Missouri Revised Statutes
Chapter 287
Workers' Compensation Law
←287.135
Section 287.140.1
287.141→
August 28, 2015
Employer to provide medical and other services, transportation, artificial devices, reactivation of claim--duties of health care providers--refusal of treatment, effect--medical evidence--division, commission responsibilities--notice to health care provider of workers' compensation claim, contents, effect--use of employee leave time.
287.140. 1. In addition to all other compensation paid to the
employee under this section, the employee shall receive and the employer
shall provide such medical, surgical, chiropractic, and hospital treatment,
including nursing, custodial, ambulance and medicines, as may reasonably be
required after the injury or disability, to cure and relieve from the
effects of the injury. If the employee desires, he shall have the right to
select his own physician, surgeon, or other such requirement at his own
expense. Where the requirements are furnished by a public hospital or
other institution, payment therefor shall be made to the proper
authorities. Regardless of whether the health care provider is selected by
the employer or is selected by the employee at the employee's expense, the
health care provider shall have the affirmative duty to communicate fully
with the employee regarding the nature of the employee's injury and
recommended treatment exclusive of any evaluation for a permanent
disability rating. Failure to perform such duty to communicate shall
constitute a disciplinary violation by the provider subject to the
provisions of chapter 620. When an employee is required to submit to
medical examinations or necessary medical treatment at a place outside of
the local or metropolitan area from the employee's principal place of
employment, the employer or its insurer shall advance or reimburse the
employee for all necessary and reasonable expenses; except that an injured
employee who resides outside the state of Missouri and who is employed by
an employer located in Missouri shall have the option of selecting the
location of services provided in this section either at a location within
one hundred miles of the injured employee's residence, place of injury or
place of hire by the employer. The choice of provider within the location
selected shall continue to be made by the employer. In case of a medical
examination if a dispute arises as to what expenses shall be paid by the
employer, the matter shall be presented to the legal advisor, the
administrative law judge or the commission, who shall set the sum to be
paid and same shall be paid by the employer prior to the medical
examination. In no event, however, shall the employer or its insurer be
required to pay transportation costs for a greater distance than two
hundred fifty miles each way from place of treatment.
2. If it be shown to the division or the commission that the
requirements are being furnished in such manner that there is reasonable
ground for believing that the life, health, or recovery of the employee is
endangered thereby, the division or the commission may order a change in
the physician, surgeon, hospital or other requirement.
3. All fees and charges under this chapter shall be fair and
reasonable, shall be subject to regulation by the division or the
commission, or the board of rehabilitation in rehabilitation cases. A
health care provider shall not charge a fee for treatment and care which is
governed by the provisions of this chapter greater than the usual and
customary fee the provider receives for the same treatment or service when
the payor for such treatment or service is a private individual or a
private health insurance carrier. The division or the commission, or the
board of rehabilitation in rehabilitation cases, shall also have
jurisdiction to hear and determine all disputes as to such charges. A
health care provider is bound by the determination upon the reasonableness
of health care bills.
4. The division shall, by regulation, establish methods to resolve
disputes concerning the reasonableness of medical charges, services, or
aids. This regulation shall govern resolution of disputes between
employers and medical providers over fees charged, whether or not paid, and
shall be in lieu of any other administrative procedure under this chapter.
The employee shall not be a party to a dispute over medical charges, nor
shall the employee's recovery in any way be jeopardized because of such
dispute. Any application for payment of additional reimbursement, as such
term is used in 8 CSR 50-2.030, as amended, shall be filed not later than:
(1) Two years from the date the first notice of dispute of the
medical charge was received by the health care provider if such services
were rendered before July 1, 2013; and
(2) One year from the date the first notice of dispute of the medical
charge was received by the health care provider if such services were
rendered after July 1, 2013.
Notice shall be presumed to occur no later than five business days after
transmission by certified United States mail.
