DAR File No. 32276

Labor Commission, Adjudication

R602-2-2

Guidelines for Utilization of Medical Panel

NOTICE OF PROPOSED RULE

DAR File No.: 32276
Filed: 01/06/2009, 12:51
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this rule change is to reverse a recent change to this rule. The recent change added the modifier "expert" to the type of medical opinion that may warrant appointment of a medical panel. This rule change removes the modifier "expert" from the type of medical opinion that may warrant appointment of a medical panel.

Summary of the rule or change:

This rule change removes the modifier "expert" from the type of medical opinions that can support appointment of a medical panel.

State statutory or constitutional authorization for this rule:

Sections 34A-1-301 et seq. and 63G-4-102 et seq.

Anticipated cost or savings to:

the state budget:

The proposed amendment reverses a rule change recently enacted and never implemented. It will have no cost or savings to the state budget because current practice will remain the same.

local governments:

This proposed amendment reverses a rule change recently enacted and never implemented. It will have no cost or savings to the local government because current practice will remain the same.

small businesses and persons other than businesses:

This proposed amendment reverses a rule change recently enacted and never implemented. It will have no cost or savings to the local government because current practice will remain the same.

Compliance costs for affected persons:

This change maintains long-standing Commission practice of accepting conflicting medical opinions as a basis for referring workers' compensation medical issues to impartial medical panels. Consequently it will impose no compliance costs on affected persons.

Comments by the department head on the fiscal impact the rule may have on businesses:

This change merely removes the unnecessary modifier "expert" from the Commission's rule, thereby maintaining long-standing Commission practice. The change will have no fiscal impact on businesses. Sherrie Hayashi, Commissioner

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Labor Commission
Adjudication
HEBER M WELLS BLDG
160 E 300 S
SALT LAKE CITY UT 84111-2316

Direct questions regarding this rule to:

Richard M. Lajeunesse at the above address, by phone at 801-536-7928, by FAX at 801-530-6333, or by Internet E-mail at rlajeunesse@utah.gov

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

03/03/2009

This rule may become effective on:

03/10/2009

Authorized by:

Sherrie Hayashi, Commissioner

R602. Labor Commission, Adjudication.

R602-2. Adjudication of Workers' Compensation and Occupational Disease Claims.

R602-2-2. Guidelines for Utilization of Medical Panel.

Pursuant to Section 34A-2-601, the Commission adopts the following guidelines in determining the necessity of submitting a case to a medical panel:

A. A panel will be utilized by the Administrative Law Judge where one or more significant medical issues may be involved. Generally a significant medical issue must be shown by conflicting medical reports. Significant medical issues are involved when there are:

1. Conflicting [expert ]medical opinions related to causation of the injury or disease;

2. Conflicting [expert ]medical opinion of permanent physical impairment which vary more than 5% of the whole person,

3. Conflicting [expert ]medical opinions as to the temporary total cutoff date which vary more than 90 days;

4. Conflicting [expert ]medical opinions related to a claim of permanent total disability, and/or

5. Medical expenses in controversy amounting to more than $10,000.

B. A hearing on objections to the panel report may be scheduled if there is a proffer of conflicting medical testimony showing a need to clarify the medical panel report. Where there is a proffer of new written conflicting medical evidence, the Administrative Law Judge may, in lieu of a hearing, re-submit the new evidence to the panel for consideration and clarification.

C. Any expenses of the study and report of a medical panel or medical consultant and of their appearance at a hearing, as well as any expenses for further medical examination or evaluation, as directed by the Administrative Law Judge, shall be paid from the Uninsured Employers' Fund, as directed by Section 34A-2-601.

 

KEY: workers' compensation, administrative procedures, hearings, settlements

Date of Enactment or Last Substantive Amendment: [February 7, 2008]2009

Notice of Continuation: August 15, 2007

Authorizing, and Implemented or Interpreted Law: 34A-1-301 et seq.; 63G-4-102 et seq.