AN ACT RELATING TO VOCATIONAL REHABILITATION AND PAYMENT OF COMPENSATION UNDER WORKERS’ COMPENSATION
It is hereby enacted by the General Assembly of the State of Vermont:
* * * Vocational Rehabilitation Rule * * *
Sec. 1. 21 V.S.A. § 641(a) is amended to read:
(a) When as a result of an injury covered by this chapter, an employee is unable to perform work for which the employee has previous training or experience, the employee shall be entitled to vocational rehabilitation services, including retraining and job placement, as may be reasonably necessary to restore the employee to suitable employment. Vocational rehabilitation services shall be provided as follows:
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(3) The commissioner shall adopt rules to assure that a worker who requests services or who has received more than 90 days of continuous temporary total disability benefits is timely and cost-effectively screened for benefits under this section. The rules shall:
(A) Provide that all vocational rehabilitation work, except for initial screenings, shall be performed by a Vermont-certified vocational rehabilitation counselor including counselors currently certified pursuant to the rules of the department. Initial screenings shall be performed by an individual with sufficient knowledge or experience to perform adequately the vocational rehabilitation screening functions.
Provide for an initial screening to determine whether a full assessment is
appropriate. An injured worker who is determined to be
benefits shall have an appropriate initial vocational a
full assessment shall be timely assessed and be offered
appropriate vocational rehabilitation services.
commissioner shall adopt rules to provide Provide a mechanism for a
periodic review and timely screening of injured workers who are
initially found not to be ready or eligible for vocational rehabilitation
services a full assessment to determine whether a full assessment has
(D) Protect against potential conflicts of interest in the assignment and performance of initial screenings.
(E) Assure the injured worker has a choice of a vocational rehabilitation counselor.
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(5) The commissioner may set by rule reasonable reimbursement rates for vocational rehabilitation benefits and services, provided access to vocational rehabilitation services is not diminished and reasonable choices and access to benefits and services are maintained. The reimbursement shall reflect the current market hourly rate of vocational rehabilitation services as determined by a survey of vocational rehabilitation providers, including solo practitioners, small firms, and large firms. The fee schedule shall require the individual vocational rehabilitation counselor who provides services to review, initial, and certify the accuracy of the billing.
(6) The commissioner shall make annual reports to the general assembly on the success and status of the workers’ compensation vocational rehabilitation program.
* * * Discontinuance of Benefits * * *
Sec. 2. 21 V.S.A. § 643a is amended to read:
§ 643a. DISCONTINUANCE OF BENEFITS
an injured worker has successfully returned to work, an employer shall notify
both the commissioner and the employee prior to terminating benefits under
either section 642 or
section 646 of this title. The notice of
intention to discontinue payments shall be filed on forms prescribed by the
commissioner and shall include the date of the proposed discontinuance and the
reasons for it. The liability for the payments shall continue for 7 seven
days after the notice is received by the commissioner and the employee.
Those payments shall be made without prejudice to the employer and may be
deducted from any amounts due pursuant to section 648 of this title if the
commissioner determines that the discontinuance is warranted or if otherwise
ordered by the commissioner. Every notice shall be reviewed by the
commissioner to determine the sufficiency of the basis for the proposed
discontinuance. If, upon review, the commissioner finds that the evidence does
not reasonably support the proposed discontinuance, the commissioner may
shall order that payments continue until a hearing is held and a
decision is rendered. If the commissioner’s decision,
after a hearing, finds that the employee was not entitled to any or all
benefits paid between the discontinuance and the final decision, upon request
of the employer, the commissioner may order that the employee repay all
benefits to which the employee was not entitled. The employer may enforce such
a repayment order in any court of law having jurisdiction of the amount
* * * Failure to Pay Benefits * * *
Sec. 3. 21 V.S.A. § 650(e) is amended to read:
(e) If weekly compensation benefits or weekly accrued benefits are not paid within 21 days after becoming due and payable pursuant to an order of the commissioner, or in cases in which the overdue benefit is not in dispute, ten percent of the overdue amount shall be added and paid to the employee, in addition to interest and any other penalties. In the case of an initial claim, benefits are due and payable upon entering into an agreement pursuant to subsection 662(a) of this title, upon issuance of an order of the commissioner pursuant to subsection 662(b) of this title, or if the employer has not denied the claim within 21 days after the claim is filed. Benefits are in dispute if the claimant has been provided actual written notice of the dispute within 21 days of the benefit being due and payable and the evidence reasonably supports the denial. Interest shall accrue and be paid on benefits that are found to be compensable during the period of nonpayment. The commissioner shall promptly review requests for payment under this section and, consistent with the criteria in department rule 10.13, shall allow for the recovery of reasonable attorney fees associated with an employee’s successful request for payment under this subsection.
