-IR- Database Guide
-IR- Database: Indiana Register

TITLE 631 WORKER'S COMPENSATION BOARD OF INDIANA

Final Rule
LSA Document #11-357(F)

DIGEST

Amends 631 IAC 1-1-19 to update the role of the executive administrator. Amends 631 IAC 1-1-23 to deny an attorney who violates the worker's compensation act or worker's occupational diseases act permission to practice before the board. Amends 631 IAC 1-1-25 to require a medical bill review service to complete annual certificate. Amends 631 IAC 1-1-28 to require the filing of certain forms electronically. Amends 631 IAC 1-1-31 to set the date second injury fund benefits become due as the later of the date of filing of application or eligibility. Adds 631 IAC 1-1-28.5 to require exempt entities under IC 22-3-2-5 to file notice of their election with the board. Adds 631 IAC 1-1-32 to create guidelines for filing and paying medical provider fee claims. Adds 631 IAC 1-1-33 to establish a fee for board conducted mediations, as required by IC 22-3-4-4.5. Makes numerous changes to make language conform to current terminology used at IC 22-3-1. Effective 30 days after filing with the Publisher.



SECTION 1. 631 IAC 1-1-2 IS AMENDED TO READ AS FOLLOWS:

631 IAC 1-1-2 Forms; publication and distribution of pamphlets

Authority: IC 22-3-1-3
Affected: IC 22-3


Sec. 2. (a) The industrial worker's compensation board (board) will prepare and furnish free of charge all proper sample forms required by the provisions of the Indiana Workmen's worker's compensation act (IC 22-3-2 through IC 22-3-6) and the Indiana Workmen's worker's occupational diseases act (IC 22-3-7) (collectively referred to as the act), and all pleadings, reports, and papers filed with the industrial board must be in the prescribed form.

(b) Any pamphlets prepared and published by the industrial board containing a concise text of the Indiana Workmen's worker's compensation act (IC 22-3-2 through IC 22-3-6), the Indiana Workmen's worker's occupational diseases act (IC 22-3-7), and rules of the Industrial board (630 IAC 1-1-39 [630 IAC 1-1-39 was repealed filed May 12, 1983, 10:15 a.m.: 6 IR 1248, eff September 1, 1983.], 630 IAC 1-1-41 [630 IAC 1-1-41 was repealed filed May 12, 1983, 10:15 a.m.: 6 IR 1248, eff September 1, 1983.], and 630 IAC 1-1-42 [630 IAC 1-1-42 was repealed filed May 12, 1983, 10:15 a.m.: 6 IR 1248, eff September 1, 1983.]) shall be made available on the board's website and distributed by the secretary of the industrial board to anyone requesting such the pamphlets, provided, however, that the board may make a reasonable cost charge for such the pamphlets. All monies collected from the sale of said the pamphlets shall be turned over by the secretary of the industrial board to the general fund of the state of Indiana to help defray the printing expenses for said the pamphlets.
(Worker's Compensation Board of Indiana; Rule 2; filed Jul 17, 1963, 11:10 p.m.: Rules and Regs. 1964, p. 105; filed Aug 31, 1966, 2:15 p.m.: Rules and Regs. 1967, p. 83; filed May 12, 1983, 10:15 a.m.: 6 IR 1239, eff Sep 1, 1983; readopted filed Nov 13, 2001, 12:20 p.m.: 25 IR 1305; readopted filed Oct 12, 2007, 1:09 p.m.: 20071031-IR-631070472RFA; filed May 4, 2012, 10:15 a.m.: 20120530-IR-631110357FRA) NOTE: Transferred from the Industrial Board of Indiana (630 IAC 1-1-2) to the Worker's Compensation Board of Indiana (631 IAC 1-1-2) by P.L.28-1988, SECTION 121, effective July 1, 1988.


SECTION 2. 631 IAC 1-1-3 IS AMENDED TO READ AS FOLLOWS:

631 IAC 1-1-3 Rules of practice in proceedings

Authority: IC 22-3-1-3
Affected: IC 22-3


Sec. 3. Except as provided below, the industrial board will not be bound by any technical rules of practice in conducting hearings, but will conduct such hearings and make such investigations in reference to the questions at issue in such a manner as in its judgment are is best adapted to ascertain and determine expeditiously and accurately the substantial rights of the parties and to carry out justly the spirit of the Indiana Workmen's worker's compensation act (IC 22-3-2 through IC 22-3-6) and the Indiana Workmen's worker's occupational diseases act (IC 22-3-7). However, the industrial board incorporates by reference the provisions of Trial Rules 26 through 37, as amended, of the Indiana Rules of Trial Procedure, into this rule.
(Worker's Compensation Board of Indiana; Rule 3; filed Aug 2, 1949, 3:50 p.m.: Rules and Regs. 1950, p. 72; filed May 12, 1983, 10:15 a.m.: 6 IR 1240, eff Sep 1, 1983; readopted filed Nov 13, 2001, 12:20 p.m.: 25 IR 1305; readopted filed Oct 12, 2007, 1:09 p.m.: 20071031-IR-631070472RFA; filed May 4, 2012, 10:15 a.m.: 20120530-IR-631110357FRA) NOTE: Transferred from the Industrial Board of Indiana (630 IAC 1-1-3) to the Worker's Compensation Board of Indiana (631 IAC 1-1-3) by P.L.28-1988, SECTION 121, effective July 1, 1988.


SECTION 3. 631 IAC 1-1-4 IS AMENDED TO READ AS FOLLOWS:

631 IAC 1-1-4 Pleadings in subsequent proceedings

Authority: IC 22-3-1-3


Sec. 4. The applications or petitions for the review or modification of any award or order of the industrial board shall be entitled with parties, plaintiff and defendant, as in the proceedings, in which the award or order was made, bear the number of the original proceedings and be filed therein.
(Worker's Compensation Board of Indiana; Rule 5; filed Aug 2, 1949, 3:50 p.m.: Rules and Regs. 1950, p. 72; filed May 12, 1983, 10:15 a.m.: 6 IR 1240, eff Sep 1, 1983; readopted filed Nov 13, 2001, 12:20 p.m.: 25 IR 1305; readopted filed Oct 12, 2007, 1:09 p.m.: 20071031-IR-631070472RFA; filed May 4, 2012, 10:15 a.m.: 20120530-IR-631110357FRA) NOTE: Transferred from the Industrial Board of Indiana (630 IAC 1-1-5) to the Worker's Compensation Board of Indiana (631 IAC 1-1-4) by P.L.28-1988, SECTION 121, effective July 1, 1988.


