .
             818          (5) Each employer shall provide the employee with:
             819          (a) a copy of the report submitted to the division; and
             820          (b) a statement, as prepared by the division, of the employee's rights and
             821      responsibilities related to the occupational disease.
             822          (6) Each employer shall maintain a record in a manner prescribed by the division of all
             823      occupational diseases resulting in:
             824          (a) medical treatment;
             825          (b) loss of consciousness;
             826          (c) loss of work;
             827          (d) restriction of work; or
             828          (e) transfer to another job.
             829          (7) Any employer who refuses or neglects to make reports, to maintain records, or to
             830      file reports with the division as required by this section is guilty of a class C misdemeanor and
             831      subject to citation under Section 34A-6-302 and a civil assessment as provided under Section
             832      34A-6-307 , unless the division finds that the employer has shown good cause for submitting a
             833      report later than required by this section.


             834          (8) (a) Except as provided in Subsection (8)(c), all physicians, surgeons, and other
             835      health providers attending occupationally diseased employees shall:
             836          (i) comply with all the rules, including the schedule of fees, for their services as
             837      adopted by the commission; and
             838          (ii) make reports to the division at any and all times as required as to the condition and
             839      treatment of an occupationally diseased employee or as to any other matter concerning
             840      industrial cases they are treating.
             841          (b) A physician, as defined in [Subsection] Section 34A-2-111 [(2)], who is associated
             842      with, employed by, or bills through a hospital is subject to Subsection (8)(a).
             843          (c) A hospital is not subject to the requirements of Subsection (8)(a) except a hospital
             844      is subject to rules made by the commission under Subsections 34A-2-407 (9)(a)(ii) and (iii).
             845          (d) The commission's schedule of fees may reasonably differentiate remuneration to be
             846      paid to providers of health services based on:
             847          (i) the severity of the employee's condition;
             848          (ii) the nature of the treatment necessary; and
             849          (iii) the facilities or equipment specially required to deliver that treatment.
             850          (e) This Subsection (8) does not [modify contracts with providers] prohibit a contract
             851      with a provider of health services relating to the pricing of goods and services [existing on May
             852      1, 1995].
             853          [(f) In accordance with Title 63, Chapter 46b, Administrative Procedures Act, a
             854      physician, surgeon, or other health provider may file an application for hearing with the
             855      Division of Adjudication to contest a decision or final order to the extent it concerns the fees
             856      charged by the physician, surgeon, or other health provider.]
             857          (9) A copy of the physician's initial report shall be furnished to the:
             858          (a) division;
             859          (b) employee; and
             860          (c) employer or its insurance carrier.
             861          (10) Any [physician, surgeon, or other health provider, excluding any hospital,] person
             862      subject to reporting under Subsection (8)(a)(ii) or Subsection 34A-2-407 (9)(a)(iii) who refuses
             863      or neglects to make any report or comply with this section is guilty of a class C misdemeanor
             864      for each offense, unless the division finds that there is good cause for submitting a late report.


             865          (11) (a) Applications for a hearing to resolve disputes regarding occupational disease
             866      claims shall be filed with the Division of Adjudication.
             867          (b) After the filing, a copy shall be forwarded by mail to:
             868          (i) the employer or to the employer's insurance carrier;
             869          (ii) the applicant; and
             870          (iii) the attorneys for the parties.
             871          (12) (a) Subject to appellate review under Section 34A-1-303 , the commission has
             872      exclusive jurisdiction to hear and determine:
             873          (i) whether [the treatment] goods provided to or services rendered to [employees by
             874      physicians, surgeons, or other health providers are: (i) reasonably related to industrial injuries
             875      or occupational diseases; and (ii)] an employee is compensable pursuant to this chapter and
             876      Chapter 2, Workers' Compensation Act[.], including the following:
             877          (A) medical, nurse, or hospital services;
             878          (B) medicines; and
             879          (C) artificial means, appliances, or prosthesis;
             880          (ii) the reasonableness of the amounts charged or paid for a good or service described
             881      in Subsection (12)(a)(i); and
             882          (iii) collection issues related to a good or service described in Subsection (12)(a)(i).
             883          (b) Except as provided in Subsection (12)(a), Subsection 34A-2-211 (7), or Section
             884      34A-2-212 , a person may not maintain a cause of action in any forum within this state other
             885      than the commission for collection or payment of [a physician's, surgeon's, or other health
             886      provider's billing for treatment] goods or services described in Subsection (12)(a) that are
             887      compensable under this chapter or Chapter 2, Workers' Compensation Act.
             888          Section 8. Legislative intent language.
             889          It is the intent of the Legislature that the amendments to Section 34A-2-413 in this bill
             890      be interpreted as merely clarifying an existing principle that the employee bears the burden of
             891      proving that the employee is permanently totally disabled based on those factors listed as
             892      matters on which the commission is to make a conclusion in Subsection 34A-2-413 (1)(c), as
             893      enacted before the amendments of this bill.





Legislative Review Note
    as of 1-24-06 9:53 AM


Based on a limited legal review, this legislation has not been determined to have a high
probability of being held unconstitutional.

Office of Legislative Research and General Counsel


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