Senate Bill 1658

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    Florida Senate - 1998                                  SB 1658

    By Senator Gutman





    34-837A-98

  1                      A bill to be entitled

  2         An act relating to workers' compensation;

  3         amending s. 440.13, F.S.; deleting limitations

  4         on chiropractic treatment; requiring a

  5         physician to provide copies of medical reports

  6         to an injured employee; deleting certification

  7         requirements; deleting limitations on referrals

  8         between health care providers; expanding the

  9         membership of the panel that determines maximum

10         reimbursement allowances; deleting a

11         requirement for a copayment for medical

12         services; amending s. 440.15, F.S.; increasing

13         the period for temporary total disability,

14         permanent impairment, and temporary partial

15         disability benefits; revising criteria to

16         establish the schedule of impairment benefits;

17         increasing the rate of payment of impairment

18         benefits; removing the prohibition against

19         compensation for mental, psychological, or

20         emotional injury; revising criteria for an

21         obligation to rehire; amending s. 440.191,

22         F.S.; requiring employers and carriers to pay

23         attorneys' fees in specified circumstances;

24         amending s. 440.192, F.S.; providing for

25         payment of attorneys' fees; amending s. 440.34,

26         F.S.; revising the formula for setting

27         attorneys' fees; revising the application of a

28         law relating to payment of compensation;

29         repealing s. 440.25(4)(j), F.S., which provides

30         for expedited dispute resolution; providing an

31         effective date.

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  1  Be It Enacted by the Legislature of the State of Florida:

  2

  3         Section 1.  Subsections (2), (3), (12), and (14) of

  4  section 440.13, Florida Statutes, are amended to read:

  5         440.13  Medical services and supplies; penalty for

  6  violations; limitations.--

  7         (2)  MEDICAL TREATMENT; DUTY OF EMPLOYER TO FURNISH.--

  8         (a)  Subject to the limitations specified elsewhere in

  9  this chapter, the employer shall furnish to the employee such

10  medically necessary remedial treatment, care, and attendance

11  for such period as the nature of the injury or the process of

12  recovery may require, including medicines, medical supplies,

13  durable medical equipment, orthoses, prostheses, and other

14  medically necessary apparatus. Remedial treatment, care, and

15  attendance, including work-hardening programs or

16  pain-management programs accredited by the Commission on

17  Accreditation of Rehabilitation Facilities or Joint Commission

18  on the Accreditation of Health Organizations or

19  pain-management programs affiliated with medical schools,

20  shall be considered as covered treatment only when such care

21  is given based on a referral by a physician as defined in this

22  chapter. Each facility shall maintain outcome data, including

23  work status at discharges, total program charges, total number

24  of visits, and length of stay. The department shall utilize

25  such data and report to the President of the Senate and the

26  Speaker of the House of Representatives regarding the efficacy

27  and cost-effectiveness of such program, no later than October

28  1, 1994. Medically necessary treatment, care, and attendance

29  does not include chiropractic services in excess of 18

30  treatments or rendered 8 weeks beyond the date of the initial

31  chiropractic treatment, whichever comes first, unless the

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  1  carrier authorizes additional treatment or the employee is

  2  catastrophically injured.

  3         (b)  The employer shall provide appropriate

  4  professional or nonprofessional attendant care performed only

  5  at the direction and control of a physician when such care is

  6  medically necessary. The value of nonprofessional attendant

  7  care provided by a family member must be determined as

  8  follows:

  9         1.  If the family member is not employed, the per-hour

10  value equals the federal minimum hourly wage.

11         2.  If the family member is employed and elects to

12  leave that employment to provide attendant or custodial care,

13  the per-hour value of that care equals the per-hour value of

14  the family member's former employment, not to exceed the

15  per-hour value of such care available in the community at

16  large. A family member or a combination of family members

17  providing nonprofessional attendant care under this paragraph

18  may not be compensated for more than a total of 12 hours per

19  day.

