Kentucky Statutes 342.735 – Additional authority for administrative regulations on expediting payment of temporary total disability benefits, use of managed care, and expediting payment for and resolution of disputes concerning medical benefits
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(1) The commissioner shall promulgate administrative regulations to expedite the payment of temporary total disability and medical expense benefits.
(2) The commissioner may promulgate administrative regulations incorporating managed care intended to reduce costs or to speed the delivery or payment of medical services to employees receiving medical and related benefits under this chapter.
(3) The commissioner shall promulgate administrative regulations pursuant to KRS Chapter 13A establishing an expedited method for resolving medical issues prior to the filing of a claim with the Department of Workers’ Claims. The administrative regulations shall permit an employee or other interested party, prior to the filing of a claim, to request a determination by an administrative law judge on medical issues relating to the reasonableness or appropriateness of the proposed medical care or relating to the obligation of the employer or the employer’s insurance carrier to make payment of contested medical bills. However, the employee has the burden of proof to show the medical expenses are related to the injury, reasonable and necessary prior to an application of benefits being filed and before an award or order of benefits. Thereafter, the burden is upon the employer. The respondent to the moving party shall be given ten (10) days to answer a request for an expedited determination of medical issues, and the administrative law judge shall issue a ruling within seven (7) days thereafter. The interested parties shall be provided a form to provide to the medical care provider and the completed form filed with the department and served upon the respondent shall initiate the time for response and determination.
Effective: July 15, 2010
History: Amended 2010 Ky. Acts ch. 24, sec. 1844, effective July 15, 2010. — Amended 2000 Ky. Acts ch. 514, sec. 32, effective July 14, 2000. — Amended 1996 (1st Extra. Sess.) Ky. Acts ch. 1, sec. 67, effective December 12, 1996. — Amended
1994 Ky. Acts ch. 181, Part 5, sec. 21, effective April 4, 1994. — Created 1980 Ky. Acts ch. 104, sec. 17, effective July 15, 1980.
(2) The commissioner may promulgate administrative regulations incorporating managed care intended to reduce costs or to speed the delivery or payment of medical services to employees receiving medical and related benefits under this chapter.
Terms Used In Kentucky Statutes 342.735
- Answer: The formal written statement by a defendant responding to a civil complaint and setting forth the grounds for defense.
- Carrier: means any insurer, or legal representative thereof, authorized to insure the liability of employers under this chapter and includes a self-insurer. See Kentucky Statutes 342.0011
- Commissioner: means the commissioner of the Department of Workers' Claims under the direction and supervision of the secretary of the Education and Labor Cabinet. See Kentucky Statutes 342.0011
- Department: means the Department of Workers' Claims in the Education and
Labor Cabinet. See Kentucky Statutes 342.0011 - Injury: when used generally, unless the context indicates otherwise, shall include an occupational disease and damage to a prosthetic appliance, but shall not include a psychological, psychiatric, or stress-related change in the human organism, unless it is a direct result of a physical injury. See Kentucky Statutes 342.0011
- Medical and related benefits: means payments made for medical, hospital, burial, and other services as provided in this chapter, other than income benefits. See Kentucky Statutes 342.0011
- Medical services: means medical, surgical, dental, hospital, nursing, and medical rehabilitation services, medicines, and fittings for artificial or prosthetic devices. See Kentucky Statutes 342.0011
- Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
- Temporary total disability: means the condition of an employee who has not reached maximum medical improvement from an injury and has not reached a level of improvement that would permit a return to employment. See Kentucky Statutes 342.0011
(3) The commissioner shall promulgate administrative regulations pursuant to KRS Chapter 13A establishing an expedited method for resolving medical issues prior to the filing of a claim with the Department of Workers’ Claims. The administrative regulations shall permit an employee or other interested party, prior to the filing of a claim, to request a determination by an administrative law judge on medical issues relating to the reasonableness or appropriateness of the proposed medical care or relating to the obligation of the employer or the employer’s insurance carrier to make payment of contested medical bills. However, the employee has the burden of proof to show the medical expenses are related to the injury, reasonable and necessary prior to an application of benefits being filed and before an award or order of benefits. Thereafter, the burden is upon the employer. The respondent to the moving party shall be given ten (10) days to answer a request for an expedited determination of medical issues, and the administrative law judge shall issue a ruling within seven (7) days thereafter. The interested parties shall be provided a form to provide to the medical care provider and the completed form filed with the department and served upon the respondent shall initiate the time for response and determination.
Effective: July 15, 2010
History: Amended 2010 Ky. Acts ch. 24, sec. 1844, effective July 15, 2010. — Amended 2000 Ky. Acts ch. 514, sec. 32, effective July 14, 2000. — Amended 1996 (1st Extra. Sess.) Ky. Acts ch. 1, sec. 67, effective December 12, 1996. — Amended
1994 Ky. Acts ch. 181, Part 5, sec. 21, effective April 4, 1994. — Created 1980 Ky. Acts ch. 104, sec. 17, effective July 15, 1980.