S.B. 231 Enrolled

1

MEDICAL BENEFITS UNDER WORKERS' COMPENSATION
2 2010 GENERAL SESSION
3 STATE OF UTAH
4 Chief Sponsor: D. Chris Buttars
5 House Sponsor: Wayne A. Harper
6
7 LONG TITLE
8 General Description:
9 This bill modifies the Workers' Compensation Act to address issues related to the
10 payment of medical benefits in the case of an industrial accident.
11 Highlighted Provisions:
12 This bill:
13 . provides that legislative changes in the time limits in seeking medical benefits are
14 to be applied retroactively; and
15 . makes technical changes.
16 Monies Appropriated in this Bill:
17 None
18 Other Special Clauses:
19 None
20 Utah Code Sections Affected:
21 AMENDS:
22 34A-2-417, as last amended by Laws of Utah 2007, Chapter 62
23
24 Be it enacted by the Legislature of the state of Utah:
25 Section 1. Section 34A-2-417 is amended to read:
26 34A-2-417. Claims and benefits -- Time limits for filing -- Burden of proof.
27 (1) (a) Except with respect to prosthetic devices or in a permanent total disability case,
28 an employee is entitled to be compensated for a medical expense if:
29 [(a)] (i) the medical expense is:

30 [(i)] (A) reasonable in amount; and
31 [(ii)] (B) necessary to treat the industrial accident; and
32 [(b)] (ii) the employee submits or makes a reasonable attempt to submit the medical
33 expense:
34 [(i)] (A) to the employee's employer or insurance carrier for payment; and
35 [(ii)] (B) within one year from the later of:
36 [(A)] (I) the day on which the medical expense is incurred; or
37 [(B)] (II) the day on which the employee knows or in the exercise of reasonable
38 diligence should have known that the medical expense is related to the industrial accident.
39 (b) For an industrial accident that occurs on or after July 1, 1988, and is the basis of a
40 claim for a medical expense, an employee is entitled to be compensated for the medical
41 expense if the employee meets the requirements of Subsection (1)(a).
42 (2) (a) A claim described in Subsection (2)(b) is barred, unless the employee:
43 (i) files an application for hearing with the Division of Adjudication no later than six
44 years from the date of the accident; and
45 (ii) by no later than 12 years from the date of the accident, is able to meet the
46 employee's burden of proving that the employee is due the compensation claimed under this
47 chapter.
48 (b) Subsection (2)(a) applies to a claim for compensation for:
49 (i) temporary total disability benefits;
50 (ii) temporary partial disability benefits;
51 (iii) permanent partial disability benefits; or
52 (iv) permanent total disability benefits.
53 (c) The commission may enter an order awarding or denying an employee's claim for
54 compensation under this chapter within a reasonable time period beyond 12 years from the
55 date of the accident, if:
56 (i) the employee complies with Subsection (2)(a); and
57 (ii) 12 years from the date of the accident:

58 (A) (I) the employee is fully cooperating in a commission approved reemployment
59 plan; and
60 (II) the results of that commission approved reemployment plan are not known; or
61 (B) the employee is actively adjudicating issues of compensability before the
62 commission.
63 (3) A claim for death benefits is barred unless an application for hearing is filed within
64 one year of the date of death of the employee.
65 (4) (a) (i) Subject to Subsections (2)(c) and (4)(b), after an employee files an
66 application for hearing within six years from the date of the accident, the Division of
67 Adjudication may enter an order to show cause why the employee's claim should not be
68 dismissed because the employee has failed to meet the employee's burden of proof to establish
69 an entitlement to compensation claimed in the application for hearing.
70 (ii) The order described in Subsection (4)(a)(i) may be entered on the motion of the:
71 (A) Division of Adjudication;
72 (B) employee's employer; or
73 (C) employer's insurance carrier.
74 (b) Under Subsection (4)(a), the Division of Adjudication may dismiss a claim:
75 (i) without prejudice; or
76 (ii) with prejudice only if:
77 (A) the Division of Adjudication adjudicates the merits of the employee's entitlement
78 to the compensation claimed in the application for hearing; or
79 (B) the employee fails to comply with Subsection (2)(a)(ii).
80 (c) If a claim is dismissed without prejudice under Subsection (4)(b), the employee is
81 subject to the time limits under Subsection (2)(a) to claim compensation under this chapter.
82 (5) A claim for compensation under this chapter is subject to a claim or lien for
83 recovery under Section 26-19-5 .