20         (c)  If the employer fails to provide treatment or care

21  required by this section after request by the injured

22  employee, the employee may obtain such treatment at the

23  expense of the employer, if the treatment is compensable and

24  medically necessary. There must be a specific request for the

25  treatment, and the employer or carrier must be given a

26  reasonable time period within which to provide the treatment

27  or care. However, the employee is not entitled to recover any

28  amount personally expended for the treatment or service unless

29  he or she has requested the employer to furnish that treatment

30  or service and the employer has failed, refused, or neglected

31  to do so within a reasonable time or unless the nature of the

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  1  injury requires such treatment, nursing, and services and the

  2  employer or his or her superintendent or foreman, having

  3  knowledge of the injury, has neglected to provide the

  4  treatment or service.

  5         (d)  The carrier has the right to transfer the care of

  6  an injured employee from the attending health care provider if

  7  an independent medical examination determines that the

  8  employee is not making appropriate progress in recuperation.

  9         (e)  Except in emergency situations and for treatment

10  rendered by a managed care arrangement, after any initial

11  examination and diagnosis by a physician providing remedial

12  treatment, care, and attendance, and before a proposed course

13  of medical treatment begins, each insurer shall review, in

14  accordance with the requirements of this chapter, the proposed

15  course of treatment, to determine whether such treatment would

16  be recognized as reasonably prudent. The review must be in

17  accordance with all applicable workers' compensation practice

18  parameters. The insurer must accept any such proposed course

19  of treatment unless the insurer notifies the physician of its

20  specific objections to the proposed course of treatment by the

21  close of the tenth business day after notification by the

22  physician, or a supervised designee of the physician, of the

23  proposed course of treatment.

24         (f)  A physician shall provide copies of all medical

25  reports, except psychiatric or psychological reports, to an

26  injured employee at the same time as copies are provided to

27  the attorneys for the carrier and the employee.

28         (3)  PROVIDER ELIGIBILITY; AUTHORIZATION.--

29         (a)  As a condition to eligibility for payment under

30  this chapter, a health care provider who renders services must

31  be a certified health care provider and must receive

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  1  authorization from the carrier before providing treatment.

  2  This paragraph does not apply to emergency care. The division

  3  shall adopt rules to implement the certification of health

  4  care providers. As a one-time prerequisite to obtaining

  5  certification, the division shall require each physician to

  6  demonstrate proof of completion of a minimum 5-hour course

  7  that covers the subject areas of cost containment, utilization

  8  control, ergonomics, and the practice parameters adopted by

  9  the division governing the physician's field of practice. The

10  division shall coordinate with the Agency for Health Care

11  Administration, the Florida Medical Association, the Florida

12  Osteopathic Medical Association, the Florida Chiropractic

13  Association, the Florida Podiatric Medical Association, the

14  Florida Optometric Association, the Florida Dental

15  Association, and other health professional organizations and

16  their respective boards as deemed necessary by the Agency for

17  Health Care Administration in complying with this subsection.

18  No later than October 1, 1994, the division shall adopt rules

19  regarding the criteria and procedures for approval of courses

20  and the filing of proof of completion by the physicians.

21         (b)  A health care provider who renders emergency care

22  must notify the carrier by the close of the third business day

23  after it has rendered such care. If the emergency care results

24  in admission of the employee to a health care facility, the

25  health care provider must notify the carrier by telephone

26  within 24 hours after initial treatment. Emergency care is not

27  compensable under this chapter unless the injury requiring

28  emergency care arose as a result of a work-related accident.

29  Pursuant to chapter 395, all licensed physicians and health

30  care providers in this state shall be required to make their

31  services available for emergency treatment of any employee

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  1  eligible for workers' compensation benefits. To refuse to make

  2  such treatment available is cause for revocation of a license.

  3         (c)  A health care provider may not refer the employee

  4  to another health care provider, diagnostic facility, therapy

  5  center, or other facility without prior authorization from the

  6  carrier, except when emergency care is rendered. Any referral

  7  must be to a health care provider that has been certified by

  8  the division, unless the referral is for emergency treatment.

