Modifies provisions relating to workers' compensation

EXPLANATION-Matter enclosed in bold-faced brackets [thus] in this bill is not enacted
and is intended to be omitted in the law.
SECOND REGULAR SESSION
SENATE BILL NO. 865
103RD GENERAL ASSEMBLY
INTRODUCED BY SENATOR BECK.
4869S.02I KRISTINA MARTIN, Secretary
AN ACT
To repeal sections 287.020, 287.043, 287.067, 287.120, and 287.140, RSMo, and to enact in lieu
thereof six new sections relating to workers' compensation, with penalty provisions.
Be it enacted by the General Assembly of the State of Missouri, as follows:
Section A. Sections 287.020, 287.043, 287.067, 287.120, 1
and 287.140, RSMo, are repealed and six new sections enacted in 2
lieu thereof, to be known as sections 287.020, 287.043, 287.067, 3
287.120, 287.140, and 287.485, to read as follows:4
287.020. 1. The word "employee" as used in this 1
chapter shall be construed to mean every person in the 2
service of any employer, as defined in this chapter, under 3
any contract of hire, express or implied, oral or written, 4
or under any appointment or election, including executive 5
officers of corporations. Except as otherwise provided in 6
section 287.200, any reference to any employee who has been 7
injured shall, when the employee is dead, also include his 8
or her dependents, and other persons to whom compensation 9
may be payable. The word "employee" shall also include all 10
minors who work for an employer, whether or not such minors 11
are employed in violation of law, and all such minors are 12
hereby made of full age for all purposes under, in 13
connection with, or arising out of this chapter. The word 14
"employee" shall not include an individual who is the owner, 15
as defined in section 301.010, and operator of a motor 16
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vehicle which is leased or contracted with a driver to a for- 17
hire motor carrier operating within a commercial zone as 18
defined in section 390.020 or 390.041, or operating under a 19
certificate issued by the Missouri department of 20
transportation or by the United States Department of 21
Transportation, or any of its subagencies. The word 22
"employee" also shall not include any person performing 23
services for board, lodging, aid, or sustenance received 24
from any religious, charitable, or relief organization. 25
2. The word "accident" as used in this chapter shall 26
mean an unexpected [traumatic event or unusual strain 27
identifiable by time and place of occurrence] or unforeseen 28
identifiable event or series of events happening suddenly 29
and violently, with or without human fault, and producing at 30
the time objective symptoms of an injury [caused by a 31
specific event during a single work shift]. An injury is 32
compensable if it is clearly work related. An injury is 33
clearly work related if work was a substantial factor in the 34
cause of the resulting medical condition or disability. An 35
injury is not compensable merely because work was a 36
triggering or precipitating factor. 37
3. (1) In this chapter the term "injury" is hereby 38
defined to be an injury which has arisen out of and in the 39
course of employment. [An injury by accident is compensable 40
only if the accident was the prevailing factor in causing 41
both the resulting medical condition and disability. "The 42
prevailing factor" is defined to be the primary factor, in 43
relation to any other factor, causing both the resulting 44
medical condition and disability.] 45
(2) An injury shall be deemed to arise out of and in 46
the course of the employment only if: 47
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(a) It is reasonably apparent, upon consideration of 48
all the circumstances, that the [accident] employment is 49
[the prevailing] a substantial factor in causing the injury; 50
and 51
(b) It can be seen to have followed as a natural 52
incident of the work; and 53
(c) It can be fairly traced to the employment as a 54
proximate cause; and 55
(d) It does not come from a hazard or risk unrelated 56
to the employment to which workers would have been equally 57
exposed outside of and unrelated to the employment in normal 58
nonemployment life. 59
(3) An injury resulting directly or indirectly from 60
idiopathic causes is not compensable. 61
(4) A cardiovascular, pulmonary, respiratory, or other 62
disease, or cerebrovascular accident or myocardial 63
infarction suffered by a worker is an injury only if the 64
[accident] employment is [the prevailing] a substantial 65
factor in causing the resulting medical condition. 66
(5) The terms "injury" and "personal injuries" shall 67
mean violence to the physical structure of the body and to 68
the personal property which is used to make up the physical 69