SECTION 4. 631 IAC 1-1-5 IS AMENDED TO READ AS FOLLOWS:

631 IAC 1-1-5 Pleadings and papers to be printed or typewritten; filing; service

Authority: IC 22-3-1-3


Sec. 5. (a) All applications must be:
(1) printed or typewritten in the manner prescribed by the board; and must be
(2) filed in triplicate with an adequate number of addressed stamped envelopes to effect service of the filing.

(b) After filing the original application with the industrial board, all subsequent petitions, motions, complaints, answers, special answers, appearances, briefs, or other pleadings filed with the industrial board shall contain the street and e-mail address and telephone number of the party or counsel filing the document and a certification that on or before the day of filing a copy of said the document was served upon the opposing party or counsel. The industrial board incorporates the provisions of Trial Rule 5, as amended, Indiana Rules of Trial Procedure, by reference into this rule for the purposes of the calculation of time limitations with regard to service and filing of documents with the industrial board.

(c) Parties desiring to file briefs must do so on or before the date of hearing or at such time as the industrial board may determine. Applications and other documents should be filed on eight and one-half (8 1/2) x inch by eleven (11) inch paper.
(Worker's Compensation Board of Indiana; Rule 6; filed Aug 2, 1949, 3:50 p.m.: Rules and Regs. 1950, p. 72; filed Aug 31, 1966, 2:15 p.m.: Rules and Regs. 1967, p. 83; filed May 12, 1983, 10:15 a.m.: 6 IR 1240, eff Sep 1, 1983; readopted filed Nov 13, 2001, 12:20 p.m.: 25 IR 1305; readopted filed Oct 12, 2007, 1:09 p.m.: 20071031-IR-631070472RFA; filed May 4, 2012, 10:15 a.m.: 20120530-IR-631110357FRA) NOTE: Transferred from the Industrial Board of Indiana (630 IAC 1-1-6) to the Worker's Compensation Board of Indiana (631 IAC 1-1-5) by P.L.28-1988, SECTION 121, effective July 1, 1988.


SECTION 5. 631 IAC 1-1-7 IS AMENDED TO READ AS FOLLOWS:

631 IAC 1-1-7 Defendants

Authority: IC 22-3-1-3


Sec. 7. All persons should be joined as defendants against whom the right to any relief is alleged to exist, whether jointly, severally, or in the alternative, and the industrial board at any time, upon a proper showing, or of its own motion, may order that any additional party be joined, when it deems the presense presence of such the party necessary.
(Worker's Compensation Board of Indiana; Rule 8; filed Aug 2, 1949, 3:50 p.m.: Rules and Regs. 1950, p. 73; filed May 12, 1983, 10:15 a.m.: 6 IR 1241, eff Sep 1, 1983; readopted filed Nov 13, 2001, 12:20 p.m.: 25 IR 1305; readopted filed Oct 12, 2007, 1:09 p.m.: 20071031-IR-631070472RFA; filed May 4, 2012, 10:15 a.m.: 20120530-IR-631110357FRA) NOTE: Transferred from the Industrial Board of Indiana (630 IAC 1-1-8) to the Worker's Compensation Board of Indiana (631 IAC 1-1-7) by P.L.28-1988, SECTION 121, effective July 1, 1988.


SECTION 6. 631 IAC 1-1-10 IS AMENDED TO READ AS FOLLOWS:

631 IAC 1-1-10 Expediting proceedings; notice of hearings; continuances

Authority: IC 22-3-1-3
Affected: IC 22-3


Sec. 10. (a) The policy of the industrial board, implementing the spirit of the Workmen's worker's compensation act (IC 22-3-2 through IC 22-3-6), is to determine all questions brought before it as speedily and expeditiously as possible. Therefore, proceedings before the industrial board shall be conducted with the least possible expense and with the greatest practical dispatch. Notice of all hearings and proceedings before the board, unless otherwise directed by statute, shall be given by electronic mail when possible. If not, notice shall be by U.S. mail, and proof of the mailing of any such notice shall be prima facie proof of the service thereof.

(b) The secretary of the industrial board shall give written notice by electronic or U.S. mail to all parties or their counsel of each hearing scheduled before either a single hearing member or the full industrial board. When it appears from the board's records of the industrial board that any party in a proceeding pending before the industrial board it is represented by an attorney, such the notices as well as all other communications concerning such the proceeding shall be sent to such the attorney or attorneys. Unless otherwise ordered by the industrial board, at least ten (10) days notice of all hearings will be given from the date of mailing the notice thereof.

(c) There shall be no continuances granted to either party except for good cause shown by motion. All requests for continuances must be filed not less than ten (10) days before a scheduled hearing. Any request for continuance filed less than ten (10) days prior to a scheduled hearing will be denied unless there shall be conclusively shown in the motion or petition that, in addition to good cause for the continuance, an emergency exists excusing the late filing of the request.

(d) If a request for a continuance is refused by the industrial board, the industrial board may proceed to make any adjudication necessary for a final determination of a pending application.
(Worker's Compensation Board of Indiana; Rule 12; filed Jul 17, 1963, 11:10 p.m.: Rules and Regs. 1964, p. 106; filed Aug 31, 1966, 2:15 p.m.: Rules and Regs. 1967, p. 84; filed May 12, 1983, 10:15 a.m.: 6 IR 1241, eff Sep 1, 1983; readopted filed Nov 13, 2001, 12:20 p.m.: 25 IR 1305; readopted filed Oct 12, 2007, 1:09 p.m.: 20071031-IR-631070472RFA; filed May 4, 2012, 10:15 a.m.: 20120530-IR-631110357FRA) NOTE: Transferred from the Industrial Board of Indiana (630 IAC 1-1-12) to the Worker's Compensation Board of Indiana (631 IAC 1-1-10) by P.L.28-1988, SECTION 121, effective July 1, 1988.


SECTION 7. 631 IAC 1-1-11 IS AMENDED TO READ AS FOLLOWS:

631 IAC 1-1-11 Stipulations

Authority: IC 22-3-1-3


Sec. 11. (a) The parties to any proceeding before the industrial board may shall stipulate the facts in writing. and thereupon. If all related facts and issues are so stipulated, the board will may make its order or award without a hearing.

(b) Where the stipulation covers a permanent partial impairment, it will be necessary to file with said the stipulation with the industrial board a report of a physician furnished by the employer and also a report of a physician employed by and representing the employee, as to their opinions of percent of permanent partial impairment unless such reports have been previously filed. The employee may waive examination by a physician other than the one provided by the employer. In such cases, the employee's written waiver shall be filed with the report of the employer's physician.

