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S.B. 120 Enrolled

             1     

WORKERS' COMPENSATION ACT - MEDICAL

             2     
REPORTS

             3     
2009 GENERAL SESSION

             4     
STATE OF UTAH

             5     
Chief Sponsor: Karen Mayne

             6     
House Sponsor: Michael T. Morley

             7     
             8      LONG TITLE
             9      General Description:
             10          This bill modifies the Workers' Compensation Act to address the mailing of medical
             11      reports.
             12      Highlighted Provisions:
             13          This bill:
             14          .    removes the requirement that a medical report be mailed by certified mail, return
             15      receipt requested;
             16          .    expands the list of persons required to receive a copy of a medical report;
             17          .    modifies time to object to a report; and
             18          .    makes technical changes.
             19      Monies Appropriated in this Bill:
             20          None
             21      Other Special Clauses:
             22          None
             23      Utah Code Sections Affected:
             24      AMENDS:
             25          34A-2-601, as last amended by Laws of Utah 2002, Chapter 303
             26     
             27      Be it enacted by the Legislature of the state of Utah:
             28          Section 1. Section 34A-2-601 is amended to read:
             29           34A-2-601. Medical panel, director, or consultant -- Findings and reports --


             30      Objections to report -- Hearing -- Expenses.
             31          (1) (a) The Division of Adjudication may refer the medical aspects of a case described
             32      in this Subsection (1)(a) to a medical panel appointed by an administrative law judge:
             33          (i) upon the filing of a claim for compensation arising out of and in the course of
             34      employment for:
             35          (A) disability by accident; or
             36          (B) death by accident; and
             37          (ii) if the employer or the employer's insurance carrier denies liability.
             38          (b) An administrative law judge may appoint a medical panel [appointed by an
             39      administrative law judge] upon the filing of a claim for compensation based upon disability or
             40      death due to an occupational disease.
             41          (c) A medical panel appointed under this section shall consist of one or more
             42      physicians specializing in the treatment of the disease or condition involved in the claim.
             43          (d) As an alternative method of obtaining an impartial medical evaluation of the
             44      medical aspects of a controverted case, the division may employ a medical director or one or
             45      more medical consultants:
             46          (i) on a full-time or part-time basis; and
             47          (ii) for the purpose of:
             48          (A) evaluating [the] medical evidence; and
             49          (B) advising an administrative law judge with respect to the administrative law judge's
             50      ultimate fact-finding responsibility.
             51          (e) If all parties agree to the use of a medical director or one or more medical
             52      consultants, the medical director or one or more medical consultants [shall be] is allowed to
             53      function in the same manner and under the same procedures as required of a medical panel.
             54          (2) (a) A medical panel, medical director, or medical consultant may do the following
             55      to the extent the medical panel, medical director, or medical consultant determines that it is
             56      necessary or desirable:
             57          (i) conduct a study;


             58          (ii) take an x-ray;
             59          (iii) perform a test; or
             60          (iv) if authorized by an administrative law judge, conduct a post-mortem examination.
             61          (b) A medical panel, medical director, or medical consultant shall make:
             62          (i) a report in writing to the administrative law judge in a form prescribed by the
             63      Division of Adjudication; and
             64          (ii) additional findings as the administrative law judge may require.
             65          (c) In an occupational disease case, in addition to the requirements of Subsection
             66      (2)(b), a medical panel, medical director, or medical consultant shall certify to the
             67      administrative law judge:
             68          (i) the extent, if any, of the disability of the claimant from performing work for
             69      remuneration or profit;
             70          (ii) whether the sole cause of the disability or death, in the opinion of the medical
             71      panel, medical director, or medical consultant results from the occupational disease; and
             72          (iii) (A) whether any other [causes have] cause aggravated, prolonged, accelerated, or
             73      in any way contributed to the disability or death; and
             74          (B) if another cause [has] contributed to the disability or death, the extent in
             75      percentage to which the other cause [has] contributed to the disability or death.
             76          (d) (i) [The] An administrative law judge shall promptly distribute full copies of a
             77      report submitted to the administrative law judge under this Subsection (2) by [certified] mail
             78      [with return receipt requested] to:
             79          (A) the applicant;
             80          (B) the employer; [and]
             81          (C) the employer's insurance carrier[.]; and
             82          (D) an attorney employed by a person listed in Subsections (2)(d)(i)(A) through (C).
             83          (ii) Within [15] 20 days after the report described in Subsection (2)(d)(i) is deposited
             84      in the United States post office, the following may file with the administrative law judge a
             85      written [objections] objection to the report:


             86          (A) the applicant;
             87          (B) the employer; or
             88          (C) the employer's insurance carrier.
             89          (iii) If no written [objections are] objection is filed within the period described in
             90      Subsection (2)(d)(ii), the report is considered admitted in evidence.
             91          (e) (i) [The] An administrative law judge may base the administrative law judge's
             92      finding and decision on the report of:
             93          (A) a medical panel;
             94          (B) the medical director; or
             95          (C) one or more medical consultants.
             96          (ii) Notwithstanding Subsection (2)(e)(i), an administrative law judge is not bound by
             97      a report described in Subsection (2)(e)(i) if other substantial conflicting evidence in the case
             98      supports a contrary finding.
             99          (f) (i) If [an] a written objection to a report is filed under Subsection (2)(d), the
             100      administrative law judge may set the case for hearing to determine the facts and issues
             101      involved.
             102          (ii) At a hearing held pursuant to this Subsection (2)(f), any party may request the
             103      administrative law judge to have any of the following present at the hearing for examination
             104      and cross-examination:
             105          (A) the chair of the medical panel;
             106          (B) the medical director; or
             107          (C) the one or more medical consultants.
             108          (iii) For good cause shown, [the] an administrative law judge may order the following
             109      to be present at the hearing for examination and cross-examination:
             110          (A) a member of a medical panel, with or without the chair of the medical panel;
             111          (B) the medical director; or
             112          (C) a medical consultant.
             113          (g) (i) [The] A written report of a medical panel, medical director, or one or more


             114      medical consultants may be received as an exhibit at [the] a hearing described in Subsection
             115      (2)(f).
             116          (ii) Notwithstanding Subsection (2)(g)(i), a report received as an exhibit under
             117      Subsection (2)(g)(i) may not be considered as evidence in the case except as far as the report is
             118      sustained by the testimony admitted.
             119          (h) For [any] a claim referred under Subsection (1) to a medical panel, medical
             120      director, or medical consultant before July 1, 1997, the commission shall pay out of the
             121      Employers' Reinsurance Fund established in Section 34A-2-702 :
             122          (i) expenses of [the] a study [and] or report of the medical panel, medical director, or
             123      medical consultant; and
             124          (ii) the expenses of the medical panel's, medical director's, or medical consultant's
             125      appearance before [the] an administrative law judge.
             126          (i) (i) For [any] a claim referred under Subsection (1) to a medical panel, medical
             127      director, or medical consultant on or after July 1, 1997, the commission shall pay out of the
             128      Uninsured Employers' Fund established in Section 34A-2-704 the expenses of:
             129          (A) [the] a study [and] or report of the medical panel, medical director, or medical
             130      consultant; and
             131          (B) the medical panel's, medical director's, or medical consultant's appearance before
             132      [the] an administrative law judge.
             133          (ii) Notwithstanding Section 34A-2-704 , the expenses described in Subsection (2)(i)(i)
             134      shall be paid from the Uninsured Employers' Fund whether or not the employment relationship
             135      during which the industrial accident or occupational disease occurred is localized in Utah as
             136      described in Subsection 34A-2-704 (20).


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