structure of the body, such as artificial dentures, 70
artificial limbs, glass eyes, eyeglasses, and other 71
prostheses which are placed in or on the body to replace the 72
physical structure and such disease or infection as 73
naturally results therefrom. These terms shall in no case 74
except as specifically provided in this chapter be construed 75
to include occupational disease in any form, nor shall they 76
be construed to include any contagious or infectious disease 77
contracted during the course of the employment, nor shall 78
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they include death due to natural causes occurring while the 79
worker is at work. 80
4. "Death" when mentioned as a basis for the right to 81
compensation means only death resulting from such violence 82
and its resultant effects occurring within three hundred 83
weeks after the accident; except that in cases of 84
occupational disease, the limitation of three hundred weeks 85
shall not be applicable. 86
5. Injuries sustained in company-owned or subsidized 87
automobiles in accidents that occur while traveling from the 88
employee's home to the employer's principal place of 89
business or from the employer's principal place of business 90
to the employee's home are not compensable. The extension 91
of premises doctrine [is abrogated to the extent it extends] 92
as it existed prior to August 28, 2005 is reinstated for 93
liability for accidents that occur on property not owned or 94
controlled by the employer even if the accident occurs on 95
customary, approved, permitted, usual or accepted routes 96
used by the employee to get to and from their place of 97
employment. 98
6. The term "total disability" as used in this chapter 99
shall mean inability to return to any employment and not 100
merely mean inability to return to the employment in which 101
the employee was engaged at the time of the accident. 102
7. As used in this chapter and all acts amendatory 103
thereof, the term "commission" shall hereafter be construed 104
as meaning and referring exclusively to the labor and 105
industrial relations commission of Missouri, and the term 106
"director" shall hereafter be construed as meaning the 107
director of the department of commerce and insurance of the 108
state of Missouri or such agency of government as shall 109
exercise the powers and duties now conferred and imposed 110
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upon the department of commerce and insurance of the state 111
of Missouri. 112
8. The term "division" as used in this chapter means 113
the division of workers' compensation of the department of 114
labor and industrial relations of the state of Missouri. 115
9. For the purposes of this chapter, the term "minor" 116
means a person who has not attained the age of eighteen 117
years; except that, for the purpose of computing the 118
compensation provided for in this chapter, the provisions of 119
section 287.250 shall control. 120
10. In applying the provisions of this chapter, it is 121
the intent of the legislature to [reject and abrogate 122
earlier] adopt case law interpretations on the meaning of or 123
definition of "accident", "occupational disease", "arising 124
out of", and "in the course of the employment" to include, 125
but not be limited to, holdings in: Bennett v. Columbia 126
Health Care and Rehabilitation, 80 S.W.3d 524 (Mo.App. W.D. 127
2002); Kasl v. Bristol Care, Inc., 984 S.W.2d 852 (Mo.banc 128
1999); and Drewes v. TWA, 984 S.W.2d 512 (Mo.banc 1999) and 129
all cases citing, interpreting, applying, or following those 130
cases. All case law inconsistent with such interpretations 131
is abrogated. 132
11. For the purposes of this chapter, "occupational 133
diseases due to toxic exposure" shall only include the 134
following: mesothelioma, asbestosis, berylliosis, coal 135
worker's pneumoconiosis, brochiolitis obliterans, silicosis, 136
silicotuberculosis, manganism, acute myelogenous leukemia, 137
and myelodysplastic syndrome. 138
12. For the purposes of this chapter, "maximum medical 139
improvement" shall mean the point at which the injured 140
employee's medical condition has stabilized and can no 141
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longer reasonably improve with additional medical care, as 142
determined within a reasonable degree of medical certainty. 143
287.043. In applying the provisions of subsection 1 of 1
section 287.020 and subsection 4 of section 287.040, it is 2
the intent of the legislature to [reject and abrogate 3
earlier] adopt case law interpretations on the meaning of or 4
definition of "owner", as extended in the following cases: 5
Owner Operator Independent Drivers Ass'n., Inc. v. New 6