(c) To the end that proceedings may be disposed of expeditiously and with the least possible expense to the parties and the state, the board desires to encourage encourages the parties to stipulate facts whenever it can reasonably be done.
(Worker's Compensation Board of Indiana; Rule 13; filed Aug 2, 1949, 3:50 p.m.: Rules and Regs. 1950, p. 75; filed May 12, 1983, 10:15 a.m.: 6 IR 1242, eff Sep 1, 1983; readopted filed Nov 13, 2001, 12:20 p.m.: 25 IR 1305; readopted filed Oct 12, 2007, 1:09 p.m.: 20071031-IR-631070472RFA; filed May 4, 2012, 10:15 a.m.: 20120530-IR-631110357FRA) NOTE: Transferred from the Industrial Board of Indiana (630 IAC 1-1-13) to the Worker's Compensation Board of Indiana (631 IAC 1-1-11) by P.L.28-1988, SECTION 121, effective July 1, 1988.


SECTION 8. 631 IAC 1-1-15 IS AMENDED TO READ AS FOLLOWS:

631 IAC 1-1-15 Facts upon review; additional evidence; oral arguments

Authority: IC 22-3-1-3


Sec. 15. (a) The facts upon review by the full board will be determined upon the evidence introduced in the original hearing, without hearing new or additional evidence, at the discretion of the industrial board. Any party desiring to introduce new or additional evidence shall file an affidavit setting forth therein the names and residences of the witnesses to be called to testify before the full board, the facts to which they will testify, or, if the new evidence be documentary, then a copy of the document proposed to be introduced setting forth good reason for failure to introduce such evidence at the original hearing. If such the petition is granted, the opposing party shall have the right to introduce such additional evidence as may be necessary in rebuttal.

(b) Oral argument shall not be required in cases coming before the full board on applications for review. No later than thirty (30) days prior to the date set by notice for consideration of an application by the full board, the applicant or counsel may file with the industrial board a brief or statement specifically setting forth the errors alleged for review, argument on those errors, and authorities, if any, supporting such argument. Such The brief or statement shall be filed with seven (7) copies. The opposing party or counsel may file, no later than ten (10) days prior to such the hearing date, any rebuttal.
(Worker's Compensation Board of Indiana; Rule 18; filed Aug 2, 1949, 3:50 p.m.: Rules and Regs. 1950, p. 76; filed May 12, 1983, 10:15 a.m.: 6 IR 1242, eff Sep 1, 1983; errata, 6 IR 1751; readopted filed Nov 13, 2001, 12:20 p.m.: 25 IR 1305; readopted filed Oct 12, 2007, 1:09 p.m.: 20071031-IR-631070472RFA; filed May 4, 2012, 10:15 a.m.: 20120530-IR-631110357FRA) NOTE: Transferred from the Industrial Board of Indiana (630 IAC 1-1-18) to the Worker's Compensation Board of Indiana (631 IAC 1-1-15) by P.L.28-1988, SECTION 121, effective July 1, 1988.


SECTION 9. 631 IAC 1-1-16 IS AMENDED TO READ AS FOLLOWS:

631 IAC 1-1-16 X-ray films; admissibility

Authority: IC 22-3-1-3


Sec. 16. Upon hearings before the industrial board or any of its members, x-ray films may be exhibited to show the existing condition of an injured employee, but such films themselves will not be considered a part of the evidence.
(Worker's Compensation Board of Indiana; Rule 19; filed Aug 2, 1949, 3:50 p.m.: Rules and Regs. 1950, p. 76; filed May 12, 1983, 10:15 a.m.: 6 IR 1243, eff Sep 1, 1983; errata, 6 IR 1751; readopted filed Nov 13, 2001, 12:20 p.m.: 25 IR 1305; readopted filed Oct 12, 2007, 1:09 p.m.: 20071031-IR-631070472RFA; filed May 4, 2012, 10:15 a.m.: 20120530-IR-631110357FRA) NOTE: Transferred from the Industrial Board of Indiana (630 IAC 1-1-19) to the Worker's Compensation Board of Indiana (631 IAC 1-1-16) by P.L.28-1988, SECTION 121, effective July 1, 1988.


SECTION 10. 631 IAC 1-1-17 IS AMENDED TO READ AS FOLLOWS:

631 IAC 1-1-17 Number of witnesses; challenging jurisdiction of board; insurance as proof of compliance

Authority: IC 22-3-1-3
Affected: IC 22-3


Sec. 17. (a) Upon hearings before the industrial board or any of its members, the board or such member may refuse to hear more than three (3) witnesses produced by the same party to prove the same fact.

(b) When a motion or pleading is filed presenting the question of jurisdiction of the industrial board, such the motion or pleading shall be heard and the question presented thereby determined before the application for compensation shall be heard on its merits.

(c) Where an employer has insurance pursuant to under the Indiana Workmen's worker's compensation act (IC 22-3-2 through IC 22-3-6) and the Indiana Workmen's worker's occupational diseases act (IC 22-3-7), the signature of such the compensation carrier by its representative on behalf of such the employer in the discharge of their duties under said the act may be accepted by the industrial board as compliance with the compensation law.
(Worker's Compensation Board of Indiana; Rule 20; filed Aug 2, 1949, 3:50 p.m.: Rules and Regs. 1950, p. 77; filed May 12, 1983, 10:15 a.m.: 6 IR 1243, eff Sep 1, 1983; readopted filed Nov 13, 2001, 12:20 p.m.: 25 IR 1305; readopted filed Oct 12, 2007, 1:09 p.m.: 20071031-IR-631070472RFA; filed May 4, 2012, 10:15 a.m.: 20120530-IR-631110357FRA) NOTE: Transferred from the Industrial Board of Indiana (630 IAC 1-1-20) to the Worker's Compensation Board of Indiana (631 IAC 1-1-17) by P.L.28-1988, SECTION 121, effective July 1, 1988.


SECTION 11. 631 IAC 1-1-18 IS AMENDED TO READ AS FOLLOWS:

631 IAC 1-1-18 Advice and information furnished by executive administrator

Authority: IC 22-3-1-3


Sec. 18. The secretary of the board executive administrator will, upon request, advise any party as to the form of petition, answer, or other paper necessary to be filed in any case and furnish such the information from the files of the board as will conduce to a full presentation of facts material to the controversy.
(Worker's Compensation Board of Indiana; Rule 21; filed Aug 2, 1949, 3:50 p.m.: Rules and Regs. 1950, p. 77; filed May 12, 1983, 10:15 a.m.: 6 IR 1243, eff Sep 1, 1983; readopted filed Nov 13, 2001, 12:20 p.m.: 25 IR 1305; readopted filed Oct 12, 2007, 1:09 p.m.: 20071031-IR-631070472RFA; filed May 4, 2012, 10:15 a.m.: 20120530-IR-631110357FRA) NOTE: Transferred from the Industrial Board of Indiana (630 IAC 1-1-21) to the Worker's Compensation Board of Indiana (631 IAC 1-1-18) by P.L.28-1988, SECTION 121, effective July 1, 1988.