5. No compensation shall be payable for the death or disability of an
employee, if and insofar as the death or disability may be caused,
continued or aggravated by any unreasonable refusal to submit to any
medical or surgical treatment or operation, the risk of which is, in the
opinion of the division or the commission, inconsiderable in view of the
seriousness of the injury. If the employee dies as a result of an
operation made necessary by the injury, the death shall be deemed to be
caused by the injury.
6. The testimony of any physician or chiropractic physician who
treated the employee shall be admissible in evidence in any proceedings for
compensation under this chapter, subject to all of the provisions of
section 287.210.
7. Every hospital or other person furnishing the employee with
medical aid shall permit its record to be copied by and shall furnish full
information to the division or the commission, the employer, the employee
or his dependents and any other party to any proceedings for compensation
under this chapter, and certified copies of the records shall be admissible
in evidence in any such proceedings.
8. The employer may be required by the division or the commission to
furnish an injured employee with artificial legs, arms, hands, surgical
orthopedic joints, or eyes, or braces, as needed, for life whenever the
division or the commission shall find that the injured employee may be
partially or wholly relieved of the effects of a permanent injury by the
use thereof. The director of the division shall establish a procedure
whereby a claim for compensation may be reactivated after settlement of
such claim is completed. The claim shall be reactivated only after the
claimant can show good cause for the reactivation of this claim and the
claim shall be made only for the payment of medical procedures involving
life-threatening surgical procedures or if the claimant requires the use of
a new, or the modification, alteration or exchange of an existing,
prosthetic device. For the purpose of this subsection, "life threatening"
shall mean a situation or condition which, if not treated immediately, will
likely result in the death of the injured worker.
9. Nothing in this chapter shall prevent an employee being provided
treatment for his injuries by prayer or spiritual means if the employer
does not object to the treatment.
10. The employer shall have the right to select the licensed treating
physician, surgeon, chiropractic physician, or other health care provider;
provided, however, that such physicians, surgeons or other health care
providers shall offer only those services authorized within the scope of
their licenses. For the purpose of this subsection, subsection 2 of
section 287.030 shall not apply.
11. Any physician or other health care provider who orders, directs
or refers a patient for treatment, testing, therapy or rehabilitation at
any institution or facility shall, at or prior to the time of the referral,
disclose in writing if such health care provider, any of his partners or
his employer has a financial interest in the institution or facility to
which the patient is being referred, to the following:
(1) The patient;
(2) The employer of the patient with workers' compensation liability
for the injury or disease being treated;
(3) The workers' compensation insurer of such employer; and
(4) The workers' compensation adjusting company for such insurer.
12. Violation of subsection 11 of this section is a class A
misdemeanor.
13. (1) No hospital, physician or other health care provider, other
than a hospital, physician or health care provider selected by the employee
at his own expense pursuant to subsection 1 of this section, shall bill or
attempt to collect any fee or any portion of a fee for services rendered to
an employee due to a work-related injury or report to any credit reporting
agency any failure of the employee to make such payment, when an injury
covered by this chapter has occurred and such hospital, physician or health
care provider has received actual notice given in writing by the employee,
the employer or the employer's insurer. Actual notice shall be deemed
received by the hospital, physician or health care provider five days after
mailing by certified mail by the employer or insurer to the hospital,
physician or health care provider.
(2) The notice shall include:
(a) The name of the employer;
(b) The name of the insurer, if known;
(c) The name of the employee receiving the services;
(d) The general nature of the injury, if known; and
(e) Where a claim has been filed, the claim number, if known.
(3) When an injury is found to be noncompensable under this chapter,
the hospital, physician or other health care provider shall be entitled to
pursue the employee for any unpaid portion of the fee or other charges for
authorized services provided to the employee. Any applicable statute of
limitations for an action for such fees or other charges shall be tolled
from the time notice is given to the division by a hospital, physician or
other health care provider pursuant to subdivision (6) of this subsection,
until a determination of noncompensability in regard to the injury which is
the basis of such services is made, or in the event there is an appeal to
the labor and industrial relations commission, until a decision is rendered
by that commission.
