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Basic Deadlines

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by

Denise Iannotti

on 2 February 2018

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Transcript of Basic Deadlines

Outline:
Employee Timing Obligations
The employee must provide the employer with a written notice of injury within four (4) days of the injury.
Initial Report
Insurer must file either an admission or Notice of Contest (NOC) within 20 days of the E-1, within 20 days from the date that the E-1
should
have been filed, or within 20 days from the date of mailing of the Workers' Claim for Compensation.
Failure to timely admit/deny can result in penalties.
Medical Reports and Records
All medical records should be exchanged within 15 business days of receipt.

The parties shall exchange medical records within 5 business days of a request.

A party has 15 days to complete, sign, and return a release for medical or other relevant information.

A party has 15 days to respond to a request for wage information.
The Space-Time Continuum of WC Deadlines
Presented by Lee + Brown, LLC 2018
Employee Obligations
Employer Obligations
Initial Report
Payment of Benefits
Medical Services
Closure and Reopening
If not, there may be a loss of up to 1 day's compensation for each day's failure to timely report.
Statute of Limitations to File Claim
Employee must file the claim within 2 years of the injury or else it is barred by the statute of limitations (SOL). Section 8-43-103(2)
SOL does not apply in cases where injury or death resulted from exposure to radioactive materials, fissionable materials, poisoning by uranium, asbestosis, silicosis, and anthracosis.

The ALJ may extend the SOL to 3 years if the employee has a reasonable excuse.

Failure to file Employer's First Report of Injury may indefinitely extend the SOL. It is important to ensure that this is filed!
Section 8-43-102 (1)(a)

Employer Timing Obligations
Within 10 days of notice or knowledge of an injury, the employer must report any work-related injury to insurer.
Employer's First Report of Injury (E-1) must be filed
immediately
with the Division if injury results in death or an accident injures 3+ employees. Section 8-43-103(1); W.C.R.P. Rule 5-1(B)(1)
E-1 must be filed with Division within 10 days of notice or knowledge that employee:
Contracted an enumerated occupational disease
Sustained a permanent impairment
Lost over 3 days of scheduled shifts at work
Made a claim for benefits, including "med only" that is denied for any reason
Electronic Data Interchange (EDI)
Any First Report of Injury or Notice of Contest must be filed electronically using EDI.

They cannot be submitted via email.

W.C.R.P. Rule 5-1(c)
W.C.R.P. Rule 16: Authorize or Deny Medical Treatment
Rule 16-9: If you get a Notification Form from an ATP, you must respond on the same form within 5 business days.
Rule 16-10 & 16-11: If you get a request for prior authorization, you must respond within 7 business days.
To deny for
non-medical
reasons, you must notify the ATP and parties in writing explaining the denial.
To deny for
medical
reasons, you must get a review and attach the report to a written letter explaining the denial to the ATP and parties OR
schedule
an IME within 7 business days.
Rule 16-12: If you get a medical bill, you must respond within 30 days.
Timing Requirements for Paying Benefits
Upon termination or reduction in compensation, a new admission must be filed before the next scheduled date for payment of compensation.
An admission must be filed within
30 days
of any resumption or increase in benefits.
Following any Order that alters benefits, a new admission must be filed.
Benefits awarded by Order are due on the date of the Order.
Must pay benefits within
30 days
of when the benefits were due.
Process After Maximum Medical Improvement (MMI)
ATP places Claimant at MMI with impairment rating
Within
30 days
of the date of mailing or physical delivery of the MMI report, the adjuster must file an FAL with the ATP findings OR Notice and Proposal to Select a DIME.
If Respondents only challenge a scheduled impairment rating, they can file the Application for Hearing without the DIME.
The Claimant has 30 days from the FAL to file a Notice and Proposal to Select a DIME (or an Application for Hearing if it is only a scheduled impairment)
If no action from Claimant within 30 days of FAL, the file is closed subject to reopening statutes.
DIME Process
If a party pursues the DIME:
Parties have 30 days to negotiate the DIME physician after N+ P.
If no agreement, Respondents must file Notice of Failed IME Negotiations.
Requesting party then files the Application for DIME within 30 days.
DIME panel is issued and parties make strikes to select physician.
Within
20 days
of date of mailing of Division's Notice of DIME Completion, Respondents must either file FAL or Application for Hearing.
Temporary disability benefits awarded by an admission are due on the date of the admission!
The initial payment after an admission is filed must be received by the Claimant no later than
5 calendar days
after the date of the admission. W.C.R.P. Rule 5-6(B)
Example
: If you pay two weeks of TTD benefits on April 1, but then file the 1st GAL on April 3, you would be in violation of this rule because Claimant would not get the initial payment following the GAL within 5 days of the admission.
Ongoing TTD or TPD must be paid at least once every two weeks.
Timing Requirements for Payments Continued...
PPD benefits awarded by an admission are retroactive to the date of MMI and must be paid no later than
five calendar days
after the admission.
Ongoing PPD must be paid at least every two weeks.
Insurer can credit any TTD/TPD paid after MMI toward the PPD award due.
Closure and Reopening
A claim automatically closes with regard to issues admitted in the FAL if the employee does not (1) object within 30 days or (2) objects, but does not litigate any contested issues within 30 days.
If there is no legal activity for over 6 months, Respondents can file a Motion to Show Cause to close the claim.
If the Claimant responds, the Director will determine whether good cause has been shown to keep the claim open.
Questions?
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