Prime, Inc., 133 S.W.3d 162 (Mo. App. S.D., 2004); Nunn v. 7
C.C. Midwest, 151 S.W.3d 388 (Mo. App. W.D., 2004). All 8
case law inconsistent with such interpretations is abrogated. 9
287.067. 1. In this chapter the term "occupational 1
disease" is hereby defined to mean, unless a different 2
meaning is clearly indicated by the context, an identifiable 3
disease arising with or without human fault out of and in 4
the course of the employment. Ordinary diseases of life to 5
which the general public is exposed outside of the 6
employment shall not be compensable, except where the 7
diseases follow as an incident of an occupational disease as 8
defined in this section. The disease need not to have been 9
foreseen or expected but after its contraction it must 10
appear to have had its origin in a risk connected with the 11
employment and to have flowed from that source as a rational 12
consequence. 13
2. An injury or death by occupational disease is 14
compensable [only] if [the occupational exposure was the 15
prevailing factor in causing both the resulting medical 16
condition and disability. The "prevailing factor" is 17
defined to be the primary factor, in relation to any other 18
factor, causing both the resulting medical condition and 19
disability. Ordinary, gradual deterioration, or progressive 20
degeneration of the body caused by aging or by the normal 21
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activities of day-to-day living shall not be compensable] it 22
is clearly work related and meets the requirements of an 23
injury which is compensable as provided in subsections 2 and 24
3 of section 287.020. An occupational disease is not 25
compensable merely because work was a triggering or 26
precipitating factor. 27
3. An injury due to repetitive motion is recognized as 28
an occupational disease for purposes of this chapter. An 29
occupational disease due to repetitive motion is compensable 30
[only] if the occupational exposure was [the prevailing] a 31
substantial factor in causing both the resulting medical 32
condition and disability. [The "prevailing factor" is 33
defined to be the primary factor, in relation to any other 34
factor, causing both the resulting medical condition and 35
disability. Ordinary, gradual deterioration, or progressive 36
degeneration of the body caused by aging or by the normal 37
activities of day-to-day living shall not be compensable.] 38
4. "Loss of hearing due to industrial noise" is 39
recognized as an occupational disease for purposes of this 40
chapter and is hereby defined to be a loss of hearing in one 41
or both ears due to prolonged exposure to harmful noise in 42
employment. "Harmful noise" means sound capable of 43
producing occupational deafness. 44
5. "Radiation disability" is recognized as an 45
occupational disease for purposes of this chapter and is 46
hereby defined to be that disability due to radioactive 47
properties or substances or to Roentgen rays (X-rays) or 48
exposure to ionizing radiation caused by any process 49
involving the use of or direct contact with radium or 50
radioactive properties or substances or the use of or direct 51
exposure to Roentgen rays (X-rays) or ionizing radiation. 52
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6. Disease of the lungs or respiratory tract, 53
hypotension, hypertension, or disease of the heart or 54
cardiovascular system, including carcinoma, may be 55
recognized as occupational diseases for the purposes of this 56
chapter and are defined to be disability due to exposure to 57
smoke, gases, carcinogens, inadequate oxygen, of paid 58
firefighters of a paid fire department or paid police 59
officers of a paid police department certified under chapter 60
590 if a direct causal relationship is established, or 61
psychological stress of firefighters of a paid fire 62
department or paid peace officers of a police department who 63
are certified under chapter 590 if a direct causal 64
relationship is established. 65
7. Any employee who is exposed to and contracts any 66
contagious or communicable disease arising out of and in the 67
course of his or her employment shall be eligible for 68
benefits under this chapter as an occupational disease. 69
8. With regard to occupational disease due to 70
repetitive motion, if the exposure to the repetitive motion 71
which is found to be the cause of the injury is for a period 72
of less than three months and the evidence demonstrates that 73
the exposure to the repetitive motion with the immediate 74
prior employer was [the prevailing] a substantial 75
contributing factor in causing the injury, the prior 76
employer shall be liable for such occupational disease. 77
9. (1) (a) Posttraumatic stress disorder (PTSD), as 78