(4) If a hospital, physician or other health care provider or a debt
collector on behalf of such hospital, physician or other health care
provider pursues any action to collect from an employee after such notice
is properly given, the employee shall have a cause of action against the
hospital, physician or other health care provider for actual damages
sustained plus up to one thousand dollars in additional damages, costs and
reasonable attorney's fees.
(5) If an employer or insurer fails to make payment for authorized
services provided to the employee by a hospital, physician or other health
care provider pursuant to this chapter, the hospital, physician or other
health care provider may proceed pursuant to subsection 4 of this section
with a dispute against the employer or insurer for any fees or other
charges for services provided.
(6) A hospital, physician or other health care provider whose
services have been authorized in advance by the employer or insurer may
give notice to the division of any claim for fees or other charges for
services provided for a work-related injury that is covered by this
chapter, with copies of the notice to the employee, employer and the
employer's insurer. Where such notice has been filed, the administrative
law judge may order direct payment from the proceeds of any settlement or
award to the hospital, physician or other health care provider for such
fees as are determined by the division. The notice shall be on a form
prescribed by the division.
14. The employer may allow or require an employee to use any of the
employee's accumulated paid leave, personal leave, or medical or sick leave
to attend to medical treatment, physical rehabilitation, or medical
evaluations during work time. The intent of this subsection is to
specifically supercede and abrogate any case law that contradicts the
express language of this section.
(RSMo 1939 § 3701, A.L. 1951 p. 613, A.L. 1957 p. 560, A.L. 1959 S.B.
167, A.L. 1965 pp. 397, 413, A.L. 1977 S.B. 49, S.B. 399, A.L.
1980 H.B. 1396, A.L. 1983 H.B. 243 & 260, A.L. 1988 H.B. 1277,
A.L. 1990 S.B. 751, A.L. 1992 H.B. 975, A.L. 1993 S.B. 251, A.L.
1998 H.B. 1237, et al., A.L. 2005 S.B. 1 & 130, A.L. 2013 S.B. 1)
Prior revision: 1929 § 3311
Effective 1-01-14
2005
1998
2005
287.140. 1. In addition to all other compensation paid to the employee
under this section, the employee shall receive and the employer shall provide
such medical, surgical, chiropractic, and hospital treatment, including
nursing, custodial, ambulance and medicines, as may reasonably be required
after the injury or disability, to cure and relieve from the effects of the
injury. If the employee desires, he shall have the right to select his own
physician, surgeon, or other such requirement at his own expense. Where the
requirements are furnished by a public hospital or other institution, payment
therefor shall be made to the proper authorities. Regardless of whether the
health care provider is selected by the employer or is selected by the
employee at the employee's expense, the health care provider shall have the
affirmative duty to communicate fully with the employee regarding the nature
of the employee's injury and recommended treatment exclusive of any
evaluation for a permanent disability rating. Failure to perform such duty to
communicate shall constitute a disciplinary violation by the provider subject
to the provisions of chapter 620. When an employee is required to submit to
medical examinations or necessary medical treatment at a place outside of the
local or metropolitan area from the employee's principal place of employment,
the employer or its insurer shall advance or reimburse the employee for all
necessary and reasonable expenses; except that an injured employee who
resides outside the state of Missouri and who is employed by an employer
located in Missouri shall have the option of selecting the location of
services provided in this section either at a location within one hundred
miles of the injured employee's residence, place of injury or place of hire
by the employer. The choice of provider within the location selected shall
continue to be made by the employer. In case of a medical examination if a
dispute arises as to what expenses shall be paid by the employer, the matter
shall be presented to the legal advisor, the administrative law judge or the
commission, who shall set the sum to be paid and same shall be paid by the
employer prior to the medical examination. In no event, however, shall the
employer or its insurer be required to pay transportation costs for a greater
distance than two hundred fifty miles each way from place of treatment.
2. If it be shown to the division or the commission that the requirements
are being furnished in such manner that there is reasonable ground for
believing that the life, health, or recovery of the employee is endangered
thereby, the division or the commission may order a change in the physician,
surgeon, hospital or other requirement.