* * * Interim Orders * * *
Sec. 4. 21 V.S.A § 662(b) is amended to read:
the absence of an agreement pursuant to subsection (a) of this section, the
employer or insurance carrier shall notify the commissioner and the employee in
writing that the claim is denied and the reasons therefor. Upon the employee’s
application for a hearing under section 663 of this title, within 60 days,
may shall review the evidence upon which denial
is based and if the evidence does not reasonably support the denial, the
commissioner may shall order that payments be made until a
hearing is held and a decision is rendered. Payments pursuant to this
subsection shall not be deemed an admission of liability by the employer nor
shall such payments preclude subsequent agreement under subsection (a) of this
section or prejudice the rights of either party to hearing or appeal under this
chapter. If the commissioner’s decision, after a hearing,
finds that the employee was not entitled to any or all benefits paid between
the initial denial and the final decision, upon request of the employer, the
commissioner may order that the employee repay all benefits to which the
employee was not entitled. The employer may enforce such a repayment order in
any court of law having jurisdiction of the amount involved. Nothing in this
section shall require the commissioner to order payments pending a hearing if
the commissioner concludes that the benefit at issue is not compensable
regardless of the lack of evidence supporting the denial. For the purposes of
this section, any written communication by an unrepresented claimant that
questions the denial of any benefit shall be deemed to be an application for
hearing under section 663 of this title.
* * * Lump Sum Payment * * *
Sec. 5. 21 V.S.A. § 652(c) is added to read:
(c) Unless otherwise requested by the claimant, an order for a lump sum payment of permanent partial or permanent total disability benefits or a lump sum settlement of a disputed claim shall include a provision accounting for excludable expenses and prorating the remainder of the lump sum payment in the manner set forth by the Social Security Administration in order to protect the claimant’s entitlement to Social Security benefits.
Sec. 6. WORKERS’ COMPENSATION: INTERIM ORDER STUDY
(a) The newly created department of labor shall issue a report to the general assembly on or before February 1, 2006, in which the department analyzes and proposes recommendations to improve the timeliness of payments to injured workers in a manner that is fair and efficient for employers and employees. The report will investigate the following:
(1) the timeliness and accuracy of benefit payments to workers compensation claimants. The department shall review the number of requests for interim orders received, the reasons for the request, the number of informal conferences conducted, the number of interim orders issued and denied; the number of requests for reconsideration, and the number of interim orders upheld after formal hearing or claim resolution.
(2) the timeliness and accuracy of workers compensation insurer claim denials and/or requests to discontinue benefits. The department shall review the number of requests for discontinuance of benefits and the basis for each request, whether evidence or law supported the request, the number of discontinuances disapproved, the number of informal conferences conducted; and the number of discontinuances and denials upheld after formal hearing or claim resolution.
(b) As part of its analysis the department of labor shall consult with an advisory committee appointed by the commissioner of labor composed of three representatives of workers compensation insurers and three representatives of workers compensation claimants, during the analysis and report preparation required in subsection (a) of this section.
The Vermont General Assembly
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