SECTION 12. 631 IAC 1-1-19 IS AMENDED TO READ AS FOLLOWS:

631 IAC 1-1-19 Powers and duties of board's executive administrator

Authority: IC 22-3-1-3
Affected: IC 22-3-1-1


Sec. 19. (a) The secretary of the board board's executive administrator is charged with the special duty of directing the clerical assistants in coordinating the discharge of their duties of making or having made all proper records, of giving or causing to be given all notices of hearings before the board or any member thereof, of issuing or causing to be issued all subpoenas, and of indexing, numbering and preserving all pleadings, reports and papers filed with the board. of the board's staff with the needs of the worker's compensation community, the board members, and other state agencies. The executive administrator shall manage the operation of the board's office in the absence of the chairman.

(b) The executive administrator shall also serve as the administrator of the self insurance and fiscal officer program and oversee the second injury fund in conjunction with the chairman.
(Worker's Compensation Board of Indiana; Rule 22; filed Aug 2, 1949, 3:50 p.m.: Rules and Regs. 1950, p. 77; filed May 12, 1983, 10:15 a.m.: 6 IR 1243, eff Sep 1, 1983; readopted filed Nov 13, 2001, 12:20 p.m.: 25 IR 1305; readopted filed Oct 12, 2007, 1:09 p.m.: 20071031-IR-631070472RFA; filed May 4, 2012, 10:15 a.m.: 20120530-IR-631110357FRA) NOTE: Transferred from the Industrial Board of Indiana (630 IAC 1-1-22) to the Worker's Compensation Board of Indiana (631 IAC 1-1-19) by P.L.28-1988, SECTION 121, effective July 1, 1988.


SECTION 13. 631 IAC 1-1-20 IS AMENDED TO READ AS FOLLOWS:

631 IAC 1-1-20 Record of claims; electronic record

Authority: IC 22-3-1-3
Affected: IC 22-3-1-3


Sec. 20. (a) The secretary board shall keep a claim register and a card index of maintain an electronic system of recording claims filed in the office of the board (the cause system), in which all cases shall be entered at the time and in the order in which they are filed. Each case shall be numbered in the order in which it is filed.

(b) The card index cause system of claims shall show the title of the cause, the date of filing, the order or award, and the name of the board member making it. The original award shall be filed with the original papers in the case.
(Worker's Compensation Board of Indiana; Rule 23; filed Aug 2, 1949, 3:50 p.m.: Rules and Regs. 1950, p. 78; filed May 12, 1983, 10:15 a.m.: 6 IR 1244, eff Sep 1, 1983; readopted filed Nov 13, 2001, 12:20 p.m.: 25 IR 1305; readopted filed Oct 12, 2007, 1:09 p.m.: 20071031-IR-631070472RFA; filed May 4, 2012, 10:15 a.m.: 20120530-IR-631110357FRA) NOTE: Transferred from the Industrial Board of Indiana (630 IAC 1-1-23) to the Worker's Compensation Board of Indiana (631 IAC 1-1-20) by P.L.28-1988, SECTION 121, effective July 1, 1988.


SECTION 14. 631 IAC 1-1-21 IS AMENDED TO READ AS FOLLOWS:

631 IAC 1-1-21 Certified copies of records, orders, and transcripts

Authority: IC 22-3-1-3


Sec. 21. (a) Certified copies of the files, orders, awards, and records, and transcripts of evidence will be furnished only on the written order of the party desiring the same. copies and upon payment of the fee for preparation of the transcript.

(b) When a certified copy of an award or an agreement ordering payment of compensation is requested, there shall be attached to such the copy the memorandum, if one has been filed, provided for by Rule 32 (630 IAC 1-1-32 [630 IAC 1-1-32 was repealed filed May 12, 1983, 10:15 a.m.: 6 IR 1248, eff September 1, 1983.]), and the certification by the secretary of the industrial board executive administrator shall include such the memorandum as a part of the records of the industrial board with reference to such the award or agreement.
(Worker's Compensation Board of Indiana; Rule 25; filed Aug 2, 1949, 3:50 p.m.: Rules and Regs. 1950, p. 78; filed May 12, 1983, 10:15 a.m.: 6 IR 1244, eff Sep 1, 1983; readopted filed Nov 13, 2001, 12:20 p.m.: 25 IR 1305; readopted filed Oct 12, 2007, 1:09 p.m.: 20071031-IR-631070472RFA; filed May 4, 2012, 10:15 a.m.: 20120530-IR-631110357FRA) NOTE: Renumbered Rule 24 by 1967; 84. NOTE: Transferred from the Industrial Board of Indiana (630 IAC 1-1-24) to the Worker's Compensation Board of Indiana (631 IAC 1-1-21) by P.L.28-1988, SECTION 121, effective July 1, 1988.


SECTION 15. 631 IAC 1-1-22 IS AMENDED TO READ AS FOLLOWS:

631 IAC 1-1-22 Appeal to court of appeals

Authority: IC 22-3-1-3
Affected: IC 22-3-4-3


Sec. 22. Any party desiring to appeal to the court of appeals from an award of the industrial board must file with the secretary of the board within fifteen (15) days from the date of such the award, a written praecipe designating specifically the pleadings to be incorporated into the transcript for such the appeal.
(Worker's Compensation Board of Indiana; Rule 26; filed Aug 2, 1949, 3:50 p.m.: Rules and Regs. 1950, p. 79; filed May 12, 1983, 10:15 a.m.: 6 IR 1244, eff Sep 1, 1983; readopted filed Nov 13, 2001, 12:20 p.m.: 25 IR 1305; readopted filed Oct 12, 2007, 1:09 p.m.: 20071031-IR-631070472RFA; filed May 4, 2012, 10:15 a.m.: 20120530-IR-631110357FRA) NOTE: Renumbered Rule 25 by 1967; 84. NOTE: Transferred from the Industrial Board of Indiana (630 IAC 1-1-25) to the Worker's Compensation Board of Indiana (631 IAC 1-1-22) by P.L.28-1988, SECTION 121, effective July 1, 1988.


SECTION 16. 631 IAC 1-1-23 IS AMENDED TO READ AS FOLLOWS:

631 IAC 1-1-23 Representing litigants before board

Authority: IC 22-3-1-3


Sec. 23. (a) The parties to a proceeding before the industrial board may appear either in person or by an attorney. Before any person shall be permitted to represent any party litigant before the industrial board, of Indiana, he or she shall make an oath in writing, showing qualifications as prescribed by law, in the form as follows:
STATE OF INDIANA  SS: 
COUNTY OF ________   
_____ the undersigned affirms under the penalties for perjury, that the foregoing representations are true: that he or she has been duly admitted to practice law in the Circuit and/or Superior Court of _____ County, Indiana, and in the Supreme Court of the State of Indiana, and is at this time in good standing as a practitioner before said Courts. 
     
