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BILL AS INTRODUCED 2007-2008

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S.335

Introduced by Senator Campbell of Windsor District

Referred to Committee on

Date:

Subject:  Labor; workers’ compensation; attorney fees; time frames for denial; state employees

Statement of purpose:  This bill proposes to clarify time frames for notice of denial of a claim, when a claimant is entitled to attorney fees, and how workers’ compensation claims by state employees are to be handled.

AN ACT RELATING TO WORKERS’ COMPENSATION AND STATE EMPLOYEES

It is hereby enacted by the General Assembly of the State of Vermont:

Sec. 1.  29 V.S.A. § 1409 is added to read:

§ 1409.  CLAIM ADJUSTMENT

(a)  Upon notification that a state employee has suffered a work injury, the department shall immediately file a first report of injury and comply with all provisions of chapter 9 of Title 21.  The department shall also immediately provide the injured employee a pamphlet that advises in plain, easy‑to‑understand language of the benefits available if the claim is compensable.  The pamphlet shall include at least all the following information regarding compensable work injuries:

(1)  The circumstances under which temporary total or temporary partial disability benefits are available and how they are computed.

(2)  The employee’s right to choose independently a medical care provider for treatment of a work-related injury and the available medical benefits.

(3)  The circumstances under which permanent partial or permanent total disability benefits are available, how they are computed, and that the employee is entitled to an independent permanency rating by a physician of the employee’s choice to be paid by the department.

(4)  The employee’s right to vocational rehabilitation benefits, the circumstances under which the employee is entitled to vocational rehabilitation benefits, and the employee’s right to choose independently a vocational rehabilitation counselor to be paid by the department.

(5)  Any other benefits to which the employee is entitled and a detailed explanation of those benefits.

(b)  The department shall not require claimants to sign any medical authorization form other than a form 7, department of labor workers’ compensation medical authorization.

(c)  Upon notification that a state employee has suffered a work injury, the department shall immediately investigate and determine whether the claim is compensable and notify the claimant of the department’s determination no later than 21 days after the filing of the first report of injury.  If the department fails to notify the claimant as required by this subsection, the department shall begin voluntary payments to the claimant without prejudice to the department for any period before the department notifies the claimant.  Payments made pursuant to this subsection may not be recovered by the department.

(d)  If payments are made to a claimant after the claimant has filed a notice and application for hearing based on a previous denial, the claimant is entitled to an award of reasonable attorney fees which shall be the greater of the following:

(1)  Not more than $90.00 per hour supported by an itemized statement.

(2)  A contingency fee to cover all legal services not to exceed 20 percent of the compensation paid or awarded, or $9,000.00, whichever is less.

(e)  The department shall immediately reimburse a claimant for any bills for treatment of a compensable work injury that have been paid by the claimant or the claimant’s health insurer, including all out-of-pocket copayments and deductibles.

(f)  A state employee is entitled to greater benefits or protection provided to state employees in chapter 9 of Title 21 or in a collective bargaining agreement.

Sec. 2.  ANNUAL REPORTING; DEPARTMENT OF BUILDINGS AND

             GENERAL SERVICES; WORKERS’ COMPENSATION FOR

             STATE EMPLOYEES

(a)  The commissioner of buildings and general services shall issue an annual report on or before July 1, beginning in 2008, to the governor, the general assembly, and any labor organization that represents state employees.  The report shall describe workers’ compensation claims filed by state employees based on the information from the preceding fiscal year and shall include comparative data for up to three prior fiscal years.  The information shall not include any names or personal identification information.  The report shall include the following information itemized for each fiscal year:

(1)  The number of first reports and notice of injury forms filed, the number of claims determined compensable within 21 days of filing, the duration of delay between the 21 days following the first report or notice of injury and the date of payment of benefits.

(2)  The number of claims denied in whole or part; the number of claims in which benefits have been discontinued based on a reason other than that the claimant reached a medical end result or returned to work; the number of claimants represented by legal counsel who filed a notice and application for hearing and received voluntary benefits after a hearing was requested.

(3)  The name, education degrees, board certification, state of residence, and states of licensure of each independent medical examiner retained by the department including the following information:

(A)  The number of claims reviewed by each examiner and the duration of each review.

(B)  The number of claims in which the examiner recommended complete or partial denial.

(C)  The terms of each contract with an examiner, the amount paid, and the period during which services were rendered.

(4)  The name, educational degrees, certifications, state of residence, and states of licensure of each person retained by the department to conduct visual or audio surveillance on claimants, including the following information for each:

(A)  The number of claimants investigated by surveillance.

(B)  The terms of contract with each investigator, the amount actually paid, and the period during which services were rendered.

(C)  The number of claims in which a claimant was advised of the surveillance.

(D)  The number of claims denied in which surveillance was a factor.

(E)  The number of claims voluntarily withdrawn by a claimant without payment of benefits after disclosure of surveillance.

(F)  The number of claimants who have been convicted of fraud based on surveillance information.

(5)  The name and address of each attorney retained to represent the department relating to workers’ compensation claims, including the following information for each attorney:

(A)  The number of claims involving an attorney retained by the department.

(B)  The terms of each contract, the amount actually paid under the contract, and the period during which services were rendered.

(C)  The number of contested claims in which the attorney prevailed.

(D)  The amount of attorney fees paid to attorneys representing claimants, the name of each attorney, and the date and amount of each payment.

(6)  The amount expended by the department for payment of medical benefits for work-related injuries and illnesses not including independent medical examinations, including:

(A)  Amounts reimbursed for medical costs paid by the claimant.

(B)  The average time between medical treatment and payment of the medical bill.

(7)  Information regarding vocation rehabilitation, including the number of claimants who:

(A)  Have and have not returned to suitable employment following injury.

(B)  Have been screened for vocational rehabilitation benefits.

(C)  Have been determined eligible for vocational rehabilitation benefits.



Published by:

The Vermont General Assembly
115 State Street
Montpelier, Vermont


www.leg.state.vt.us