Changes in Board Procedures
SETTLEMENT AGREEMENTS
In any case where a provider fee application has been filed, the provider must sign off on any settlement agreement between the employee and employer before it will be approved by the Board. In cases where no provider application has been filed, medical expenses must nonetheless be addressed. If all medical treatment has been provided and paid for, this should be spelled out. In all other cases, financial responsibility for the past care provided and any future care must be stated.
PPI PAYMENTS, 1043s and 38911s
A copy of the medical report on which the employer is relying to pay a PPI or terminate TTD because the employee has reached MMI must be sent to the employee as well as the Board along with the form.
INDEPENDENT MEDICAL EXAMINATIONS/ 38911s
Before TTD benefits may be terminated pursuant to IC 22-3-3-7 (c ), when not for one of the 5 enumerated reasons, the employer must send the 38911 before benefits are terminated. As the statute states the employer must inform the employee if its intent to terminate, if the 38911 is mailed, sufficient time must be allowed for the form to reach the employee before payment of TTD is stopped.
If the employee disagrees with the termination of benefits, employee must notify the Board, at which time a Case Coordinator will endeavor to resolve the dispute. If the dispute cannot be resolved in a timely fashion, the Board will then appoint an independent medical examiner ( doctor) who shall address only whether the person has reached MMI and whether the employee is able to be returned to work, and what kind of work.
New 38911 forms are being drafted, as well as a separate form for denial of benefits. These should be ready soon and will be available on our website when finished. An announcement will be made when they are available.
PENALTIES
Penalties set out in the Worker’s Compensation Act will be assessed for failure to meet the dictates of the relevant Indiana Code section as of October 1, 2008. One “free pass” will be allowed for the first such violation by an employer/insurer/ TPA. This free pass will apply in situations such as violations of IC 22-3-3-7, IC 22-3-2-22 and IC 22-3-4-13. There shall be no free pass for failure to carry worker’s compensation insurance covering an employer’s employees.
