The Vermont legislature has passed a bill with sections that
will change certain aspects of workers’ compensation claims administration. Assuming the Governor signs the legislation, the following changes go into effect July 1,
2014.
Below are summaries of four sections of the bill that will
impact the handling of claims including: limitations on the employer’s ability
to obtain a second opinion; increases to the maximum amounts paid for burial
and funeral expenses in death claims; changes to the process for obtaining a
discontinuance; and a requirement that contact with injured workers contain a
statement regarding the ability to contact the Department of Labor.
Second Opinions:
The Legislature has limited the ability of an employer to
have a medical provider conduct a second opinion with regards to a workers’
compensation claim. Previously any exam
performed at the request of the employer must be reasonable as to time and
place. With this legislation employers
are limited to scheduling examinations within a two hour driving distance of
the residence of the employee. The
Commissioner may permit an examination outside of the two hour driving radius
if it is necessary to obtain the services of a provider that specializes in
evaluation and treatment specific to the nature and extent of the employee’s
injury. See, 21 VSA §655.
Burial and Funeral Expenses:
The legislation increases the amount paid by employers for
burial expenses when a work related injury results in death. When death results from a work related injury
the employer is responsible for paying the actual costs of burial and funeral
expenses in an amount not to exceed $10,000 and the actual expenses for out of
state transportation of the decedent to the place of burial in an amount not to
exceed $5,000. Previously an employer
was to pay $5,500 for burial and funeral expenses and $1,000 for
transportation. Also, every two years
the Commissioner is tasked with evaluating the average amount for burial and
funeral expenses, and provide a recommendation to the Legislature as to whether
an adjustment is warranted. See, 21
VSA §632.
If a person has suffered a work injury and dies from some
other cause while receiving disability or impairment benefits if the person
does not have a dependent, then the employer is liable to pay the remaining
amount due but no more than the actual burial and funeral expenses not to
exceed $10,000.00 and the actual expenses for out-of-state transportation of
the decedent to the place of burial not to exceed $5,000.00. See, 21 VSA §639.
Discontinuance of
Benefits:
When an employer seeks to discontinue benefits the employer
shall continue to give the employee seven days notice from receipt of the
discontinuance before terminating the benefit.
However, new language has been added that “if the claimant disputes the
discontinuance, the Claimant may file with the Commissioner an objection to the
discontinuance and seek an extension of 14 days. The objection to the discontinuance shall be
specific as to the reasons and shall include supporting evidence. A copy of the objection shall be provided to
the employer at the time the request is made to the Commissioner.” The statute
continues to provide that the payments are made without prejudice and may be
deducted from any amounts due for impairment if the Commissioner approves the
discontinuance. See, 21 VSA §643a. The
statute has a sunset provision repealing it on July 1, 2018 and replacing it
with statute that was in effect prior to this amendment.
There is also a provision that the Commissioner assess the
financial and administrative impacts of the provisions and provide the
Legislature with a report in 2017 that addresses: whether the statutory
provisions expedited the discontinuance process; whether the statutory
provisions affected workers’ compensation rates; how many requests were
received, acted on, the time required for action; whether there was an order
for reinstatement of benefits; and any other matters deemed relevant by the
Commissioner. See, 21 VSA §654c.
Notice Required on
Communications with Claimants:
A new provision requires that any communication from the
employer or insurance carrier to the claimant that is not required to be on a
form must include a statement advising the claimant that he or she should
contact the Department of Labor’s Workers’ Compensation Division to determine
any right to object or appeal, as provided by law and to seek information from
the Department on process and procedures. See,
21 VSA §602.
