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Colorado Workers’ Compensation Legislative Rule Changes

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Denise Iannotti

on 27 March 2015

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Transcript of Colorado Workers’ Compensation Legislative Rule Changes

Designated Provider Lists
Rule 8 provides the procedure for designation of providers. Effective April 1, 2015, the number of providers required for a designated provider list must be increased.


Annual Changes in Benefit Rates
Transportation Network Companies (TNC)
TNC: company that uses an online-enabled platform to connect passengers with drivers using their personal, non-commercial vehicles.
Examples: Lyft, Uber, Sidecar, etc.
TNC Drivers use their own personal vehicles to provide services for riders matched through the TNC’s digital network.
Drivers may not be employees of the TNC.

Procedures After Discharge for Nonmedical Reasons
New Rule provides additional requirements for an ATP after the ATP refuses to treat or discharges an injured worker from care for nonmedical reasons when the employee requires medical treatment to cure or relieve the work injury.

Overview
1. Transportation Network Company Drivers
2. Medical Treatment Guidelines
3. Procedures After Discharge for Nonmedical Reasons
4. Limits on Lump Sum Payments
5. Changes in Designated Provider Lists
6. Use of Electronic Mail in Settlement Procedures
7. Changes in Hearing Deadlines
8. Out-of-State Parties to Appear at Hearing
9. Reimbursement for Attending IMEs
10. Annual Changes in Benefit Rates

For Dates of Injury prior to January 1, 2014:
The aggregate of all lump sums granted to a Claimant or to a sole dependent in a compensable claim must not exceed
$80,868.10.
For death claims with multiple dependents, the aggregate lump sum must not exceed
$161,734.15.

Colorado Workers’ Compensation Legislative Rule Changes
Presented by Lee+Kinder, LLC

Medical Treatment Guidelines (MTG)
While the Director or ALJ will consider the MTG when determining the reasonableness, necessity, and relatedness of a proposed medical treatment, there is
NO
requirement that the MTG be used as a sole basis for the decision. Thus, if the proposed medical treatment is not within the MTG, the ALJ may still be able to find it reasonable, necessary, and related.

The ATP must:
Notify the injured worker and insurer by certified mail return receipt requested within 3 business days;
Explain the reasons for refusal or discharge; and
Offer to transfer the employee’s medical records to any new ATP upon receipt of signed authorization from injured worker to do so.
The Director or ALJ will have jurisdiction to resolve disputes as to whether discharge from medical care or refusal to treat was for medical or nonmedical reasons.

For injuries occurring after July 1, 2014:
Max TTD rate = $881.65/week.
Scheduled impairment = $277.03/week
Disfigurement Max = $4,673.47
Or $9,345.38 for “extensive” disfigurement.
Benefits Cap on combined TTD/TPD/PPD:
$81,435.67 for 25% or less impairment
$162,869.28 for 26% or more impairment

C.R.S.§8-41-211: Effective July 1, 2014

C.R.S. §8-43-201(3): Effective July 1, 2014

The insurer must designate a new ATP within 15 calendar days after receipt of the notice from the ATP or from the injured worker.
Failure to designate a new ATP will result in the employee having the right of selection.
C.R.S. §8-43-404(10)(b): Effective July 1, 2014.

Lump Sum Limits
Exception for Rural Areas
If there are
more than 3, but less than 9
physicians or corporate medical providers willing to treat injured workers within
30 miles
of the employer's place of business, the employer may designate
2
physicians, or
2
corporate medical providers, or a combination of both.

The 2 physicians or corporate medical providers must be at
two distinct
locations without common ownership.

If there are not 2 providers at 2 distinct locations w/out common ownership w/in 30 miles of the employers’ place of business, the employer may designate 2 providers at the same location or w/ shared ownership interests

C.R.S. §8-43-404(5)(a)(I)(B)& (C): Effective April 1, 2015.

C.R.S. §8-43-404(5)(a)(I)(B)& (C): Effective April 1, 2015
New Rule makes settlement procedures easier and more efficient through the use of electronic mail.
Represented Claimants are now permitted to submit settlement documents via electronic mail.
The Division will send copies of the Order approving settlements via electronic mail to the counsel of record or the insurance carrier or self-insured employer, if unrepresented.

Use of Electronic Mail in Settlements
C.R.S. §8-43-204(8): Effective July 1, 2014.

Changes in Hearing Deadlines
Hearings shall now commence within 120 days after the date of the certificate of service on the AH.
ALJ still has authority to grant one extension of time, not exceeding 60 days.
Hearings must be set at least 15 days, but no more than 30 days from the date of filing of the AH.
RAH are now due within 15 days from the date of the filing of the AH
Out of State Parties to Appear at Hearings
The Director and ALJ now have authority to order out-of-state parties to appear in person or by telephone for a deposition or hearing, upon good cause shown.
If a party fails to comply with such order, he or she may be liable for penalties.
C.R.S. §8-43-315(2) & (3): Effective July 1, 2014.

Reimbursement for Attending IMEs
Respondents must now reimburse a Claimant for lost wages sustained as a result of attending a Respondent-sponsored IME.
C.R.S. §8-43-404(1)(b)(I): Effective July 1, 2014.

Lump Sum Limits
The Director will adjust the lump sum limits on July 1 of each year by the percentage increase or decrease of the state average weekly wage.

For Dates of Injury on or after January 1, 2014:
Claimants may receive an aggregate of
$81,435.67
in lump sum disbursements.
For death claims with multiple dependents, the aggregate lump sum must not exceed
$162,869.28
.
Exception for Rural Areas
If there are
3 or less
physicians or corporate medical providers within
30 miles
of the employer's place of business who are willing to treat injured workers, the employer may designate
only 1
physician or
1
corporate medical provider.
Designated Provider List Cheat Sheet
Available Providers Within 30 Miles Required Number of Designated Providers


Three or Less One


At Least Four But Less than Nine Two


Nine or More Four


The Director now has authority to determine whether TNCs have an obligation to provide or offer WC's insurance coverage for purchase to TNC drivers.
May result in a new rule determined at a later date.
TNCs Continued
Designated Provider
Lists
If
9 or more
providers exist within 30 miles, employers MUST now designate the names of at least
4
physicians or
4
corporate medical providers or a combination of both.
At least 1 of the providers must be at a different location from the other 3 and have distinct ownership.
Designated Provider Lists
• In all cases, and upon request, a designated provider must provide a list of ownership interests and employment relationships, if any, to an interested party within 5 days of receipt of the request.

• In all cases, a written copy of the designated provider list must be given within
7 business days
following the date the employer has notice of an injury.

• In all cases, the designated provider list must also include: contact information for the self-insured employer or insurer of record, including address, phone number an claims contact information of the persons responsible for adjusting the claim.

Reimbursement for Attending IMEs
Compensation will be at a rate of $75 per day.

Claimant must prove that he or she would incur wage losses as a result of attending the IME.

Failure to pay will constitute grounds for the Claimant to refuse to attend the IME.

If Claimant is already receiving TTD benefits, he or she is not also entitled to the $75.
Navigating the WC Act can be complex.
We are here to help!
Contact Lee+Kinder at 303-539-5421
Full transcript