described in the Diagnostic and Statistical Manual of Mental 79
Health Disorders, Fifth Edition, published by the American 80
Psychiatric Association, (DSM-5) is recognized as a 81
compensable occupational disease for purposes of this 82
chapter when diagnosed in a first responder, as that term is 83
defined under section 67.145. 84
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(b) Benefits payable to a first responder under this 85
section shall not require a physical injury to the first 86
responder, and are not subject to any preexisting PTSD. 87
(c) Benefits payable to a first responder under this 88
section are compensable only if demonstrated by clear and 89
convincing evidence that PTSD has resulted from the course 90
and scope of employment, and the first responder is examined 91
and diagnosed with PTSD by an authorized treating physician, 92
due to the first responder experiencing one of the following 93
qualifying events: 94
a. Seeing for oneself a deceased minor; 95
b. Witnessing directly the death of a minor; 96
c. Witnessing directly the injury to a minor who 97
subsequently died prior to or upon arrival at a hospital 98
emergency department, participating in the physical 99
treatment of, or manually transporting, an injured minor who 100
subsequently died prior to or upon arrival at a hospital 101
emergency department; 102
d. Seeing for oneself a person who has suffered 103
serious physical injury of a nature that shocks the 104
conscience; 105
e. Witnessing directly a death, including suicide, due 106
to serious physical injury; or homicide, including murder, 107
mass killings, manslaughter, self-defense, misadventure, and 108
negligence; 109
f. Witnessing directly an injury that results in 110
death, if the person suffered serious physical injury that 111
shocks the conscience; 112
g. Participating in the physical treatment of an 113
injury, including attempted suicide, or manually 114
transporting an injured person who suffered serious physical 115
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injury, if the injured person subsequently died prior to or 116
upon arrival at a hospital emergency department; or 117
h. Involvement in an event that caused or may have 118
caused serious injury or harm to the first responder or had 119
the potential to cause the death of the first responder, 120
whether accidental or by an intentional act of another 121
individual. 122
(2) The time for notice of injury or death in cases of 123
compensable PTSD under this section is measured from 124
exposure to one of the qualifying stressors listed in the 125
DSM-5 criteria, or the diagnosis of the disorder, whichever 126
is later. Any claim for compensation for such injury shall 127
be properly noticed within fifty-two weeks after the 128
qualifying exposure, or the diagnosis of the disorder, 129
whichever is later. 130
287.120. 1. Every employer subject to the provisions 1
of this chapter shall be liable, irrespective of negligence, 2
to furnish compensation under the provisions of this chapter 3
for personal injury or death of the employee by accident or 4
occupational disease arising out of and in the course of the 5
employee's employment. Any employee of such employer shall 6
not be liable for any injury or death for which compensation 7
is recoverable under this chapter and every employer and 8
employees of such employer shall be released from all other 9
liability whatsoever, whether to the employee or any other 10
person, except that an employee shall not be released from 11
liability for injury or death if the employee engaged in an 12
affirmative negligent act that purposefully and dangerously 13
caused or increased the risk of injury. The term "accident" 14
as used in this section shall include, but not be limited 15
to, injury or death of the employee caused by the unprovoked 16
violence or assault against the employee by any person. 17
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2. The rights and remedies herein granted to an 18
employee shall exclude all other rights and remedies of the 19
employee, the employee's spouse, parents, personal 20
representatives, dependents, heirs or next kin, at common 21
law or otherwise, on account of such injury or death by 22
accident or occupational disease, except such rights and 23
remedies as are not provided for by this chapter. 24
3. No compensation shall be allowed under this chapter 25
for the injury or death due to the employee's intentional 26
self-inflicted injury, but the burden of proof of 27
intentional self-inflicted injury shall be on the employer 28
or the person contesting the claim for allowance. 29
4. Where the injury is caused by the failure of the 30