  Signature of Attorney   
     
  Printed Name   
     
  Office Address   
  (    )   
  Telephone Number   
  (    )   
  Fax Number   
     
  E-mail Address   
     
Attorney #     

(b) Failure of any such attorney to comply with the worker's compensation or occupational diseases act as set out at IC 22 may subject the attorney to revocation of the attorney's certificate to practice before the board, upon a hearing on the issue by the full board.
(Worker's Compensation Board of Indiana; Rule 27; filed Aug 2, 1949, 3:50 p.m.: Rules and Regs. 1950, p. 79; filed Aug 31, 1966, 2:15 p.m.: Rules and Regs. 1967, p. 84; filed May 12, 1983, 10:15 a.m.: 6 IR 1244, eff Sep 1, 1983; readopted filed Nov 13, 2001, 12:20 p.m.: 25 IR 1305; readopted filed Oct 12, 2007, 1:09 p.m.: 20071031-IR-631070472RFA; filed May 4, 2012, 10:15 a.m.: 20120530-IR-631110357FRA) NOTE: Renumbered Rule 26 by 1967; 84. NOTE: Transferred from the Industrial Board of Indiana (630 IAC 1-1-26) to the Worker's Compensation Board of Indiana (631 IAC 1-1-23) by P.L.28-1988, SECTION 121, effective July 1, 1988.


SECTION 17. 631 IAC 1-1-25 IS AMENDED TO READ AS FOLLOWS:

631 IAC 1-1-25 Claims for fees; disputes

Authority: IC 22-3-1-3
Affected: IC 22-3-3-5.2


Sec. 25. (a) Unless otherwise ordered by the board, all claims for physician's fees, attorney's fees, nurses' fees, hospital or medical facility bills, and all disputes pertaining thereto will be scheduled and heard at the office of the board. in the same manner as contested claims for benefits. In such cases, the parties may make their proof by oral testimony, by depositions, or by affidavits, or by all of such methods.

(b) Billing review services wishing to review worker's compensation medical provider claims under IC 22-3-3-5.2 must complete a certification annually, on a form prescribed by the board.
(Worker's Compensation Board of Indiana; Rule 29; filed Aug 2, 1949, 3:50 p.m.: Rules and Regs. 1950, p. 80; filed May 12, 1983, 10:15 a.m.: 6 IR 1245, eff Sep 1, 1983; readopted filed Nov 13, 2001, 12:20 p.m.: 25 IR 1305; readopted filed Oct 12, 2007, 1:09 p.m.: 20071031-IR-631070472RFA; filed May 4, 2012, 10:15 a.m.: 20120530-IR-631110357FRA) NOTE: Renumbered Rule 28 by 1967; 84. NOTE: Transferred from the Industrial Board of Indiana (630 IAC 1-1-28) to the Worker's Compensation Board of Indiana (631 IAC 1-1-25) by P.L.28-1988, SECTION 121, effective July 1, 1988.


SECTION 18. 631 IAC 1-1-26 IS AMENDED TO READ AS FOLLOWS:

631 IAC 1-1-26 Compensation agreements; failure to make payments

Authority: IC 22-3-1-3


Sec. 26. (a) No later than fifteen (15) days from the date upon which the first weekly installment of compensation shall be due to an injured employee or his or her dependents within this state, the employer or his or her insurance carrier shall present to such the injured employee or his or her dependents, if such the injured employee or his or her dependents be at the time within said the state and his, her, or their address is known to the employer or his or her insurance carrier, for signature, a properly prepared compensation agreement in the form prescribed by the industrial board, and at such time shall pay or tender to such the person or persons all compensation then due.

(b) After the compensation agreement has been executed by the parties, it shall be filed with the industrial board and a copy shall be served upon the injured employee or his or her dependents within fifteen (15) days of execution.

(c) The presentation to such the person or persons of the check or draft of the employer or insurance carrier for the proper amount, drawn upon a bank in which money is on deposit to pay the same on demand, shall be sufficient tender of such the compensation.

(d) If such the agreement is not so presented and payment made or tender of the full amount of compensation then due, so made within said time, then the failure so to do may be sufficient cause for the revocation of the certificate of the employer which that has authorized him or her to carry his or her own risk without insurance or of the insurance policy form of such the insurance carrier, provided, that this rule shall not apply to injuries of which the employer has no notice or knowledge, or when the employer and the injured employee or his or her dependents, in good faith, have failed to reach an agreement in regard to the compensation payable or when the employer has reported to the industrial board within the time and in the manner required by law, and in which report the employer, in good faith, shall have denied compensation liability and shall have stated therein a valid reason for such denial.
(Worker's Compensation Board of Indiana; Rule 31; filed Aug 2, 1949, 3:50 p.m.: Rules and Regs. 1950, p. 81; filed May 12, 1983, 10:15 a.m.: 6 IR 1245, eff Sep 1, 1983; readopted filed Nov 13, 2001, 12:20 p.m.: 25 IR 1305; readopted filed Oct 12, 2007, 1:09 p.m.: 20071031-IR-631070472RFA; filed May 4, 2012, 10:15 a.m.: 20120530-IR-631110357FRA) NOTE: Renumbered Rule 30 by 1967; 84. NOTE: Transferred from the Industrial Board of Indiana (630 IAC 1-1-30) to the Worker's Compensation Board of Indiana (631 IAC 1-1-26) by P.L.28-1988, SECTION 121, effective July 1, 1988.


SECTION 19. 631 IAC 1-1-27 IS AMENDED TO READ AS FOLLOWS:

631 IAC 1-1-27 Time period of payments; memorandum of termination

Authority: IC 22-3-1-3


Sec. 27. (a) If an injured employee, or his or her dependents have been awarded compensation for temporary total disability by the industrial board, either by approval of an agreement or by an award, the employer shall continue the payments of compensation under the terms of such the award or agreement for the specific period therein fixed, or until such the employee returns to work, or the dependency ends, or the employer shall have in good faith disagreed with the injured employee or the dependents as to the continuation of such the compensation payments.

(b) The employer or such employer's insurance carrier or third party administrator (TPA) shall file with the industrial board and the injured worker a memorandum prescribed by the industrial board noticing compensation payment termination whenever a notice of termination is due to the injured worker according to the act.