3. All fees and charges under this chapter shall be fair and reasonable,
shall be subject to regulation by the division or the commission, or the
board of rehabilitation in rehabilitation cases. A health care provider
shall not charge a fee for treatment and care which is governed by the
provisions of this chapter greater than the usual and customary fee the
provider receives for the same treatment or service when the payor for such
treatment or service is a private individual or a private health insurance
carrier. The division or the commission, or the board of rehabilitation in
rehabilitation cases, shall also have jurisdiction to hear and determine all
disputes as to such charges. A health care provider is bound by the
determination upon the reasonableness of health care bills.
4. The division shall, by regulation, establish methods to resolve
disputes concerning the reasonableness of medical charges, services, or aids.
This regulation shall govern resolution of disputes between employers and
medical providers over fees charged, whether or not paid, and shall be in lieu
of any other administrative procedure under this chapter. The employee shall
not be a party to a dispute over medical charges, nor shall the employee's
recovery in any way be jeopardized because of such dispute.
5. No compensation shall be payable for the death or disability of an
employee, if and insofar as the death or disability may be caused, continued
or aggravated by any unreasonable refusal to submit to any medical or surgical
treatment or operation, the risk of which is, in the opinion of the division
or the commission, inconsiderable in view of the seriousness of the injury.
If the employee dies as a result of an operation made necessary by the
injury, the death shall be deemed to be caused by the injury.
6. The testimony of any physician or chiropractic physician who treated
the employee shall be admissible in evidence in any proceedings for
compensation under this chapter, subject to all of the provisions of section
287.210.
7. Every hospital or other person furnishing the employee with medical
aid shall permit its record to be copied by and shall furnish full
information to the division or the commission, the employer, the employee or
his dependents and any other party to any proceedings for compensation under
this chapter, and certified copies of the records shall be admissible in
evidence in any such proceedings.
8. The employer may be required by the division or the commission to
furnish an injured employee with artificial legs, arms, hands, surgical
orthopedic joints, or eyes, or braces, as needed, for life whenever the
division or the commission shall find that the injured employee may be
partially or wholly relieved of the effects of a permanent injury by the use
thereof. The director of the division shall establish a procedure whereby a
claim for compensation may be reactivated after settlement of such claim is
completed. The claim shall be reactivated only after the claimant can show
good cause for the reactivation of this claim and the claim shall be made
only for the payment of medical procedures involving life-threatening surgical
procedures or if the claimant requires the use of a new, or the modification,
alteration or exchange of an existing, prosthetic device. For the purpose of
this subsection, "life threatening" shall mean a situation or condition which,
if not treated immediately, will likely result in the death of the injured
worker.
9. Nothing in this chapter shall prevent an employee being provided
treatment for his injuries by prayer or spiritual means if the employer does
not object to the treatment.
10. The employer shall have the right to select the licensed treating
physician, surgeon, chiropractic physician, or other health care provider;
provided, however, that such physicians, surgeons or other health care
providers shall offer only those services authorized within the scope of their
licenses. For the purpose of this subsection, subsection 2 of section
287.030 shall not apply.
11. Any physician or other health care provider who orders, directs or
refers a patient for treatment, testing, therapy or rehabilitation at any
institution or facility shall, at or prior to the time of the referral,
disclose in writing if such health care provider, any of his partners or his
employer has a financial interest in the institution or facility to which the
patient is being referred, to the following:
(1) The patient;
(2) The employer of the patient with workers' compensation liability for
the injury or disease being treated;
(3) The workers' compensation insurer of such employer; and
(4) The workers' compensation adjusting company for such insurer.