employer to comply with any statute in this state or any 31
lawful order of the division or the commission, the 32
compensation and death benefit provided for under this 33
chapter shall be increased fifteen percent. 34
5. Where the injury is caused by the failure of the 35
employee to use safety devices where provided by the 36
employer, or from the employee's failure to obey any 37
reasonable rule adopted by the employer for the safety of 38
employees, the compensation and death benefit provided for 39
herein shall be reduced at least twenty-five but not more 40
than fifty percent; provided, that it is shown that the 41
employee had actual knowledge of the rule so adopted by the 42
employer; and provided, further, that the employer had, 43
prior to the injury, made a reasonable effort to cause his 44
or her employees to use the safety device or devices and to 45
obey or follow the rule so adopted for the safety of the 46
employees. 47
6. (1) Where the employee fails to obey any rule or 48
policy adopted by the employer relating to a drug-free 49
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workplace or the use of alcohol or nonprescribed controlled 50
drugs in the workplace, the compensation and death benefit 51
provided for herein shall be reduced fifty percent if the 52
injury was sustained in conjunction with the use of alcohol 53
or nonprescribed controlled drugs. 54
(2) If, however, the use of alcohol or nonprescribed 55
controlled drugs in violation of the employer's rule or 56
policy is the proximate cause of the injury, then the 57
benefits or compensation otherwise payable under this 58
chapter for death or disability shall be forfeited. 59
(3) The voluntary use of alcohol to the percentage of 60
blood alcohol sufficient under Missouri law to constitute 61
legal intoxication shall give rise to a rebuttable 62
presumption that the voluntary use of alcohol under such 63
circumstances was the proximate cause of the injury. A 64
preponderance of the evidence standard shall apply to rebut 65
such presumption. An employee's refusal to take a test for 66
alcohol or a nonprescribed controlled substance, as defined 67
by section 195.010, at the request of the employer shall 68
result in the forfeiture of benefits under this chapter if 69
the employer had sufficient cause to suspect use of alcohol 70
or a nonprescribed controlled substance by the claimant or 71
if the employer's policy clearly authorizes post-injury 72
testing. 73
(4) Any positive test result for a nonprescribed 74
controlled drug or the metabolites of such drug from an 75
employee shall give rise to a rebuttable presumption, which 76
may be rebutted by a preponderance of evidence, that the 77
tested nonprescribed controlled drug was in the employee's 78
system at the time of the accident or injury and that the 79
injury was sustained in conjunction with the use of the 80
tested nonprescribed controlled drug if: 81
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(a) The initial testing was administered within twenty- 82
four hours of the accident or injury; 83
(b) Notice was given to the employee of the test 84
results within fourteen calendar days of the insurer or 85
group self-insurer receiving actual notice of the 86
confirmatory test results; 87
(c) The employee was given an opportunity to perform a 88
second test upon the original sample; and 89
(d) The initial or any subsequent testing that forms 90
the basis of the presumption was confirmed by mass 91
spectrometry using generally accepted medical or forensic 92
testing procedures. 93
7. Where the employee's participation in a 94
recreational activity or program is the [prevailing] 95
proximate cause of the injury, benefits or compensation 96
otherwise payable under this chapter for death or disability 97
shall be forfeited regardless that the employer may have 98
promoted, sponsored or supported the recreational activity 99
or program, expressly or impliedly, in whole or in part. 100
The forfeiture of benefits or compensation shall not apply 101
when: 102
(1) The employee was directly ordered by the employer 103
to participate in such recreational activity or program; 104
(2) The employee was paid wages or travel expenses 105
while participating in such recreational activity or 106
program; or 107
(3) The injury from such recreational activity or 108
program occurs on the employer's premises due to an unsafe 109
condition and the employer had actual knowledge of the 110
employee's participation in the recreational activity or 111
program and of the unsafe condition of the premises and 112
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failed to either curtail the recreational activity or 113
program or cure the unsafe condition. 114