(c) The memoranda shall be issued for each period of compensation payments showing the following:
(1) The total amount of all payments made.
(2) The date of the employee's return to work, if applicable.
(3) The first date of cessation and for which compensation was paid.
(4) The last date for which compensation was paid.
(5) The reason for termination of the payments. and
(6) Any other fact or facts pertaining to the cessation termination of said the payments of compensation and serve upon the employee or his dependents a copy thereof. that the board requires on the approved form.
(Worker's Compensation Board of Indiana; Rule 32; filed Aug 2, 1949, 3:50 p.m.: Rules and Regs. 1950, p. 82; filed May 12, 1983, 10:15 a.m.: 6 IR 1246, eff Sep 1, 1983; readopted filed Nov 13, 2001, 12:20 p.m.: 25 IR 1305; readopted filed Oct 12, 2007, 1:09 p.m.: 20071031-IR-631070472RFA; filed May 4, 2012, 10:15 a.m.: 20120530-IR-631110357FRA) NOTE: Renumbered Rule 31 by 1967; 84. NOTE: Transferred from the Industrial Board of Indiana (630 IAC 1-1-31) to the Worker's Compensation Board of Indiana (631 IAC 1-1-27) by P.L.28-1988, SECTION 121, effective July 1, 1988.


SECTION 20. 631 IAC 1-1-28 IS AMENDED TO READ AS FOLLOWS:

631 IAC 1-1-28 Reports by employers

Authority: IC 22-3-1-3
Affected: IC 22-3


Sec. 28. (a) Employers who have been granted by the industrial board a certificate of financial ability to pay direct compensation in the amount and manner and when due, as provided in the Indiana Workmen's worker's compensation act (IC 22-3-2 through IC 22-3-6) and the Indiana Workmen's worker's occupational diseases act (IC 22-3-7), as well as those who have not been granted such certificate, must make all reports required by said the act upon forms that are prescribed by the industrial board.

(b) All accident reports pursuant to under IC 22-3-4-13 shall be in writing and mailed to filed electronically with the industrial board on forms as prescribed by the board for that purpose.

(c) Reports of disablements occasioned by an occupational disease pursuant to under IC 22-3-7-37 shall be in writing and mailed to the industrial board on forms prescribed for that purpose. also be filed electronically.
(Worker's Compensation Board of Indiana; Rule 35; filed Aug 2, 1949, 3:50 p.m.: Rules and Regs. 1950, p. 83; filed May 12, 1983, 10:15 a.m.: 6 IR 1246, eff Sep 1, 1983; readopted filed Nov 13, 2001, 12:20 p.m.: 25 IR 1305; readopted filed Oct 12, 2007, 1:09 p.m.: 20071031-IR-631070472RFA; filed May 4, 2012, 10:15 a.m.: 20120530-IR-631110357FRA) NOTE: Renumbered Rule 34 by 1967; 84. NOTE: Transferred from the Industrial Board of Indiana (630 IAC 1-1-34) to the Worker's Compensation Board of Indiana (631 IAC 1-1-28) by P.L.28-1988, SECTION 121, effective July 1, 1988.


SECTION 21. 631 IAC 1-1-28.5 IS ADDED TO READ AS FOLLOWS:

631 IAC 1-1-28.5 Exempt entities

Authority: IC 22-3-1-3
Affected: IC 22-3-2-5


Sec. 28.5. Exempt entities under IC 22-3-2-5(a) shall provide notice to the board of their election. The name and contact information of a person authorized to act for the purposes of worker's compensation matters, along with other pertinent data, shall be provided on the form prescribed by the board for that purpose and updated annually. Details regarding excess coverage must be included.
(Worker's Compensation Board of Indiana; 631 IAC 1-1-28.5; filed May 4, 2012, 10:15 a.m.: 20120530-IR-631110357FRA)


SECTION 22. 631 IAC 1-1-29 IS AMENDED TO READ AS FOLLOWS:

631 IAC 1-1-29 Self-insurers; application for certification

Authority: IC 22-3-1-3
Affected: IC 22-3


Sec. 29. Any employer, other than those excepted in IC 22-3-2-5, desiring a certificate of financial ability to pay compensation direct directly without insurance shall file with the industrial board, upon the form prescribed by the board, an application for such the certificate and shall furnish therein all the information required. Such The employer shall certify to the industrial board that it has adequate facilities for making necessary accident reports, executing compensation agreements and other necessary documents for the handling of workmen's worker's compensation matters and that it has placed in charge of this work a person or persons within the state familiar with the Indiana Workmen's worker's compensation act (IC 22-3-2 through IC 22-3-6) and the Indiana Workmen's worker's occupational diseases act (IC 22-3-7) and the rules of the industrial board. of Indiana. Failure of such employer to timely fulfill its obligations under these laws may result in revocation of its certificate.
(Worker's Compensation Board of Indiana; Rule 37; filed Aug 2, 1949, 3:50 p.m.: Rules and Regs. 1950, p. 84; filed May 12, 1983, 10:15 a.m.: 6 IR 1246, eff Sep 1, 1983; readopted filed Nov 13, 2001, 12:20 p.m.: 25 IR 1305; readopted filed Oct 12, 2007, 1:09 p.m.: 20071031-IR-631070472RFA; filed May 4, 2012, 10:15 a.m.: 20120530-IR-631110357FRA) NOTE: Renumbered Rule 36 by 1967; 84. NOTE: Transferred from the Industrial Board of Indiana (630 IAC 1-1-36) to the Worker's Compensation Board of Indiana (631 IAC 1-1-29) by P.L.28-1988, SECTION 121, effective July 1, 1988.


SECTION 23. 631 IAC 1-1-30 IS AMENDED TO READ AS FOLLOWS:

631 IAC 1-1-30 Request for certification of compliance

Authority: IC 22-3-1-3
Affected: IC 22-3


Sec. 30. (a) Upon written request, from any person, to the industrial board for a showing of compliance by any principal contractor, intermediate contractor, or subcontractor with IC 22-3-5, IC 22-3-5-1, and IC 22-3-5-2 as required by IC 22-3-2-14 and with IC 22-3-7-34(a) and IC 22-3-7-34(b) as required by IC 22-3-7-34(i), the industrial board will issue a certificate showing such compliance as it is reflected by the board's its records.

(b) Each request must be accompanied by a preaddressed, stamped envelope for each party who is to receive a copy of such the certificate.
(Worker's Compensation Board of Indiana; Rule 38; filed Aug 2, 1949, 3:50 p.m.: Rules and Regs. 1950, p. 84; filed Aug 3, 1973, 3:00 p.m.: Rules and Regs. 1974, p. 361; filed May 12, 1983, 10:15 a.m.: 6 IR 1247, eff Sep 1, 1983; readopted filed Nov 13, 2001, 12:20 p.m.: 25 IR 1305; readopted filed Oct 12, 2007, 1:09 p.m.: 20071031-IR-631070472RFA; filed May 4, 2012, 10:15 a.m.: 20120530-IR-631110357FRA) NOTE: Renumbered Rule 37 by 1967; 84. NOTE: Transferred from the Industrial Board of Indiana (630 IAC 1-1-37) to the Worker's Compensation Board of Indiana (631 IAC 1-1-30) by P.L.28-1988, SECTION 121, effective July 1, 1988.