12. Violation of subsection 11 of this section is a class A misdemeanor.
13. (1) No hospital, physician or other health care provider, other
than a hospital, physician or health care provider selected by the employee
at his own expense pursuant to subsection 1 of this section, shall bill or
attempt to collect any fee or any portion of a fee for services rendered to an
employee due to a work-related injury or report to any credit reporting
agency any failure of the employee to make such payment, when an injury
covered by this chapter has occurred and such hospital, physician or health
care provider has received actual notice given in writing by the employee, the
employer or the employer's insurer. Actual notice shall be deemed received
by the hospital, physician or health care provider five days after mailing by
certified mail by the employer or insurer to the hospital, physician or
health care provider.
(2) The notice shall include:
(a) The name of the employer;
(b) The name of the insurer, if known;
(c) The name of the employee receiving the services;
(d) The general nature of the injury, if known; and
(e) Where a claim has been filed, the claim number, if known.
(3) When an injury is found to be noncompensable under this chapter, the
hospital, physician or other health care provider shall be entitled to pursue
the employee for any unpaid portion of the fee or other charges for authorized
services provided to the employee. Any applicable statute of limitations for
an action for such fees or other charges shall be tolled from the time notice
is given to the division by a hospital, physician or other health care
provider pursuant to subdivision (6) of this subsection, until a
determination of noncompensability in regard to the injury which is the basis
of such services is made, or in the event there is an appeal to the labor and
industrial relations commission, until a decision is rendered by that
commission.
(4) If a hospital, physician or other health care provider or a debt
collector on behalf of such hospital, physician or other health care provider
pursues any action to collect from an employee after such notice is properly
given, the employee shall have a cause of action against the hospital,
physician or other health care provider for actual damages sustained plus up
to one thousand dollars in additional damages, costs and reasonable
attorney's fees.
(5) If an employer or insurer fails to make payment for authorized
services provided to the employee by a hospital, physician or other health
care provider pursuant to this chapter, the hospital, physician or other
health care provider may proceed pursuant to subsection 4 of this section
with a dispute against the employer or insurer for any fees or other charges
for services provided.
(6) A hospital, physician or other health care provider whose services
have been authorized in advance by the employer or insurer may give notice to
the division of any claim for fees or other charges for services provided for
a work-related injury that is covered by this chapter, with copies of the
notice to the employee, employer and the employer's insurer. Where such
notice has been filed, the administrative law judge may order direct payment
from the proceeds of any settlement or award to the hospital, physician or
other health care provider for such fees as are determined by the division.
The notice shall be on a form prescribed by the division.
14. The employer may allow or require an employee to use any of the
employee's accumulated paid leave, personal leave, or medical or sick leave
to attend to medical treatment, physical rehabilitation, or medical
evaluations during work time. The intent of this subsection is to
specifically supercede and abrogate any case law that contradicts the express
language of this section.
1998
287.140. 1. In addition to all other compensation, the employee
shall receive and the employer shall provide such medical, surgical,
chiropractic, and hospital treatment, including nursing, custodial,
ambulance and medicines, as may reasonably be required after the injury or
disability, to cure and relieve from the effects of the injury. If the
employee desires, he shall have the right to select his own physician,
surgeon, or other such requirement at his own expense. Where the
requirements are furnished by a public hospital or other institution,
payment therefor shall be made to the proper authorities. Regardless of
whether the health care provider is selected by the employer or is selected
by the employee at the employee's expense, the health care provider shall
have the affirmative duty to communicate fully with the employee regarding
the nature of the employee's injury and recommended treatment exclusive of
any evaluation for a permanent disability rating. Failure to perform such
duty to communicate shall constitute a disciplinary violation by the
provider subject to the provisions of chapter 620, RSMo. When an employee
is required to submit to medical examinations or necessary medical
treatment at a place outside of the local or metropolitan area from the
place of injury or the place of his residence, the employer or its insurer
shall advance or reimburse the employee for all necessary and reasonable