8. Mental injury resulting from work-related stress 115
does not arise out of and in the course of the employment, 116
unless it is demonstrated that the stress is work related 117
and was extraordinary and unusual. The amount of work 118
stress shall be measured by objective standards and actual 119
events. 120
9. A mental injury is not considered to arise out of 121
and in the course of the employment if it resulted from any 122
disciplinary action, work evaluation, job transfer, layoff, 123
demotion, termination or any similar action taken in good 124
faith by the employer. 125
10. The ability of a firefighter to receive benefits 126
for psychological stress under section 287.067 shall not be 127
diminished by the provisions of subsections 8 and 9 of this 128
section. 129
287.140. 1. In addition to all other compensation 1
paid to the employee under this section, the employee shall 2
receive and the employer shall provide such medical, 3
surgical, chiropractic, and hospital treatment, including 4
nursing, custodial, ambulance and medicines, as may 5
reasonably be required after the injury or disability, to 6
cure and relieve from the effects of the injury. If the 7
employee desires, he shall have the right to select his own 8
physician, surgeon, or other such requirement at his own 9
expense. Where the requirements are furnished by a public 10
hospital or other institution, payment therefor shall be 11
made to the proper authorities. Regardless of whether the 12
health care provider is selected by the employer or is 13
selected by the employee at the employee's expense, the 14
health care provider shall have the affirmative duty to 15
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communicate fully with the employee regarding the nature of 16
the employee's injury and recommended treatment exclusive of 17
any evaluation for a permanent disability rating. Failure 18
to perform such duty to communicate shall constitute a 19
disciplinary violation by the provider subject to the 20
provisions of chapter 620. When an employee is required to 21
submit to medical examinations or necessary medical 22
treatment at a place outside of the local or metropolitan 23
area from the employee's principal place of employment, the 24
employer or its insurer shall advance or reimburse the 25
employee for all necessary and reasonable expenses; except 26
that an injured employee who resides outside the state of 27
Missouri and who is employed by an employer located in 28
Missouri shall have the option of selecting the location of 29
services provided in this section either at a location 30
within one hundred miles of the injured employee's 31
residence, place of injury or place of hire by the 32
employer. The choice of provider within the location 33
selected shall continue to be made by the employer. In case 34
of a medical examination if a dispute arises as to what 35
expenses shall be paid by the employer, the matter shall be 36
presented to the legal advisor, the administrative law judge 37
or the commission, who shall set the sum to be paid and same 38
shall be paid by the employer prior to the medical 39
examination. In no event, however, shall the employer or 40
its insurer be required to pay transportation costs for a 41
greater distance than two hundred fifty miles each way from 42
place of treatment. 43
2. If it be shown to the division or the commission 44
that the requirements are being furnished in such manner 45
that there is reasonable ground for believing that the life, 46
health, or recovery of the employee is endangered thereby, 47
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the division or the commission may order a change in the 48
physician, surgeon, hospital or other requirement. 49
3. All fees and charges under this chapter shall be 50
fair and reasonable, shall be subject to regulation by the 51
division or the commission, or the board of rehabilitation 52
in rehabilitation cases. A health care provider shall not 53
charge a fee for treatment and care which is governed by the 54
provisions of this chapter greater than the usual and 55
customary fee the provider receives for the same treatment 56
or service when the payor for such treatment or service is a 57
private individual or a private health insurance carrier. 58
The division or the commission, or the board of 59
rehabilitation in rehabilitation cases, shall also have 60
jurisdiction to hear and determine all disputes as to such 61
charges. A health care provider is bound by the 62
determination upon the reasonableness of health care bills. 63
4. The division shall, by regulation, establish 64
methods to resolve disputes concerning the reasonableness of 65
medical charges, services, or aids. This regulation shall 66
