|BILL AS INTRODUCED||2007-2008|
Introduced by Senator Racine of Chittenden District, Senator Carris of Rutland District, Senator Miller of Chittenden District and Senator Mullin of Rutland District
Subject: Labor; workers’ compensation; fraud; safe and healthy workplaces; premium reduction; small deductible policies; medical only payment; fraud
Statement of purpose: This bill proposes to reduce the cost of workers’ compensation insurance by rewarding employers who have safe and healthy workplaces by reducing premiums; requiring insurers to offer small deductible workers’ compensation insurance policies to all employers; permitting employers to pay single visit, medical only claims out of pocket; and making workers’ compensation fraud claims.
AN ACT RELATING TO REDUCING THE COST OF WORKERS’ COMPENSATION INSURANCE
It is hereby enacted by the General Assembly of the State of Vermont:
Sec. 1. 8 V.S.A. § 4750(b) is amended to read:
(b) The commissioner may require an insurer to file annually its anti-fraud plan with the department and an annual summary of the insurer’s anti-fraud activities and results. Upon request of the commissioner of labor, a workers’ compensation insurer shall file its anti-fraud plan with the department of labor with information about any fraud investigations, referrals, or prosecutions conducted involving Vermont workers’ compensation claims.
Sec. 2. 13 V.S.A. § 2031 is amended to read:
§ 2031. INSURANCE FRAUD
(a) Definitions. As used in this section:
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(2) “Insurance policy” has the same meaning as in 8 V.S.A. § 4722(3) and includes a workers’ compensation policy issued pursuant to chapter 9 of Title 21.
(3) “Insurer” has the same meaning as in 8 V.S.A. § 4901(2) and includes a workers’ compensation insurer pursuant to chapter 9 of Title 21.
means a natural person, company, corporation, unincorporated association,
partnership, professional corporation, agency of government, or any other
* * *
section shall not apply to workers’ compensation fraud. Cases involving workers’
compensation fraud shall be prosecuted under section 2024 of this title.
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Sec. 3. 21 V.S.A. § 624(l) is added to read:
(l) An employer who is able to demonstrate that it has an effective workplace safety and health program shall receive a ten percent workers’ compensation insurance premium reduction. For the purposes of this section “effective workplace safety and health program” means any one of the following:
(1) The employer has been awarded merit or star status by the VOSHA’s voluntary protection program.
(2) The employer has been awarded SHARP status by project worksafe.
(3) For the past three years, the employer has complied with all the following:
(A) Had no workplace fatalities.
(B) Had a three-year average total case incidence rate (TCIR) and a days away, restricted, or job transfer (DART) case incidence rate below the national average for that industry’s NAISC code as published by the Bureau of Labor Statistics.
(C) Received no VOSHA citations or penalties.
(D) Had a comprehensive, written safety and health plan in place.
Sec. 4. 21 V.S.A. § 640(e) is added to read:
(e) In the case of a work‑related, first aid only injury, the employer shall file the first report of injury with the department of labor. The employer may then file the first report of injury with the workers’ compensation insurance carrier or pay the medical bill within 30 days. If the employer contests a claim, a first report of injury shall be forwarded to the department of labor and the insurer within five days of notice. If additional treatment or medical visits are required or if the employee loses three or more days of work, the claim shall be promptly reported to the workers’ compensation insurer, which shall adjust the claim. “Work‑related, first aid only treatment” means any one-time treatment that generates a bill for less than $750.00.
Sec. 5. 21 V.S.A. § 642a is added to read:
§ 642a. TEMPORARY TOTAL BENEFIT REVIEW
Benefits provided under section 642 of this title shall not exceed 104 weeks unless the injured worker demonstrates that his or her medical condition is substantially likely to continue to improve and enable a return to work if benefits are provided for an additional defined period of time.
Sec. 6. 21 V.S.A. § 687(e) is added to read:
(e) All insurance carriers authorized to write workers’ compensation insurance policy shall make available, at the written request of the employer, a workers’ compensation insurance rate that contains a deductible provision that binds the employer to reimburse the workers’ compensation insurer, at a minimum, 100 percent of the first $500.00 of benefits due to an injured employee, whether these benefits are medical or indemnity benefits. Claims shall be adjusted and paid by the insurer, and the employer shall reimburse the insurer for the amount of the deductible.
The Vermont General Assembly
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