  9         (d)  A carrier must respond, by telephone or in

10  writing, to a request for authorization by the close of the

11  third business day after receipt of the request. A carrier who

12  fails to respond to a written request for authorization for

13  referral for medical treatment by the close of the third

14  business day after receipt of the request consents to the

15  medical necessity for such treatment. All such requests must

16  be made to the carrier. Notice to the carrier does not include

17  notice to the employer.

18         (e)  Carriers shall adopt procedures for receiving,

19  reviewing, documenting, and responding to requests for

20  authorization. Such procedures shall be for a health care

21  provider certified under this section.

22         (f)  By accepting payment under this chapter for

23  treatment rendered to an injured employee, a health care

24  provider consents to the jurisdiction of the division as set

25  forth in subsection (11) and to the submission of all records

26  and other information concerning such treatment to the

27  division in connection with a reimbursement dispute, audit, or

28  review as provided by this section. The health care provider

29  must further agree to comply with any decision of the division

30  rendered under this section.

31

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  1         (g)  The employee is not liable for payment for medical

  2  treatment or services provided pursuant to this section except

  3  as otherwise provided in this section.

  4         (h)  The provisions of s. 455.236 are applicable to

  5  referrals among health care providers, as defined in

  6  subsection (1), treating injured workers.

  7         (h)(i)  Notwithstanding paragraph (d), a claim for

  8  specialist consultations, surgical operations,

  9  physiotherapeutic or occupational therapy procedures, X-ray

10  examinations, or special diagnostic laboratory tests that cost

11  more than $1,000 and other specialty services that the

12  division identifies by rule is not valid and reimbursable

13  unless the services have been expressly authorized by the

14  carrier, or unless the carrier has failed to respond within 10

15  days to a written request for authorization, or unless

16  emergency care is required. The insurer shall not refuse to

17  authorize such consultation or procedure unless the health

18  care provider or facility is not authorized or certified or

19  unless an expert medical advisor has determined that the

20  consultation or procedure is not medically necessary or

21  otherwise compensable under this chapter. Authorization of a

22  treatment plan does not constitute express authorization for

23  purposes of this section, except to the extent the carrier

24  provides otherwise in its authorization procedures. This

25  paragraph does not limit the carrier's obligation to identify

26  and disallow overutilization or billing errors.

27         (i)(j)  Notwithstanding anything in this chapter to the

28  contrary, a sick or injured employee shall be entitled, at all

29  times, to free, full, and absolute choice in the selection of

30  the pharmacy or pharmacist dispensing and filling

31  prescriptions for medicines required under this chapter. It is

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  1  expressly forbidden for the division, an employer, or a

  2  carrier, or any agent or representative of the division, an

  3  employer, or a carrier to select the pharmacy or pharmacist

  4  which the sick or injured employee must use; condition

  5  coverage or payment on the basis of the pharmacy or pharmacist

  6  utilized; or to otherwise interfere in the selection by the

  7  sick or injured employee of a pharmacy or pharmacist.

  8         (12)  CREATION OF THREE-MEMBER PANEL; GUIDES OF MAXIMUM

  9  REIMBURSEMENT ALLOWANCES.--

10         (a)  A five-member three-member panel is created,

11  consisting of the Insurance Commissioner, or the Insurance

12  Commissioner's designee, and four two members to be appointed

13  by the Governor, subject to confirmation by the Senate, two

14  members one member who, on account of present or previous

15  vocation, employment, or affiliation, are shall be classified

16  as representatives a representative of employers, and two

17  members the other member who, on account of previous vocation,

18  employment, or affiliation, are shall be classified as

19  representatives a representative of employees. The panel shall

20  determine statewide schedules of maximum reimbursement

21  allowances for medically necessary treatment, care, and

22  attendance provided by physicians, hospitals, ambulatory

23  surgical centers, work-hardening programs, pain programs, and

24  durable medical equipment. The maximum reimbursement

25  allowances for inpatient hospital care shall be based on a

26  schedule of per diem rates, to be approved by the five-member

27  three-member panel by November 1, 1998, no later than March 1,

28  1994, to be used in conjunction with a precertification manual

29  as determined by the division. All compensable charges for

30  hospital outpatient care shall be reimbursed at 75 percent of

31  usual and customary charges. Until the five-member

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  1  three-member panel approves a schedule of per diem rates for

  2  inpatient hospital care and it becomes effective, all

  3  compensable charges for hospital inpatient care must be

  4  reimbursed at 75 percent of their usual and customary charges.