expenses; except that an injured employee who resides outside the state of
Missouri and who is employed by an employer located in Missouri shall have
the option of selecting the location of services provided in this section
either at a location within one hundred miles of the injured employee's
residence, place of injury or place of hire by the employer. The choice of
provider within the location selected shall continue to be made by the
employer. In case of a medical examination if a dispute arises as to what
expenses shall be paid by the employer, the matter shall be presented to
the legal advisor, the administrative law judge or the commission, who
shall set the sum to be paid and same shall be paid by the employer prior
to the medical examination. In no event, however, shall the employer or
its insurer be required to pay transportation costs for a greater distance
than two hundred fifty miles each way from place of treatment. In addition
to all other payments authorized or mandated under this subsection, when an
employee who has returned to full-time employment is required to submit to
a medical examination for the purpose of evaluating permanent disability,
or to undergo physical rehabilitation, the employer or its insurer shall
pay a proportionate weekly compensation benefit based on the provisions of
section 287.180 for such wages that are lost due to time spent undergoing
such medical examinations or physical rehabilitation, except that where the
employee is undergoing physical rehabilitation, such proportionate weekly
compensation benefit payment shall be limited to a time period of no more
than twenty weeks. For purposes of this subsection only, "physical
rehabilitation" shall mean the restoration of the seriously injured person
as soon as possible and as nearly as possible to a condition of
self-support and maintenance as an able-bodied worker. Determination as to
what care and restoration constitutes physical rehabilitation shall be the
sole province of the treating physician. Should the employer or its
insurer contest the determination of the treating physician, then the
director shall review the case at question and issue his determination.
Such determination by the director shall be appealable like any other
finding of the director or the division. Serious injury includes, but is
not limited to, quadriplegia, paraplegia, amputations of hand, arm, foot or
leg, atrophy due to nerve injury or nonuse, and back injuries not amenable
alone to recognized medical and surgical procedures.
2. If it be shown to the division or the commission that the
requirements are being furnished in such manner that there is reasonable
ground for believing that the life, health, or recovery of the employee is
endangered thereby, the division or the commission may order a change in
the physician, surgeon, hospital or other requirement.
3. All fees and charges under this chapter shall be fair and
reasonable, shall be subject to regulation by the division or the
commission, or the board of rehabilitation in rehabilitation cases. A
health care provider shall not charge a fee for treatment and care which is
governed by the provisions of this chapter greater than the usual and
customary fee the provider receives for the same treatment or service when
the payor for such treatment or service is a private individual or a
private health insurance carrier. The division or the commission, or the
board of rehabilitation in rehabilitation cases, shall also have
jurisdiction to hear and determine all disputes as to such charges. A
health care provider is bound by the determination upon the reasonableness
of health care bills.
4. The division shall, by regulation, establish methods to resolve
disputes concerning the reasonableness of medical charges, services, or
aids. This regulation shall govern resolution of disputes between
employers and medical providers over fees charged, whether or not paid, and
shall be in lieu of any other administrative procedure under this chapter.
The employee shall not be a party to a dispute over medical charges, nor
shall the employee's recovery in any way be jeopardized because of such
dispute.
5. No compensation shall be payable for the death or disability of an
employee, if and insofar as the death or disability may be caused,
continued or aggravated by any unreasonable refusal to submit to any
medical or surgical treatment or operation, the risk of which is, in the
opinion of the division or the commission, inconsiderable in view of the
seriousness of the injury. If the employee dies as a result of an
operation made necessary by the injury, the death shall be deemed to be
caused by the injury.
6. The testimony of any physician or chiropractic physician who
treated the employee shall be admissible in evidence in any proceedings for
compensation under this chapter, subject to all of the provisions of
section 287.210.
7. Every hospital or other person furnishing the employee with
medical aid shall permit its record to be copied by and shall furnish full
information to the division or the commission, the employer, the employee
or his dependents and any other party to any proceedings for compensation
under this chapter, and certified copies of the records shall be admissible
in evidence in any such proceedings.