govern resolution of disputes between employers and medical 67
providers over fees charged, whether or not paid, and shall 68
be in lieu of any other administrative procedure under this 69
chapter. The employee shall not be a party to a dispute 70
over medical charges, nor shall the employee's recovery in 71
any way be jeopardized because of such dispute. Any 72
application for payment of additional reimbursement, as such 73
term is used in 8 CSR 50- 2.030, as amended, shall be filed 74
not later than: 75
(1) Two years from the date the first notice of 76
dispute of the medical charge was received by the health 77
care provider if such services were rendered before July 1, 78
2013; and 79
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(2) One year from the date the first notice of dispute 80
of the medical charge was received by the health care 81
provider if such services were rendered after July 1, 2013. 82
Notice shall be presumed to occur no later than five 83
business days after transmission by certified United States 84
mail. 85
5. No compensation shall be payable for the death or 86
disability of an employee, if and insofar as the death or 87
disability may be caused, continued or aggravated by any 88
unreasonable refusal to submit to any medical or surgical 89
treatment or operation, the risk of which is, in the opinion 90
of the division or the commission, inconsiderable in view of 91
the seriousness of the injury. If the employee dies as a 92
result of an operation made necessary by the injury, the 93
death shall be deemed to be caused by the injury. 94
6. The testimony of any physician or chiropractic 95
physician who treated the employee shall be admissible in 96
evidence in any proceedings for compensation under this 97
chapter, subject to all of the provisions of section 287.210. 98
7. Every hospital or other person furnishing the 99
employee with medical aid shall permit its record to be 100
copied by and shall furnish full information to the division 101
or the commission, the employer, the employee or his 102
dependents and any other party to any proceedings for 103
compensation under this chapter, and certified copies of the 104
records shall be admissible in evidence in any such 105
proceedings. 106
8. The employer may be required by the division or the 107
commission to furnish an injured employee with artificial 108
legs, arms, hands, surgical orthopedic joints, or eyes, or 109
braces, as needed, for life whenever the division or the 110
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commission shall find that the injured employee may be 111
partially or wholly relieved of the effects of a permanent 112
injury by the use thereof. The director of the division 113
shall establish a procedure whereby a claim for compensation 114
may be reactivated after settlement of such claim is 115
completed. The claim shall be reactivated only after the 116
claimant can show good cause for the reactivation of this 117
claim and the claim shall be made only for the payment of 118
medical procedures involving life-threatening surgical 119
procedures or if the claimant requires the use of a new, or 120
the modification, alteration or exchange of an existing, 121
prosthetic device. For the purpose of this subsection, 122
"life threatening" shall mean a situation or condition 123
which, if not treated immediately, will likely result in the 124
death of the injured worker. 125
9. Nothing in this chapter shall prevent an employee 126
being provided treatment for his injuries by prayer or 127
spiritual means if the employer does not object to the 128
treatment. 129
10. The employer shall have the right to select the 130
licensed treating physician, surgeon, chiropractic 131
physician, or other health care provider; provided, however, 132
that such physicians, surgeons or other health care 133
providers shall offer only those services authorized within 134
the scope of their licenses. For the purpose of this 135
subsection, subsection 2 of section 287.030 shall not apply. 136
11. Any physician or other health care provider who 137
orders, directs or refers a patient for treatment, testing, 138
therapy or rehabilitation at any institution or facility 139
shall, at or prior to the time of the referral, disclose in 140
writing if such health care provider, any of his partners or 141
his employer has a financial interest in the institution or 142
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facility to which the patient is being referred, to the 143
following: 144
(1) The patient; 145
(2) The employer of the patient with workers' 146
compensation liability for the injury or disease being 147
treated; 148