  5  Annually, the five-member three-member panel shall adopt

  6  schedules of maximum reimbursement allowances for physicians,

  7  hospital inpatient care, hospital outpatient care, ambulatory

  8  surgical centers, work-hardening programs, and pain programs.

  9  However, the maximum percentage of increase in the individual

10  reimbursement allowance may not exceed the percentage of

11  increase in the Consumer Price Index for the previous year. An

12  individual physician, hospital, ambulatory surgical center,

13  pain program, or work-hardening program shall be reimbursed

14  either the usual and customary charge for treatment, care, and

15  attendance, the agreed-upon contract price, or the maximum

16  reimbursement allowance in the appropriate schedule, whichever

17  is less.

18         (b)  As to reimbursement for a prescription medication,

19  the reimbursement amount for a prescription shall be the

20  average wholesale price times 1.2 plus $4.18 for the

21  dispensing fee, except where the carrier has contracted for a

22  lower amount. Fees for pharmaceuticals and pharmaceutical

23  services shall be reimbursable at the applicable fee schedule

24  amount. Where the employer or carrier has contracted for such

25  services and the employee elects to obtain them through a

26  provider not a party to the contract, the carrier shall

27  reimburse at the schedule, negotiated, or contract price,

28  whichever is lower.

29         (c)  Reimbursement for all fees and other charges for

30  such treatment, care, and attendance, including treatment,

31  care, and attendance provided by any hospital or other health

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  1  care provider, ambulatory surgical center, work-hardening

  2  program, or pain program, must not exceed the amounts provided

  3  by the uniform schedule of maximum reimbursement allowances as

  4  determined by the panel or as otherwise provided in this

  5  section. This subsection also applies to independent medical

  6  examinations performed by health care providers under this

  7  chapter. Until the five-member three-member panel approves a

  8  uniform schedule of maximum reimbursement allowances and it

  9  becomes effective, all compensable charges for treatment,

10  care, and attendance provided by physicians, ambulatory

11  surgical centers, work-hardening programs, or pain programs

12  shall be reimbursed at the lowest maximum reimbursement

13  allowance across all 1997 1992 schedules of maximum

14  reimbursement allowances for the services provided regardless

15  of the place of service. In determining the uniform schedule,

16  the panel shall first approve the data which it finds

17  representative of prevailing charges in the state for similar

18  treatment, care, and attendance of injured persons. Each

19  health care provider, health care facility, ambulatory

20  surgical center, work-hardening program, or pain program

21  receiving workers' compensation payments shall maintain

22  records verifying their usual charges. In establishing the

23  uniform schedule of maximum reimbursement allowances, the

24  panel must consider:

25         1.  The levels of reimbursement for similar treatment,

26  care, and attendance made by other health care programs or

27  third-party providers;

28         2.  The impact upon cost to employers for providing a

29  level of reimbursement for treatment, care, and attendance

30  which will ensure the availability of treatment, care, and

31  attendance required by injured workers;

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  1         3.  The financial impact of the reimbursement

  2  allowances upon health care providers and health care

  3  facilities, including trauma centers as defined in s. 395.401,

  4  and its effect upon their ability to make available to injured

  5  workers such medically necessary remedial treatment, care, and

  6  attendance. The uniform schedule of maximum reimbursement

  7  allowances must be reasonable, must promote health care cost

  8  containment and efficiency with respect to the workers'

  9  compensation health care delivery system, and must be

10  sufficient to ensure availability of such medically necessary

11  remedial treatment, care, and attendance to injured workers;

12  and

13         4.  The most recent average maximum allowable rate of

14  increase for hospitals determined by the Health Care Board

15  under chapter 408.

