DAR File No. 37622
This rule was published in the June 1, 2013, issue (Vol. 2013, No. 11) of the Utah State Bulletin.
Labor Commission, Industrial Accidents
Acceptance / Denial of a Claim
Notice of Proposed Rule
DAR File No.: 37622
Filed: 05/14/2013 10:19:02 AM
Purpose of the rule or reason for the change:
The purpose of this rule change is to outline the workplace injury reporting process within the electronic reporting environment.
Summary of the rule or change:
This rule change requires employers to report workplace injuries to insurance carriers who then report to the Labor Commission electronically. Previously both employers and carriers reported paper forms to the Labor Commission.
State statutory or constitutional authorization for this rule:
- Section 34A-3-108
- Section 34A-2-407
This rule or change incorporates by reference the following material:
- Adds Claims EDI Implementation Guide, published by Labor Commission, 04/19/2013
- Adds Utah Claims R3 EDI Tables, published by Labor Commission, 04/19/2013
Anticipated cost or savings to:
the state budget:
The Commission anticipates some cost to set up and monitor, however in the long term this is offset by personnel savings (time spent manually entering paper forms).
The Commission does not anticipate any cost or savings to local governments because they are already reporting claims to the Commission.
The Commission does not anticipate any cost to small businesses because they are already reporting claims to the Commission. There may be some savings because they will not be reporting claims to two entities.
persons other than small businesses, businesses, or local governmental entities:
The Commission anticipates insurance carriers may incur some costs to meet the electronic reporting requirements.
Compliance costs for affected persons:
Insurance carriers only operating in Utah would have initial development costs. Insurance carriers operating in other electronic reporting jurisdictions may incur costs to add Utah to their electronic distribution. Insurance carriers do incur costs associated with transmitting their reports through authorized EDI vendors and will be assessed noncompliance fines if they fail to follow reporting protocols.
Comments by the department head on the fiscal impact the rule may have on businesses:
There are no costs to small businesses, there may be a small savings to those who are currently filing reports to both the carrier and Commission.
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
HEBER M WELLS BLDG
160 E 300 S
SALT LAKE CITY, UT 84111-2316
Direct questions regarding this rule to:
- Ron Dressler at the above address, by phone at 801-530-6841, by FAX at 801-530-6804, or by Internet E-mail at firstname.lastname@example.org
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:
This rule may become effective on:
Sherrie Hayashi, Commissioner
R612. Labor Commission, Industrial Accidents.
R612-200. Workers' Compensation Rules - Filing and Paying Claims.
Acceptance/Denial of a Claim].
Upon receiving a claim for workers' compensation
benefits, the insurance carrier or self-insured employer shall
promptly investigate the claim and begin payment of compensation
within 21 days from the date of notification of a valid claim or
the insurance carrier or self-insured employer shall send the
claimant and the division written notice on a division form or
letter containing similar information, within 21 days of
notification, that further investigation is needed stating the
reason(s) for further investigation. Each insurance carrier or
self-insured employer shall complete its investigation within 45
days of receipt of the claim and shall commence the payment of
benefits or notify the claimant and division in writing that the
claim is denied and the reason(s) why the claim is being
B]. The payment of compensation shall be considered overdue
if not paid within 21 days of a valid claim or within the 45 days
of investigation unless denied.
C]. Failure to make payment or to deny a claim within the 45
day time period without good cause shall result in a referral of
the insurance company to the Insurance Department for appropriate
disciplinary action and may be cause for revocation of the
self-insurance certification for a self-insured employer. Good
cause is defined as:
1. Failure by an employee claiming benefits to sign requested medical releases;
2. Injury or occupational disease did not occur within the scope of employment;
3. Medical information does not support the claim;
4. Claim was not filed within the statute of limitations;
5. Claimant is not an employee of the employer he/she is making a claim against;
6. Claimant has failed to cooperate in the investigation of the claim;
7. A pre-existing condition is the sole cause of the medical problem and not the claimed work-related injury or occupational disease;
8. Tested positive for drugs or alcohol; or
9. Other - a very specific reason must be given.
D]. If an insurance carrier or self-insured employer begins
payment of benefits on an investigation basis so as to process the
claim in a timely fashion, a later denial of benefits based on
newly discovered information may be allowed.
KEY: workers' compensation, filing, time, administrative proceedings
Date of Enactment or Last Substantive Amendment: [
February 25, ]2013
Authorizing, and Implemented or Interpreted Law: 34A-2-101 et seq.; 34A-3-101 et seq.; 34A-1-104
The Portable Document Format (PDF) version of the Bulletin is the official version. The PDF version of this issue is available at https://rules.utah.gov/publicat/bull-pdf/2013/b20130601.pdf. The HTML edition of the Bulletin is a convenience copy. Any discrepancy between the PDF version and HTML version is resolved in favor of the PDF version.
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For questions regarding the content or application of this rule, please contact Ron Dressler at the above address, by phone at 801-530-6841, by FAX at 801-530-6804, or by Internet E-mail at email@example.com.