(3) The workers' compensation insurer of such 149
employer; and 150
(4) The workers' compensation adjusting company for 151
such insurer. 152
12. Violation of subsection 11 of this section is a 153
class A misdemeanor. 154
13. (1) No hospital, physician or other health care 155
provider, other than a hospital, physician or health care 156
provider selected by the employee at his own expense 157
pursuant to subsection 1 of this section, shall bill or 158
attempt to collect any fee or any portion of a fee for 159
services rendered to an employee due to a work-related 160
injury or report to any credit reporting agency any failure 161
of the employee to make such payment, when an injury covered 162
by this chapter has occurred and such hospital, physician or 163
health care provider has received actual notice given in 164
writing by the employee, the employer or the employer's 165
insurer. Actual notice shall be deemed received by the 166
hospital, physician or health care provider five days after 167
mailing by certified mail by the employer or insurer to the 168
hospital, physician or health care provider. 169
(2) The notice shall include: 170
(a) The name of the employer; 171
(b) The name of the insurer, if known; 172
(c) The name of the employee receiving the services; 173
(d) The general nature of the injury, if known; and 174
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(e) Where a claim has been filed, the claim number, if 175
known. 176
(3) When an injury is found to be noncompensable under 177
this chapter, the hospital, physician or other health care 178
provider shall be entitled to pursue the employee for any 179
unpaid portion of the fee or other charges for authorized 180
services provided to the employee. Any applicable statute 181
of limitations for an action for such fees or other charges 182
shall be tolled from the time notice is given to the 183
division by a hospital, physician or other health care 184
provider pursuant to subdivision (6) of this subsection, 185
until a determination of noncompensability in regard to the 186
injury which is the basis of such services is made, or in 187
the event there is an appeal to the labor and industrial 188
relations commission, until a decision is rendered by that 189
commission. 190
(4) If a hospital, physician or other health care 191
provider or a debt collector on behalf of such hospital, 192
physician or other health care provider pursues any action 193
to collect from an employee after such notice is properly 194
given, the employee shall have a cause of action against the 195
hospital, physician or other health care provider for actual 196
damages sustained plus up to one thousand dollars in 197
additional damages, costs and reasonable attorney's fees. 198
(5) If an employer or insurer fails to make payment 199
for authorized services provided to the employee by a 200
hospital, physician or other health care provider pursuant 201
to this chapter, the hospital, physician or other health 202
care provider may proceed pursuant to subsection 4 of this 203
section with a dispute against the employer or insurer for 204
any fees or other charges for services provided. 205
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(6) A hospital, physician or other health care 206
provider whose services have been authorized in advance by 207
the employer or insurer may give notice to the division of 208
any claim for fees or other charges for services provided 209
for a work-related injury that is covered by this chapter, 210
with copies of the notice to the employee, employer and the 211
employer's insurer. Where such notice has been filed, the 212
administrative law judge may order direct payment from the 213
proceeds of any settlement or award to the hospital, 214
physician or other health care provider for such fees as are 215
determined by the division. The notice shall be on a form 216
prescribed by the division. 217
[14. The employer may allow or require an employee to 218
use any of the employee's accumulated paid leave, personal 219
leave, or medical or sick leave to attend to medical 220
treatment, physical rehabilitation, or medical evaluations 221
during work time. The intent of this subsection is to 222
specifically supercede and abrogate any case law that 223
contradicts the express language of this section.] 224
287.485. Any time after one year following the date 1
when an employee has reached maximum medical improvement 2
based on the evaluation of a physician, either the employee 3
or the employer may request a final hearing. Such final 4
hearing shall be set within six months after when the 5
request is made and not to be continued, cancelled, or reset 6
without consent of both the employee and the employer. 7
✓