8. The employer may be required by the division or the commission to
furnish an injured employee with artificial legs, arms, hands, surgical
orthopedic joints, or eyes, or braces, as needed, for life whenever the
division or the commission shall find that the injured employee may be
partially or wholly relieved of the effects of a permanent injury by the
use thereof. The director of the division shall establish a procedure
whereby a claim for compensation may be reactivated after settlement of
such claim is completed. The claim shall be reactivated only after the
claimant can show good cause for the reactivation of this claim and the
claim shall be made only for the payment of medical procedures involving
life-threatening surgical procedures or if the claimant requires the use of
a new, or the modification, alteration or exchange of an existing,
prosthetic device. For the purpose of this subsection, "life threatening"
shall mean a situation or condition which, if not treated immediately, will
likely result in the death of the injured worker.
9. Nothing in this chapter shall prevent an employee being provided
treatment for his injuries by prayer or spiritual means if the employer
does not object to the treatment.
10. The employer shall have the right to select the licensed treating
physician, surgeon, chiropractic physician, or other health care provider;
provided, however, that such physicians, surgeons or other health care
providers shall offer only those services authorized within the scope of
their licenses. For the purpose of this subsection, subsection 2 of
section 287.030 shall not apply.
11. Any physician or other health care provider who orders, directs
or refers a patient for treatment, testing, therapy or rehabilitation at
any institution or facility shall, at or prior to the time of the referral,
disclose in writing if such health care provider, any of his partners or
his employer has a financial interest in the institution or facility to
which the patient is being referred, to the following:
(1) The patient;
(2) The employer of the patient with workers' compensation liability
for the injury or disease being treated;
(3) The workers' compensation insurer of such employer; and
(4) The workers' compensation adjusting company for such insurer.
12. Violation of subsection 11 of this section is a class A
misdemeanor.
13. (1) No hospital, physician or other health care provider, other
than a hospital, physician or health care provider selected by the employee
at his own expense pursuant to subsection 1 of this section, shall bill or
attempt to collect any fee or any portion of a fee for services rendered to
an employee due to a work-related injury or report to any credit reporting
agency any failure of the employee to make such payment, when an injury
covered by this chapter has occurred and such hospital, physician or health
care provider has received actual notice given in writing by the employee,
the employer or the employer's insurer. Actual notice shall be deemed
received by the hospital, physician or health care provider five days after
mailing by certified mail by the employer or insurer to the hospital,
physician or health care provider.
(2) The notice shall include:
(a) The name of the employer;
(b) The name of the insurer, if known;
(c) The name of the employee receiving the services;
(d) The general nature of the injury, if known; and
(e) Where a claim has been filed, the claim number, if known.
(3) When an injury is found to be noncompensable under this chapter,
the hospital, physician or other health care provider shall be entitled to
pursue the employee for any unpaid portion of the fee or other charges for
authorized services provided to the employee. Any applicable statute of
limitations for an action for such fees or other charges shall be tolled
from the time notice is given to the division by a hospital, physician or
other health care provider pursuant to subdivision (6) of this subsection,
until a determination of noncompensability in regard to the injury which is
the basis of such services is made, or in the event there is an appeal to
the labor and industrial relations commission, until a decision is rendered
by that commission.
(4) If a hospital, physician or other health care provider or a debt
collector on behalf of such hospital, physician or other health care
provider pursues any action to collect from an employee after such notice
is properly given, the employee shall have a cause of action against the
hospital, physician or other health care provider for actual damages
sustained plus up to one thousand dollars in additional damages, costs and
reasonable attorney's fees.
(5) If an employer or insurer fails to make payment for authorized
services provided to the employee by a hospital, physician or other health
care provider pursuant to this chapter, the hospital, physician or other
health care provider may proceed pursuant to subsection 4 of this section
with a dispute against the employer or insurer for any fees or other
charges for services provided.
(6) A hospital, physician or other health care provider whose
services have been authorized in advance by the employer or insurer may
give notice to the division of any claim for fees or other charges for
services provided for a work-related injury that is covered by this
chapter, with copies of the notice to the employee, employer and the
employer's insurer. Where such notice has been filed, the administrative
law judge may order direct payment from the proceeds of any settlement or
award to the hospital, physician or other health care provider for such
fees as are determined by the division. The notice shall be on a form
prescribed by the division.
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