MISSISSIPPI LEGISLATURE
2013 Regular Session
To: Insurance
By: Senator(s) Frazier
AN ACT TO AMEND SECTION 71-3-15, MISSISSIPPI CODE OF 1972, TO PROVIDE THAT UNDER THE WORKERS' COMPENSATION LAW, AN INJURED EMPLOYEE SHALL HAVE THE RIGHT TO SELECT THE SPECIALISTS, PRACTITIONERS OR HEALTH CARE PROVIDERS OF HIS CHOOSING WHO PROVIDE THE TYPE OF TREATMENT THAT IS PRESCRIBED BY HIS CHOSEN PHYSICIAN; AND FOR RELATED PURPOSES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:
SECTION 1. Section 71-3-15, Mississippi Code of 1972, is amended as follows:
71-3-15. (1) The employer
shall furnish such medical, surgical, and other attendance or treatment, nurse
and hospital service, medicine, crutches, artificial members, and other
apparatus for such period as the nature of the injury or the process of
recovery may require. The injured employee shall have the right to accept the
services furnished by the employer or, in his discretion, to select one (1)
competent physician of his choosing and to select such other specialists * * *, practitioners or
health care providers of his choosing who provide the type of treatment that is
prescribed by his chosen physician * * *. Referrals by
the chosen physician shall be limited to one (1) physician within a specialty
or subspecialty area. Except in an emergency requiring immediate medical
attention, any additional selection of physicians by the injured employee or
further referrals must be approved by the employer, if self-insured, or the
carrier * * *
before obtaining the services of the physician at the expense of the
employer or carrier. If denied, the injured employee may apply to the
commission for approval of the additional selection or referral, and if the
commission determines that * * * the request is reasonable, the employee
may be authorized to obtain * * * that treatment at the expense of
the employer or carrier. Approval by the employer or carrier does not require
approval by the commission. A physician to whom the employee is referred by
his employer shall not constitute the employee's selection, unless the
employee, in writing, accepts the employer's referral as his own selection.
However, if the employee is treated for his alleged work-related injury or
occupational disease by a physician for six (6) months or longer, or if the
employee has surgery for the alleged work-related injury or occupational
disease performed by a physician, then that physician shall be deemed the
employee's selection. * * *
If the employer * * *
desires, he may have the employee examined by a physician other than of
the employee's choosing for the purpose of evaluating temporary or permanent
disability or medical treatment being rendered under such reasonable terms and
conditions as may be prescribed by the commission. If at any time during * * * that period the employee
unreasonably refuses to submit to medical or surgical treatment, the commission
shall, by order, suspend the payment of further compensation during such time
as * * * the
refusal continues, and no compensation shall be paid at any time during the
period of * * *
the suspension; * * * however, no claim for medical or surgical treatment
shall be valid and enforceable, as against * * * the employer, unless within twenty
(20) days following the first treatment the physician or provider giving such
treatment * * * furnishes to the employer, if self-insured, or its
carrier, a preliminary report of * * * the injury and treatment, on a form
or in a format approved by the commission. * * * Later reports of * * * the injury and treatment must be
submitted at least every thirty (30) days thereafter until such time as a final
report * * *
has been made. Reports * * * that are required to be filed * * * under this subsection shall be
furnished by the medical provider to the employer or carrier, and it shall be
the responsibility of the employer or carrier receiving * * * those reports to promptly furnish
copies to the commission. The commission may, in its discretion, excuse the
failure to furnish * * *
the reports within the time prescribed * * * in this subsection if it finds
good cause to do so, and may, upon request of any party in interest, order or
direct the employer or carrier to pay the reasonable value of medical services
rendered to the employee.
(2) Whenever in the opinion
of the commission a physician has not correctly estimated the degree of
permanent disability or the extent of the temporary disability of an injured
employee, the commission shall have the power to cause * * * the employee to be examined by a
physician selected by the commission, and to obtain from * * * the physician a report containing
his estimate of * * *
the disabilities. The commission shall have the power, in its
discretion, to charge the cost of * * * the examination to the employer, if
he is a self-insurer, or to the insurance company which is carrying the risk.
(3) In carrying out this
section, the commission shall establish an appropriate medical provider fee
schedule, medical cost containment system and utilization review * * * that incorporates one or more
medical review panels to determine the reasonableness of charges and the
necessity for the services, and limitations on fees to be charged by medical
providers for testimony and copying or completion of records and reports and
other provisions * * *
that, at the discretion of the commission, are necessary to encompass a
complete medical cost containment program. The commission may contract with a
private organization or organizations to establish and implement such a medical
cost containment system and fee schedule with the cost for administering such a
system to be paid out of the administrative expense fund as provided in this
chapter. All fees and other charges for * * * that treatment or service shall be
limited to such charges as prevail in the same community for similar treatment
and shall be subject to regulation by the commission. No medical bill shall be
paid to any doctor until all forms and reports required by the commission have
been filed. Any employee receiving treatment or service under the provisions
of this chapter may not be held responsible for any charge for * * * that treatment or service, and no
doctor, hospital or other recognized medical provider shall attempt to bill,
charge or otherwise collect from the employee any amount greater than or in
excess of the amount paid by the employer, if self-insured, or its workers'
compensation carrier. Any dispute over the amount charged for service rendered
under the provisions of this chapter, or over the amount of reimbursement for
services rendered under the provisions of this chapter, shall be limited to and
resolved between the provider and the employer or carrier in accordance with
the fee dispute resolution procedures adopted by the commission.
(4) The liability of an
employer for medical treatment as * * * provided in this section shall
not be affected by the fact that his employee was injured through the fault or
negligence of a third party, not in the same employ, provided the injured
employee was engaged in the scope of his employment when injured. The employer
shall, however, have a cause of action against * * * the third party to recover any
amounts paid by him for * * *such the medical treatment.
(5) An injured worker who
believes that his best interest has been prejudiced by the findings of the
physician designated by the employer or carrier shall have the privilege of a
medical examination by a physician of his own choosing, at the expense of the
carrier or employer. * * *
The examination may be had at any time after injury and * * * before the closing of the case,
provided that the charge shall not exceed One Hundred Dollars ($100.00) and
shall be paid by the carrier or employer * * * if the previous medical findings
are upset, but paid by the employee if previous medical findings are confirmed.
(6) Medical and surgical
treatment as provided in this section shall not be deemed to be privileged
insofar as carrying out the provisions of this chapter is concerned. All
findings pertaining to a second opinion medical examination, at the instance of
the employer, shall be reported as * * * required in this section within
fourteen (14) days of the examination, except that copies thereof shall also be
furnished by the employer or carrier to the employee. All findings pertaining
to an independent medical examination by order of the commission shall be
reported as provided in the order for * * * the examination.
(7) Any medical benefits
paid by reason of any accident or health insurance policy or plan paid for by
the employer, which were for expenses of medical treatment under this section,
are, upon notice to the carrier * * * before payment by it, subject
to subrogation in favor of the accident or health insurance company to the
extent of its payment for medical treatment under this section. Reimbursement
to the accident or health insurance company by the carrier or employer, to the
extent of * * *
the reimbursement, shall constitute payment by the employer or carrier
of medical expenses under this section. Under no circumstances, shall any
subrogation be had by any insurance company against any compensation benefits
paid under this chapter.
SECTION 2. This act shall take effect and be in force from and after July 1, 2013.