16         (14)  PAYMENT OF MEDICAL FEES.--

17         (a)  Except for emergency care treatment, fees for

18  medical services are payable only to a health care provider

19  certified and authorized to render remedial treatment, care,

20  or attendance under this chapter. A health care provider may

21  not collect or receive a fee from an injured employee within

22  this state, except as otherwise provided by this chapter. Such

23  providers have recourse against the employer or carrier for

24  payment for services rendered in accordance with this chapter.

25         (b)  Fees charged for remedial treatment, care, and

26  attendance may not exceed the applicable fee schedules adopted

27  under this chapter.

28         (c)  Notwithstanding any other provision of this

29  chapter, following overall maximum medical improvement from an

30  injury compensable under this chapter, the employee is

31  obligated to pay a copayment of $10 per visit for medical

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  1  services. The copayment shall not apply to emergency care

  2  provided to the employee.

  3         Section 2.  Paragraph (a) of subsection (2), paragraph

  4  (a) of subsection (3), paragraph (b) of subsection (4), and

  5  subsection (6) of section 440.15, Florida Statutes, are

  6  amended to read:

  7         440.15  Compensation for disability.--Compensation for

  8  disability shall be paid to the employee, subject to the

  9  limits provided in s. 440.12(2), as follows:

10         (2)  TEMPORARY TOTAL DISABILITY.--

11         (a)  In case of disability total in character but

12  temporary in quality, 66 2/3 percent of the average weekly

13  wages shall be paid to the employee during the continuance

14  thereof, not to exceed 182 104 weeks except as provided in

15  this subsection, s. 440.12(1), and s. 440.14(3). Once the

16  employee reaches the maximum number of weeks allowed, or the

17  employee reaches the date of maximum medical improvement,

18  whichever occurs earlier, temporary disability benefits shall

19  cease and the injured worker's permanent impairment shall be

20  determined.

21         (3)  PERMANENT IMPAIRMENT AND WAGE-LOSS BENEFITS.--

22         (a)  Impairment benefits.--

23         1.  Once the employee has reached the date of maximum

24  medical improvement, impairment benefits are due and payable

25  within 20 days after the carrier has knowledge of the

26  impairment.

27         2.  The five-member three-member panel, in cooperation

28  with the division, shall establish and use a uniform permanent

29  impairment rating schedule. This schedule must be based on

30  medically or scientifically demonstrable findings as well as

31  the systems and criteria set forth in the American Medical

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  1  Association's Guides to the Evaluation of Permanent

  2  Impairment; the Snellen Charts, published by American Medical

  3  Association Committee for Eye Injuries; and the Minnesota

  4  Department of Labor and Industry Disability Schedules. The

  5  schedule should be based upon objective findings. The schedule

  6  shall be more comprehensive than the AMA Guides to the

  7  Evaluation of Permanent Impairment and shall expand the areas

  8  already addressed and address additional areas not currently

  9  contained in the guides. On August 1, 1979, and pending the

10  adoption, by rule, of a permanent schedule, Guides to the

11  Evaluation of Permanent Impairment, copyright 1977, 1971,

12  1988, by the American Medical Association, shall be the

13  temporary schedule and shall be used for the purposes hereof.

14  For injuries after July 1, 1990, pending the adoption by

15  division rule of a uniform disability rating schedule, the

16  Minnesota Department of Labor and Industry Disability Schedule

17  shall be used unless that schedule does not address an injury.

18  In such case, the Guides to the Evaluation of Permanent

19  Impairment by the American Medical Association shall be used.

20  Determination of permanent impairment under this schedule must

21  be made by a physician licensed under chapter 458, a doctor of

22  osteopathic medicine licensed under chapters 458 and 459, a

23  chiropractor licensed under chapter 460, a podiatrist licensed

24  under chapter 461, an optometrist licensed under chapter 463,

25  or a dentist licensed under chapter 466, as appropriate

26  considering the nature of the injury. No other persons are

27  authorized to render opinions regarding the existence of or

28  the extent of permanent impairment.

