There is a newer version of the Kentucky Revised Statutes
2009 Kentucky Revised Statutes
CHAPTER 342 WORKERS' COMPENSATION
342.020 Medical treatment at expense of employer -- Selection of physician and hospital -- Payment -- Managed health care system -- Artificial members and braces -- Waiver of privilege -- Disclosure of interest in referrals.
Download pdfbraces -- Waiver of privilege -- Disclosure of interest in referrals. (1) In addition to all other compensation provided in this chapter, the employer shall pay for the cure and relief from the effects of an injury or occupational disease the
medical, surgical, and hospital treatment, including nursing, medical, and surgical
supplies and appliances, as may reasonably be required at the time of the injury and
thereafter during disability, or as may be required for the cure and treatment of an
occupational disease. The employer's obligation to pay the benefits specified in this
section shall continue for so long as the employee is disabled regardless of the
duration of the employee's income benefits. In the absence of designation of a
managed health care system by the employer, the employee may select medical
providers to treat his injury or occupational disease. Even if the employer has
designated a managed health care system, the injured employee may elect to
continue treating with a physician who provided emergency medical care or
treatment to the employee. The employer, insurer, or payment obligor acting on
behalf of the employer, shall make all payments for services rendered to an
employee directly to the provider of the services within thirty (30) days of receipt of
a statement for services. The commissioner shall promulgate administrative
regulations establishing conditions under which the thirty (30) day period for
payment may be tolled. The provider of medical services shall submit the statement
for services within forty-five (45) days of the day treatment is initiated and every
forty-five (45) days thereafter, if appropriate, as long as medical services are
rendered. Except as provided in subsection (4) of this section, in no event shall a
medical fee exceed the limitations of an adopted medical fee schedule or other
limitations contained in KRS 342.035, whichever is lower. The commissioner may
promulgate administrative regulations establishing the form and content of a
statement for services and procedures by which disputes relative to the necessity,
effectiveness, frequency, and cost of services may be resolved. (2) Notwithstanding any provision of the Kentucky Revised Statutes to the contrary, medical services and treatment provided under this chapter shall not be subject to
copayments or deductibles. (3) Employers may provide medical services through a managed health care system. The managed health care system shall file with the Department of Workers' Claims
a plan for the rendition of health care services for work-related injuries and
occupational diseases to be approved by the commissioner pursuant to
administrative regulations promulgated by the commissioner. (4) All managed health care systems rendering medical services under this chapter shall include the following features in plans for workers' compensation medical care:
(a) Copayments or deductibles shall not be required for medical services rendered in connection with a work-related injury or occupational disease; (b) The employee shall be allowed choice of provider within the plan;
(c) The managed health care system shall provide an informal procedure for the expeditious resolution of disputes concerning rendition of medical services; (d) The employee shall be allowed to obtain a second opinion, at the employer's expense, from an outside physician if a managed health care system physician
recommends surgery; (e) The employee may obtain medical services from providers outside the managed health care system, at the employer's expense, when treatment is
unavailable through the managed health care system; (f) The managed health care system shall establish procedures for utilization review of medical services to assure that a course of treatment is reasonably
necessary; diagnostic procedures are not unnecessarily duplicated; the
frequency, scope, and duration of treatment is appropriate; pharmaceuticals
are not unnecessarily prescribed; and that ongoing and proposed treatment is
not experimental, cost ineffective, or harmful to the employee; and (g) Statements for services shall be audited regularly to assure that charges are not duplicated and do not exceed those authorized in the applicable fee schedules. (h) A schedule of fees for all medical services to be provided under this chapter which shall not be subject to the limitations on medical fees contained in this
