2009 Rhode Island Code
Title 28 - Labor and Labor Relations
CHAPTER 28-33 - Workers' Compensation – Benefits
§ 28-33-34.1 - Schedule of medical review.

SECTION 28-33-34.1

   § 28-33-34.1  Schedule of medical review. – (a) On or about twenty-six (26) weeks from the date of a compensable injury, any person obtaining incapacity benefits shall be examined and their diagnosis and treatment reviewed by a comprehensive independent health care review team or an impartial medical examiner. The comprehensive independent health care review team or impartial medical examiner shall be selected through a mechanism to be established by the administrator of the medical advisory board. The results of the examination and review shall be provided to the employee and the insurer or self-insured employer within fourteen (14) days of the examination and a copy shall be filed with the medical advisory board. The comprehensive independent health care review team and/or impartial medical examiner shall review the treating physician's findings and diagnosis and make its own findings of the extent and nature of the claimed disability, the degree of functional impairment and/or disability, the expectation of further medical improvement, any further medical care, treatment, and/or rehabilitation services that may be required to reach maximum medical improvement, type(s) of work that can be performed within existing physical capacity, the degree of disability expected at maximum medical improvement, whether the employee can return to the former position of employment, and compliance of the treating physician with protocols and standards of medical care established by the medical advisory board. The report shall be admissible as the court's exhibit. A party may be permitted to cross-examine the author(s) of the report with leave of the court.

   (b) On or about thirteen (13) weeks after any examination under this section or § 28-33-35, a comprehensive independent health care review team or impartial medical examiner shall perform a similar review. The same comprehensive independent health care review team or impartial medical examiner may not perform more than two (2) consecutive reviews on a particular employee.

   (c) The medical reviews required by this section may be satisfied by summary review if:

   (1) The employee is receiving benefits for total incapacity, and the employee's condition is so severe or permanent that examination and review is clearly inappropriate or unnecessary;

   (2) The employee's return to work or a suspension of benefits for other reasons is imminent;

   (3) The employee is under and following a rehabilitation program approved by the director of labor and training;

   (4) The employee's condition has been previously reviewed by the attending physician, comprehensive independent health care review team, or impartial medical examiner, or in an approved rehabilitation program report, and was then determined to be and remains stable and at maximum medical improvement, and the employee has had an earnings capacity adjustment appropriate to his or her present level of earnings capacity; or

   (5) The employee is receiving weekly compensation benefits from a self-insured employer that has filed and received approval of a request for exemption from the provisions of this section.

   (d) Failure to appear for examination under this section shall be grounds for suspension or termination of benefits unless justified by good cause. Residence outside the state does not, by itself, constitute good cause for failure to appear.