29         3.  All impairment income benefits shall be based on an

30  impairment rating using the impairment schedule referred to in

31  subparagraph 2. Impairment income benefits are paid weekly at

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  1  the rate of 66 2/3 50 percent of the employee's average weekly

  2  salary temporary total disability benefit not to exceed the

  3  maximum weekly benefit under s. 440.12. An employee's

  4  entitlement to impairment income benefits begins the day after

  5  the employee reaches maximum medical improvement or the

  6  expiration of temporary benefits, whichever occurs earlier,

  7  and continues until the earlier of:

  8         a.(I)  Eighteen weeks of eligibility for permanent

  9  impairment ratings up to and including 3 percent;

10         (II)  Thirty-six weeks of eligibility for permanent

11  impairment ratings greater than 3 percent and up to and

12  including 6 percent;

13         (III)  Fifty-four weeks of eligibility for permanent

14  impairment ratings greater than 6 percent and up to and

15  including 9 percent;

16         (IV)  Seventy-two weeks of eligibility for permanent

17  impairment ratings greater than 9 percent and up to and

18  including 12 percent;

19         (V)  Eighty-six weeks of eligibility for permanent

20  impairment ratings greater than 13 percent and up to and

21  including 14 percent;

22         (VI)  Ninety-four weeks of eligibility for permanent

23  impairment ratings greater than 14 percent and up to and

24  including 15 percent;

25         (VII)  One-hundred and five weeks of eligibility for

26  permanent impairment ratings greater than 15 percent and up to

27  and including 16 percent;

28         (VIII)  One-hundred and nineteen weeks of eligibility

29  for permanent impairment ratings greater than 16 percent and

30  up to and including 17 percent;

31

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  1         (IX)  One-hundred and thirty-three weeks of eligibility

  2  for permanent impairment ratings greater than 17 percent and

  3  up to and including 18 percent;

  4         (X)  One-hundred and forty-seven weeks of eligibility

  5  for permanent impairment ratings greater than 18 percent and

  6  up to and including 19 percent;

  7         (XI)  One-hundred sixty-one weeks of eligibility for

  8  permanent impairment ratings greater than 19 percent and up to

  9  and including 20 percent;

10         (XII)  One-hundred seventy-five weeks of eligibility

11  for permanent impairment ratings greater than 20 percent and

12  up to and including 21 percent;

13         (XIII)  One-hundred ninety-two weeks of eligibility for

14  permanent impairment ratings greater than 21 percent and up to

15  and including 22 percent;

16         (XIV)  Two-hundred ten-weeks of eligibility for

17  permanent impairment ratings greater than 22 percent and up to

18  and including 23 percent;

19         (XV)  Two-hundred twenty-seven weeks of eligibility for

20  permanent impairment ratings greater than 23 percent and up to

21  and including 24 percent;

22         (XVI)  Two-hundred forty-five weeks of eligibility for

23  permanent impairment ratings greater than 24 percent and up to

24  and including 25 percent; or

25         (XVII)  Two-hundred fifty-four weeks of eligibility for

26  permanent impairment ratings greater than 25 percent; or

27         a.  The expiration of a period computed at the rate of

28  3 weeks for each percentage point of impairment; or

29         b.  The death of the employee.

30         4.  After the employee has been certified by a doctor

31  as having reached maximum medical improvement or 6 weeks

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  1  before the expiration of temporary benefits, whichever occurs

  2  earlier, the certifying doctor shall evaluate the condition of

  3  the employee and assign an impairment rating, using the

  4  impairment schedule referred to in subparagraph 2.

  5  Compensation is not payable for the mental, psychological, or

  6  emotional injury arising out of depression from being out of

  7  work because of the employee's accident. If the certification

  8  and evaluation are performed by a doctor other than the

  9  employee's treating doctor, the certification and evaluation

10  must be submitted to the treating doctor, and the treating

11  doctor must indicate agreement or disagreement with the

12  certification and evaluation, but the opinion of the second

13  doctor counts in the final decision of impairment. If there is

14  any controversy, the judge shall resolve the dispute between

15  the two doctors. The certifying doctor shall issue a written

16  report to the division, the employee, and the carrier

17  certifying that maximum medical improvement has been reached,

18  stating the impairment rating, and providing any other

19  information required by the division. If the employee has not

20  been certified as having reached maximum medical improvement

21  before the expiration of 182 102 weeks after the date

22  temporary total disability benefits begin to accrue, the

23  carrier shall notify the treating doctor of the requirements

24  of this section.

