H 163

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1H.163
2 Introduced by Representatives Priestley of Bradford, Carris-Duncan of
3Whitingham, Duke of Burlington, Marcotte of Coventry, Olson
4of Starksboro, and White of Bethel
5 Referred to Committee on
6 Date:
7 Subject: Labor; workersʼ compensation; definitions; translation services;
8preauthorization; penalties
9 Statement of purpose of bill as introduced: This bill proposes to include health
10 insurance benefits in the definition of wages for workers’ compensation
11 claims; to require carriers to pay for translation services; to allow claimants to
12 request medical case management services; and to increase penalties for late
13 payments of workers’ compensation benefits.
14    An act relating to workersʼ compensation
15 It is hereby enacted by the General Assembly of the State of Vermont:
16 Sec. 1. 21 V.S.A § 601 is amended to read:
17 § 601. DEFINITIONS
18    As used in this chapter:
19***
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1(13) “Wages” includes bonuses and the market value of health
2 insurance, board, lodging, fuel, and other advantages that can be estimated in
3 money and that the employee receives from the employer as a part of the
4 employee’s remuneration, but does not include any sum paid by the employer
5 to the employee to cover any special expenses entailed on the employee by the
6 nature of the employment.
7***
8(31) “Medical case management” means the planning and coordination
9 of health care services appropriate to achieve the goal of medical
10 rehabilitation.
11(A) Medical case management may include medical case assessment,
12 including a personal interview with the injured employee; assistance in
13 developing, implementing, and coordinating a medical care plan with health
14 care providers in consultation with the injured employee and the employees’
15 family; and an evaluation of treatment results. The goal of medical case
16 management is to provide the injured employee with reasonable treatment
17 options to ensure that the injured employee can make an informed choice.
18(B) Medical Case Managers shall not provide medical care or adjust
19 claims.
20(C) An injured employee shall be entitled to medical case
21 management services if reasonably supported. Reasonable support includes a
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1 recommendation made by a health care provider or evidence demonstrating the
2 injured employee’s medical recovery would benefit from the services, or both.
3 Sec. 2 21 V.S.A. § 602 is amended to read:
4 § 602. PROCESS AND PROCEDURE
5***
6    (d) When an injured employee does not speak English fluently, the
7 employer shall pay for translation services to ensure the injured employee fully
8 understands the employee’s rights and can effectively participate in the
9 employee’s medical recovery and the workers’ compensation claims process.
10 Sec. 3. 21 V.S.A. 640b is amended to read:
11 § 640b. REQUEST FOR PREAUTHORIZATION TO DETERMINE IF
12PROPOSED BENEFITS OR SERVICES ARE NECESSARY
13    (a) As used in this section,
14(1) “benefits” means medical treatment and surgical, medical, and
15 nursing services and supplies, including prescription drugs and durable
16 medical equipment; and
17(2) “services” means medical case management services.
18***
19    (e) Within 14 days after receiving a request for preauthorization of
20 proposed medical case management services, the insurer shall do one of the
21 following, in writing:
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1(1) Authorize the services and notify the injured employee, the
2 Department, and the treating provider recommending the services, if
3 applicable.
4(2) Deny the services because the entire claim is disputed, and the
5 Commissioner has not issued an interim order to pay benefits. The insurer
6 shall notify the injured employee, the Department, and the treating provider
7 recommending the services, if applicable, of the decision to deny benefits.
8(3) Deny the request if there is not reasonable support for the requested
9 services. The insurer shall notify the injured employee, the Department, and
10 the treating provider recommending the services, if applicable, of the decision
11 to deny benefits.
12(4) Notify the injured employee, the Department, and the treating
13 provider recommending the services, if applicable, that the insurer has
14 scheduled an examination of the injured employee pursuant to section 655 of
15 this title or ordered a medical record review pursuant to section 655a of this
16 title. Based on the examination or review, the insurer shall notify the injured
17 employee and the Department of the decision within 45 days after a request for
18 preauthorization. The Commissioner may, in the Commissioner’s sole
19 discretion, grant a 10-day extension to the insurer to authorize or deny the
20 services, and such an extension shall not be subject to appeal.
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1    (f) If the insurer fails to authorize or deny the services pursuant to
2 subsection (e) of this section within 14 days after receiving a request, the
3 injured employee or the injured employee’s treating provider, if applicable,
4 may request that the Department issue an order authorizing services. After
5 receipt of the request, the Department shall issue an interim order within five
6 days after notice to the insurer, and five days in which to respond, absent
7 evidence that the entire claim is disputed. Upon request of a party, the
8 Commissioner shall notify the parties that the services have been authorized by
9 operation of law.
10    (g) If the insurer denies the preauthorization of the services pursuant to
11 subdivision (e)(2), (3), or (4) of this section, the Commissioner may, on the
12 Commissioner’s own initiative or upon a request by the injured worker, issue
13 an order authorizing the services if the Commissioner finds that the evidence
14 shows that the services are reasonably supported.
15 Sec. 4. 21 V.S.A. § 650 is amended to read:
16 § 650. PAYMENT; AVERAGE WAGE; COMPUTATION
17***
18    (f)(1)(A) When benefits have been awarded or are not in dispute as
19 provided in subsection (e) of this section, the employer shall establish a
20 weekday on which payment shall be mailed or deposited and notify the
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1 claimant and the Department of that day. The employer shall ensure that each
2 weekly payment is mailed or deposited on or before the day established.
3(B) Payment shall be made by direct deposit to a claimant who elects
4 that payment method. The employer shall notify the claimant of the claimant’s
5 right to payment by direct deposit.
6(2) If the benefit payment is not mailed or deposited on the day
7 established, or if the payment is not mailed or deposited within five business
8 days of the end of the pay period the payment covers, the employer shall pay to
9 the claimant a late fee equal to the greater of $10.00 or;
10(A) five percent of the benefit amount, whichever is greater, for each
11 weekly the first payment that is made after the established day;
12(B) 10 percent of the benefit amount for the second payment that is
13 made after the established day;
14(C) 15 percent of the benefit amount for the third payment that is
15 made after the established day;
16(D) 20 percent of the benefit amount for the fourth payment that is
17 made after the established day; and
18(E) 25 percent of the benefit amount for the fifth and any subsequent
19 payments that are made after the established day.
20(3) As used in this subsection, “paid” means the payment is mailed to
21 the claimant’s mailing address or, in the case of direct deposit, transferred into
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1 the designated account. In the event of a dispute, proof of payment shall be
2 established by affidavit.
3 Sec. 5. EFFECTIVE DATE
4    This act shall take effect on July 1, 2025.
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