SECTION 24. 631 IAC 1-1-31 IS AMENDED TO READ AS FOLLOWS:

631 IAC 1-1-31 Second injury fund

Authority: IC 22-3-1-3
Affected: IC 22-3


Sec. 31. The industrial board, of Indiana, in order to carry out the intent and purpose of the second injury fund (fund), adopts the following:
(1) All employers and insurance carriers, subject to the provisions of the second injury fund, shall keep an accurate record of all compensation claims paid to injured employees or their dependents under the act (IC 22-3-2 through IC 22-3-6); that the board may examine under oath or otherwise, any person, firm, or corporation, concerning the records of said the compensation payments; that the board may regulate the method and manner and provide the necessary forms whereby payments are made to said the fund.
(2) All claims made under of the second injury fund will be determined like other compensation claims, as provided for in IC 22-3-4-5.
(3) Awards for the payment of compensation from the second injury fund shall set forth that no payments out of the second injury fund will be made to a claimant until the full amount due from the employer for whom he or she was working when he or she received his or her second injury, shall have been fully paid; said payments of compensation from the second injury fund shall commence on the filing date of claimant's application for said benefits; or the date eligibility exists or is established, whichever is latest. All compensation payments paid out of the second injury fund shall be ordered payable every six (6) weeks. Under no circumstances will the board consider any request for a lump sum settlement. Any award made under the provisions of the second injury fund shall be subject to review, modification, or cancellation, as provided for under the provision of the Indiana Workmen's worker's compensation Law. act.
(4) The second injury fund shall be under the direction and supervision of an administrator named and appointed by the full industrial board. The administrator shall be charged with the duty of administering said second injury the fund as hereinbefore prescribed and, additionally, said the administrator shall personally review each application filed with the board requesting benefits from the second injury fund. In any case where the administrator of the second injury fund determines that there is a question of legal entitlement to any benefits from the second injury fund, the administrator shall refer a copy of said the application to the office of the attorney general of Indiana along with a letter or memorandum indicating wherein said the administrator feels believes a question of legal entitlement exists. and Before said the application is set for hearing before a single member of the industrial board, of Indiana, the attorney general shall have the right to defend said the fund against said the application for allowance of second injury fund benefits. The attorney general of Indiana may designate which duly appointed deputy shall appear for said the defense.
(Worker's Compensation Board of Indiana; Rule 39; filed Jul 17, 1963, 11:10 p.m.: Rules and Regs. 1964, p. 106; filed Dec 27, 1976, 3:45 p.m.: Rules and Regs. 1977, p. 219; filed May 12, 1983, 10:15 a.m.: 6 IR 1247, eff Sep 1, 1983; errata, 6 IR 1751; readopted filed Nov 13, 2001, 12:20 p.m.: 25 IR 1305; readopted filed Oct 12, 2007, 1:09 p.m.: 20071031-IR-631070472RFA; filed May 4, 2012, 10:15 a.m.: 20120530-IR-631110357FRA) NOTE: Renumbered Rule 38 by 1967; 84. NOTE: Transferred from the Industrial Board of Indiana (630 IAC 1-1-38) to the Worker's Compensation Board of Indiana (631 IAC 1-1-31) by P.L.28-1988, SECTION 121, effective July 1, 1988.


SECTION 25. 631 IAC 1-1-32 IS ADDED TO READ AS FOLLOWS:

631 IAC 1-1-32 Medical provider fee claims

Authority: IC 22-3-1-3
Affected: IC 22-3-3-5


Sec. 32. The board, under IC 22-3-1-3, and in order to regulate proceedings under IC 22-3-3-5, adopts the following:
(1) The following definitions shall apply:
(A) "CMS" refers to Centers for Medicare and Medicaid Services, an agency of the U.S. Department of Health and Human Services.
(B) "CPT" refers to the current procedural terminology manual published annually by the American Medical Association.
(C) "Payer" means an agent, a designee, an employee, an assignee, or an independent contractor of the employer including a billing review service utilized by the payer for services performed under the act.
(D) "Written communication" means the written statement made by a payer to a health care provider, in response to a claim for payment submitted to the payer by the provider, wherein the payer notifies the provider of the payer's determination of the employer's pecuniary liability for the medical treatment, services, and supplies that comprised the provider's claim for payment.
(2) Payment of medical benefits shall be made as follows:
(A) Where the compensability of billed services is not contested, payment for billed services shall be as follows:
(i) Providers shall submit bills for services rendered within one hundred twenty (120) days of the date of service. Bills submitted by providers for payment shall state the provider's actual charges for the treatment rendered. A provider's statement of actual charges is not to be construed as a request for payment in excess of the medical fee cap or schedule. The billing statement must be in detailed line item form. The payer to whom the bill is submitted shall calculate the proper amount of the payment for the treatment rendered.
(ii) Unless contested in accordance with the provisions set forth in this section, all bills submitted by a provider are due and payable in accordance with IC 22-3-3-5 within ninety (90) days after receipt of the bill by the payer. Date of receipt may be established by the payer's date stamp or electronic acknowledgement date; otherwise, receipt is presumed to occur three (3) days after the date the bill was mailed to the payer's correct address. Payer may request additional documentation to support medical bills submitted for payment by the provider, as long as the additional documentation is relevant to the treatment for which payment is sought. If a payer requests additional information or records from a provider, the ninety (90) day period shall be tolled until the documentation is received by payer.
(iii) The payer shall supply a written explanation of review (EOR) to the provider describing the calculation of payment of medical bills submitted by the provider. If payment is based on changes to a provider's codes, the EOR shall specifically state the justification for changing the original codes. If payment of a bill is denied entirely, the payer shall provide a written, detailed explanation for the denial of each covered item.
(B) If the payer agrees a service or procedure was reasonable and necessary, the provider's lack of prior authorization for payment does not warrant denial of liability for payment of the appropriate amount due under the act.
(C) The payer may only make changes to a provider's billing codes consistent with American Medical Association (AMA) guidelines and definitions in CPT coding instructions, Medicare guidelines, the act, and the Indiana Administrative Code.
(3) Medical bill disputes shall be addressed as follows:
(A) When the payer fails to make timely payment of uncontested billed services, the provider shall first attempt to resolve payment with the payer or the medical review service, or both, by any means set out in a relevant contract between the parties and those steps set out on the board's website. Where such attempts are unsuccessful, the billing party may request assistance from the board by first contacting the board's medical claims reviewer and thereafter filing an application for adjustment of claim for provider fee (application) if necessary.
(B) In all cases where a billed service is contested by the payer, the payer shall, within ninety (90) days of receipt of the bill, submit to the provider a written notification of contest setting out the reason for denial.
(C) The written notification of contest shall include the following information:
(i) The name of the injured worker.
(ii) The date or dates of the service or services being contested.
(iii) The payer's accident number or board's claim number, or both, if applicable.
(iv) If applicable, acknowledgement of specific uncontested and paid items submitted on the same bill as contested services.
(v) Reference to the bill and each item of the bill being contested.
(vi) The reason or reasons for contesting the payment of any item. The explanation shall include the citing of appropriate statutes, rules, and documents supporting the payer's reasons for contesting payment.
(D) The provider shall have sixty (60) days to respond to the payer's written or electronic notification of contest. Thereafter, the payer shall have thirty (30) days to respond to the provider's response to the notification of contest. If the parties are unable to resolve a dispute relating to the correct payment of a bill, an application may be filed after first contacting the board's medical claims reviewer for assistance.
(4) The responsibilities of the provider seeking adjudication of a claim for fees shall be as follows:
(A) Prior to filing an application, the medical provider, the employer, its insurer, and/or its billing review service must engage in a good faith attempt to negotiate an agreed payment.
(B) When seeking clarification or dispute resolution from the board, the provider must provide the following upon the request of the board:
(i) The fully completed and signed provider fee application, which must identify the specific charges for which provider seeks (additional) reimbursement beyond any reimbursement allowed by the payer.
(ii) A copy of CMS 1500 or UB04, whichever is applicable, or its replacement.
(iii) A copy of the first and final requests for reimbursement by the provider to the payer. These requests must indicate the following:
(AA) The name and address of the person contacted.
(BB) The employee's name, address, and date of service.
(CC) Any other information that will assist the carrier or employer in identifying the claim.
(iv) All information submitted by the provider to the payer including a detailed copy of the bill with the contested codes and dates of service in dispute.
(v) A complete copy of the payer's explanation as to why the billed services are being contested.
(vi) Documentation of provider and payer's negotiation proceedings and independent attempts to settle the matter.
(vii) A copy of all relevant medical record documentation.
(viii) Applications submitted without all of the necessary documentation will not be filed.
(C) The provider shall furnish a copy of the application and all attachments to the employer, its insurer, or the billing review service if designated by the employer or its insurer.
(5) The payer's responsibilities in the adjudication of a claim for medical fees shall be as follows:
(A) Within thirty (30) days of the filing of providers' application, the payer must submit to the board a written response setting forth the reasons that (additional) reimbursement is not required. Evidence rebutting the provider's demand shall accompany its response, including the data relied on to adjust the bill, if relevant.
(B) The payer shall furnish the provider with copies of the evidence provided to the board in response to the provider's application. Thereafter, within thirty (30) days of the filing of the payer's response, the provider shall file with the board rebuttal evidence, if any, it intends to use in support of its claim.
(6) Multiple procedures. When performing more than one (1) surgical procedure in a single surgical setting, multiple surgery guidelines (one hundred percent (100%) of the listed value for the primary procedure and fifty percent (50%) of the listed value for additional procedures) shall apply. The fifty percent (50%) reduction does not apply to procedures that are identified in the applicable edition of the CPT as "Add-on" or Modifier 51-exempt procedures.
(7) Fragmenting or unbundling of charges by providers. A provider may not fragment or unbundle charges except as consistent with AMA guidelines, CPT coding instructions, or Medicare rules and regulations.
(8) Payment for out-of-state medical treatment of the injured worker shall be made as follows:
(A) Out-of-state medical providers treating injured employees pursuant to the Indiana act shall be reimbursed according to the worker's compensation act of Indiana and these administrative provisions. The filing of a first report of injury with the board shall be prima facie proof of jurisdiction in Indiana.
(B) When an injured employee is treated outside of Indiana, the applicable fee shall be that which would apply if the care had been provided in this state, at a location with a similar population and medical community as that of the location of care. If such comparison is not possible or practicable, reimbursement shall be that which would apply in the community defined as the geographic service area served by the Zip codes with the first three (3) digits 462. Categorization of a hospital or facility provider according to any Indiana standards shall also apply.
(9) Reimbursement for special reports shall be as follows:
(A) Payment shall be made for special reports (CPT code 99080) only if these reports are specifically requested by the payer. Office notes and other documentation that are necessary to support billed provider codes may not be considered special reports.
(B) Payment for special reports shall be at one hundred percent (100%) of the provider's usual and customary charge.
(10) Surgical assists. Assists in surgery will be reimbursed if indicated by the relevant surgical specialty society, CMS, or Medicare guidelines as medically necessary. The rate of reimbursement is indicated by attaching modifier 80, 81, or 82 to surgical procedures. Reimbursement for procedures modified by 80 or 82 will be at twenty percent (20%) of the applicable fee schedule or rate for the code presented. Reimbursement for procedures modified by 81 will be made at ten percent (10%). Multiple and bilateral procedure rules apply.
(11) Utilization review. The board recognizes the Utilization Review Accreditation Commission's (URAC) Workers' Compensation Management 2008 guidelines to medical utilization practices, as well as the Official Disability Guidelines (ODG) published by the Work Loss Data Institute and the American College of Occupational and Environmental Medicine (ACOEM) guidelines. Recommendations from these, and other, reputable sources may be offered as one (1) form of evidence regarding appropriate medical care; however, it will not be considered as conclusive evidence by the single hearing member or the full board.
(Worker's Compensation Board of Indiana; 631 IAC 1-1-32; filed May 4, 2012, 10:15 a.m.: 20120530-IR-631110357FRA)


SECTION 26. 631 IAC 1-1-33 IS ADDED TO READ AS FOLLOWS:

631 IAC 1-1-33 Fees for mediation by the board

Authority: IC 22-3-4-4.5


Sec. 33. The charge for mediation by a qualified employee of the board shall be a flat fee of three hundred fifty dollars ($350) for five (5) hours of mediation, with an hourly rate of fifty dollars ($50) for each hour thereafter. No travel expenses will be paid by the parties.
(Worker's Compensation Board of Indiana; 631 IAC 1-1-33; filed May 4, 2012, 10:15 a.m.: 20120530-IR-631110357FRA)


LSA Document #11-357(F)
Notice of Intent: 20110615-IR-631110357NIA
Proposed Rule: 20110914-IR-631110357PRA
Hearing Held: December 5, 2011
Approved by Attorney General: May 2, 2012
Approved by Governor: May 4, 2012
Filed with Publisher: May 4, 2012, 10:15 a.m.
Documents Incorporated by Reference: None Received by Publisher
Small Business Regulatory Coordinator: Linda Hamilton, Chairman, Worker's Compensation Board of Indiana, Indiana Government Center South, 402 West Washington Street, Room W196, Indianapolis, IN 46204, (317) 232-3821, lhamilton@wcb.in.gov

Posted: 05/30/2012 by Legislative Services Agency

DIN: 20120530-IR-631110357FRA
Composed: Oct 24,2014 9:48:07PM EDT
A PDF version of this document.