25         5.  The carrier shall pay the employee impairment

26  income benefits for a period based on the impairment rating.

27         (4)  TEMPORARY PARTIAL DISABILITY.--

28         (b)  Such benefits shall be paid during the continuance

29  of such disability, not to exceed a period of 182 104 weeks,

30  as provided by this subsection and subsection (2). Once the

31  injured employee reaches the maximum number of weeks,

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  1  temporary disability benefits cease and the injured worker's

  2  permanent impairment must be determined.

  3         (6)  OBLIGATION TO REHIRE.--If the employer has not in

  4  good faith made available to the employee, within a 35-mile

  5  100-mile radius of the employee's residence, work appropriate

  6  to the employee's physical limitations within 30 days after

  7  the carrier notifies the employer of maximum medical

  8  improvement and the employee's physical limitations, the

  9  employer shall pay to the division for deposit into the

10  Workers' Compensation Administration Trust Fund a fine of $250

11  for every $5,000 of the employer's workers' compensation

12  premium or payroll, not to exceed $5,000 $2,000 per violation,

13  as the division requires by rule. The employer is not subject

14  to this subsection if the employee is receiving permanent

15  total disability benefits or if the employer has 25 50 or

16  fewer employees.

17         Section 3.  Paragraph (d) of subsection (2) of section

18  440.191, Florida Statutes, is amended to read:

19         440.191  Employee Assistance and Ombudsman Office.--

20         (2)

21         (d)  The Employee Assistance and Ombudsman Office may

22  assign an ombudsman to assist the employee in resolving the

23  dispute. If the dispute is not resolved within 30 days after

24  the employee contacts the office, the ombudsman shall, at the

25  employee's request, assist the employee in drafting a petition

26  for benefits and explain the procedures for filing petitions.

27  The employee is entitled to be represented by an attorney and,

28  the employer or carrier is liable for payment of attorney's

29  fees and costs. The Employee Assistance and Ombudsman Office

30  may not represent employees before the judges of compensation

31  claims. An employer or carrier may not pay any attorneys' fees

                                  17

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 1998                                  SB 1658
    34-837A-98




  1  on behalf of the employee for services rendered or costs

  2  incurred in connection with this section, unless expressly

  3  authorized elsewhere in this chapter.

  4         Section 4.  Subsection (6) of section 440.192, Florida

  5  Statutes, is amended to read:

  6         440.192  Procedure for resolving benefit disputes.--

  7         (6)  If the claimant is not represented by counsel, the

  8  Office of the Judges of Compensation Claims may request the

  9  Employee Assistance and Ombudsman Office to assist the

10  claimant in filing a petition that meets the requirements of

11  this section. If the claimant is represented by counsel, the

12  employer or carrier must pay the attorney's fees.

13         Section 5.  Paragraph (c) of subsection (11) of section

14  440.20, Florida Statutes, applies to all claims not settled

15  unless the claimant was injured before 1994.

16         Section 6.  Paragraph (j) of subsection (4) of section

17  440.25, Florida Statutes, is repealed.

18         Section 7.  This act shall take effect upon becoming a

19  law.

20

21            *****************************************

22                          SENATE SUMMARY

23    Amends various sections of chapter 440, F.S., relating to
      workers' compensation to:
24         Delete limitations on chiropractic treatment.
           Require a physician to provide copies of medical
25  reports to injured employees.
           Delete certification requirements.
26         Delete limitations on referrals between health care
    providers.
27         Increase the three-member panel to a five-member panel.
           Delete a copayment for medical services.
28         Increase the period for temporary total disability,
    permanent impairment, and temporary partial disability
29  benefits.
           Increase the rate of payment of impairment benefits.
30         Remove the prohibition against compensation for mental
    injury.
31         Revise criteria for an obligation to rehire.
           Provide for payment of attorney's fees.
                                  18