chapter. (i) Restrictions on provider selection imposed by a managed health care system authorized by this chapter shall not apply to emergency medical care. (5) Except for emergency medical care, medical services rendered pursuant to this chapter shall be under the supervision of a single treating physician or physicians'
group having the authority to make referrals, as reasonably necessary, to appropriate
facilities and specialists. The employee may change his designated physician one (1)
time and thereafter shall show reasonable cause in order to change physicians. (6) When a compensable injury or occupational disease results in the amputation of an arm, leg, or foot, or the loss of hearing, or the enucleation of an eye or loss of teeth,
the employer shall pay for, in addition to the other medical, surgical, and hospital
treatment enumerated in subsection (1) and this subsection, a modern artificial
member and, where required, proper braces as may reasonably be required at the
time of the injury and thereafter during disability. (7) Upon motion of the employer, with sufficient notice to the employee for a response to be filed, if it is shown to the satisfaction of the administrative law judge by
affidavits or testimony that, because of the physician selected by the employee to
treat the injury or disease, or because of the hospital selected by the employee in
which treatment is being rendered, that the employee is not receiving proper
medical treatment and the recovery is being substantially affected or delayed; or that
the funds for medical expenses are being spent without reasonable benefit to the
employee; or that because of the physician selected by the employee or because of
the type of medical treatment being received by the employee that the employer will
substantially be prejudiced in any compensation proceedings resulting from the
employee's injury or disease; then the administrative law judge may allow the
employer to select a physician to treat the employee and the hospital or hospitals in
which the employee is treated for the injury or disease. No action shall be brought
against any employer subject to this chapter by any person to recover damages for malpractice or improper treatment received by any employee from any physician,
hospital, or attendant thereof. (8) An employee who reports an injury alleged to be work-related or files an application for adjustment of a claim shall execute a waiver and consent of any physician-
patient, psychiatrist-patient, or chiropractor-patient privilege with respect to any
condition or complaint reasonably related to the condition for which the employee
claims compensation. Notwithstanding any other provision in the Kentucky Revised
Statutes, any physician, psychiatrist, chiropractor, podiatrist, hospital, or health care
provider shall, within a reasonable time after written request by the employee,
employer, workers' compensation insurer, special fund, uninsured employers' fund,
or the administrative law judge, provide the requesting party with any information
or written material reasonably related to any injury or disease for which the
employee claims compensation. (9) When a provider of medical services or treatment, required by this chapter, makes referrals for medical services or treatment by this chapter, to a provider or entity in
which the provider making the referral has an investment interest, the referring
provider shall disclose that investment interest to the employee, the commissioner,
and the employer's insurer or the party responsible for paying for the medical
services or treatment, within thirty (30) days from the date the referral was made. Effective: July 15, 2010
History: Amended 2010 Ky. Acts ch. 24, sec. 1780, effective July 15, 2010. -- Amended 2000 Ky. Acts ch. 514, sec. 2, effective July 14, 2000. -- Amended 1996
(1st Extra. Sess.) Ky. Acts ch. 1, sec. 2, effective December 12, 1996. -- Amended
1996 Ky. Acts ch. 355, sec. 4, effective July 15, 1996. -- Amended 1994 Ky. Acts
ch. 181, Part 5, sec. 17, effective April 4, 1994; and ch. 512, part 6, sec. 20, effective
July 15, 1994. Amended 1992 Ky. Acts ch. 446, sec. 6, effective July 14, 1992. --
Amended 1987 (1st Extra. Sess.) Ky. Acts ch. 1, sec. 5, effective October 26, 1987. -
- Amended 1972 Ky. Acts ch. 78, sec. 21. -- Amended 1970 Ky. Acts ch. 6, sec. 1. --
Amended 1964 Ky. Acts ch. 192, sec. 4. -- Amended 1960 Ky. Acts ch. 147, sec. 2. -
- Amended 1956 Ky. Acts ch. 77, sec. 3. -- Amended 1952 Ky. Acts ch. 182, sec. 1. -
- Amended 1950 Ky. Acts ch. 198, sec. 1. -- Amended 1948 Ky. Acts ch. 64, sec. 2. -
- Amended 1946 Ky. Acts ch. 37, sec. 1. -- Recodified 1942 Ky. Acts ch. 208, sec. 1,
effective October 1, 1942, from Ky. Stat. sec. 4883.
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