State of Connecticut Workers' Compensation Commission, John A. Mastropietro, Chairman
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Sec. 31-294d

Workers’ Compensation Act as amended to January 1, 2017

Medical and surgical aid. Hospital, ambulatory surgical center and nursing service.

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Sec. 31-294d. Medical and surgical aid. Hospital, ambulatory surgical center and nursing service. (a)(1) The employer, as soon as the employer has knowledge of an injury, shall provide a competent physician or surgeon to attend the injured employee and, in addition, shall furnish any medical and surgical aid or hospital and nursing service, including medical rehabilitation services and prescription drugs, as the physician or surgeon deems reasonable or necessary. The employer, any insurer acting on behalf of the employer, or any other entity acting on behalf of the employer or insurer shall be responsible for paying the cost of such prescription drugs directly to the provider. If the employer utilizes an approved providers list, when an employee reports a work-related injury or condition to the employer the employer shall provide the employee with such approved providers list within two business days of such reporting.

(2) If the injured employee is a local or state police officer, state marshal, judicial marshal, correction officer, emergency medical technician, paramedic, ambulance driver, firefighter, or active member of a volunteer fire company or fire department engaged in volunteer duties, who has been exposed in the line of duty to blood or bodily fluids that may carry blood-borne disease, the medical and surgical aid or hospital and nursing service provided by the employer shall include any relevant diagnostic and prophylactic procedure for and treatment of any blood-borne disease.

(b) The employee shall select the physician or surgeon from an approved list of physicians and surgeons prepared by the chairman of the Workers’ Compensation Commission. If the employee is unable to make the selection, the employer shall do so, subject to ratification by the employee or his next of kin. If the employer has a full-time staff physician or if a physician is available on call, the initial treatment required immediately following the injury may be rendered by that physician, but the employee may thereafter select his own physician as provided by this chapter for any further treatment without prior approval of the commissioner.

(c) The commissioner may, without hearing, at the request of the employer or the injured employee, when good reason exists, or on his own motion, authorize or direct a change of physician or surgeon or hospital or nursing service provided pursuant to subsection (a) of this section.

(d) (1) The pecuniary liability of the employer for the medical and surgical service required by this section shall be limited to the charges that prevail in the same community or similar communities for similar treatment of injured persons of a like standard of living when the similar treatment is paid for by the injured person. Notwithstanding the provisions of chapter 368z, prior to the date the liability of the employer is established pursuant to subdivision (2) of this subsection, the liability of the employer for hospital service shall be determined exclusively by the provisions of this subdivision and shall remain the amount it actually costs the hospital to render the service, as determined by the commissioner, except in the case of state humane institutions, the liability of the employer shall be the per capita cost as determined by the Comptroller under the provisions of section 17b-223. All disputes concerning liability for hospital services in workers’ compensation cases shall be filed not later than one year from the date the initial payment for services was remitted, regardless of the date such services were provided, unless any applicable law, rule or regulation establishes a shorter time frame, and shall be settled by the commissioner in accordance with this chapter.

(2) Commencing ninety days after the formulas established by the chairman of the Workers’ Compensation Commission have been published pursuant to subsection (e) of this section, unless the employer and hospital or ambulatory surgical center have otherwise negotiated to determine the liability of the employer for hospital or ambulatory surgical center services required by this section, the liability of the employer for hospital or ambulatory surgical center services shall be: (A) If such services are covered by Medicare, limited to the reimbursements listed in such formulas published pursuant to subsection (e) of this section, or (B) if such services are not covered by Medicare, determined by the chairman, in consultation with employers and their insurance carriers, self-insured employers, hospitals, ambulatory surgical centers, third-party reimbursement organizations and other entities as deemed necessary by the Workers’ Compensation Commission.

(e) Not later than January 1, 2015, the chairman of the Workers’ Compensation Commission shall, in consultation with employers and their insurance carriers, self-insured employers, hospitals, ambulatory surgical centers, third-party reimbursement organizations and other entities as deemed necessary by the Workers’ Compensation Commission, establish and publish Medicare-based formulas, when available, to set the liability of employers for hospital and ambulatory surgical center services required by this section that are covered by Medicare. After the initial publication of such formulas, the chairman shall publish such formulas on each January first thereafter.

(f) If the employer fails to promptly provide a physician or surgeon or any medical and surgical aid or hospital and nursing service as required by this section, the injured employee may obtain a physician or surgeon, selected from the approved list prepared by the chairman, or such medical and surgical aid or hospital and nursing service at the expense of the employer.

(P.A. 91-32, S. 12, 41; 91-339, S. 48, 55; P.A. 98-160; P.A. 00-99, S. 81, 154; P.A. 01-85, S. 2, 3; P.A. 14-167, S. 1; June Sp. Sess. P.A. 15-5, S. 52, 459.)

History: P.A. 91-339 amended Subsecs. (b) and (e) to change “commissioners” to “chairman of the workers’ compensation commission”; P.A. 98-160 amended Subsec. (a) to provide specific diagnosis and treatment for certain employees exposed in the line of duty to blood or bodily fluids; P.A. 00-99 replaced reference to high sheriff, chief deputy sheriff, deputy sheriff and special deputy sheriff with state marshal and judicial marshal in Subsec. (a), effective December 1, 2000; P.A. 01-85 amended Subsec. (a) by dividing existing provisions into Subdivs. (1) and (2), adding provisions in Subdiv. (1) re furnishing prescription drugs and payment of prescription drug costs directly to provider and making technical changes, effective January 1, 2002; P.A. 14-167 amended Subsec. (d) by designating existing provisions re pecuniary liability of employer as Subdiv. (1) and amending same to add provision re prior to date liability of employer is established pursuant to Subdiv. (2), and by adding Subdiv. (2) re employer liability for hospital or ambulatory surgical center services, added new Subsec. (e) re establishment and publication of Medicare-based formulas to set employer liability for hospital and ambulatory surgical center services and redesignated existing Subsec. (e) as Subsec. (f), effective June 11, 2014; June Sp. Sess. P.A. 15-5 amended Subsec. (d)(1) by adding provisions re notwithstanding Ch. 368z, re exclusive determination of liability and re disputes concerning liability to be filed not later than 1 year from date the initial payment for services was remitted, effective June 30, 2015, and amended Subsec. (a)(1) by adding provision re employer utilization of approved providers list, effective July 1, 2015.

Cited. 228 C. 1; 237 C. 1; 241 C. 692.

Subsec. (c):

Although workers’ compensation commissioner, acting within her discretion under statute, designated a new treating physician for plaintiff, commissioner did not have authority to make specific orders regarding a treatment plan to be imposed on a treating physician without that physician’s acquiescence. 94 CA 334.

Subsec. (d):

Since 1997 revision until the effective date of P.A. 14-167, absent a negotiated agreement setting the liability for hospital services rendered pursuant to Sec. 19a-646, a workers’ compensation commissioner shall determine an employer’s liability for hospital services on the basis of the hospital’s filed rates that the hospital is required to charge “any payer” under Sec. 19a-646(b). 315 C. 704.

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Page last revised: January 24, 2018

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State of Connecticut Workers' Compensation Commission, John A. Mastropietro, Chairman
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