Current through Register No. 40, October 3, 2024
(a) Carriers shall familiarize themselves
with the provisions of the statute and these rules.
(b) Carriers shall obtain and maintain a
supply of mandated state forms which they shall supply to their insured's and
their own claims offices.
(c)
Carriers shall keep their insured informed of the current address, telephone
number, and email address of their nearest claims office.
(d) Carriers shall provide facilities within
the state to service claims.
(e) If
the carrier elects to substitute an unaffiliated adjustment service, or a third
party administrator, it shall:
(1) Confirm
that the third party administrator is licensed by the state;
(2) Delegate sufficient authority to comply
with the statute and these rules;
(3) Notify the department of labor and the
injured worker;
(4) Notify the
department and injured worker of any subsequent change in the election of the
third party as soon as possible after the change is made to the department and
injured worker; and
(5) Include in
each notification shall include the claim number, the address, the email
address, and phone number of the third party administrator.
(f) Carriers shall process all
claims as quickly as possible. After receiving the first notice of a claim, the
claim shall be paid or denied within 21 days as provided in
Lab
506.02.
(g) Carriers shall promptly and critically
review employers' supplemental reports for the purpose of making a
determination as to compensable disability within 21 days of receipt of the
report.
(h) The carrier or
self-insurer who determines that a medical examination of an injured employee
is needed under RSA
281-A:38 shall:
(1) At least 10 days prior to the scheduled
examination, notify the employee by letter, copy to the department, of the time
and place of the examination;
(2)
Set forth the employee's rights, obligations and possible penalties under
RSA
281-A:38 and
RSA
281-A:39;
(3) Provide transportation to the examination
if needed and requested or reimburse the claimant for mileage and toll costs to
the examination as provided by
Lab
506.02(i).
(4) Not schedule an examination more than 50
miles radius from the employee's current residence, unless a waiver has been
obtained from the commissioner, as follows:
a. Provide the current address of the injured
worker and the address of location of the proposed examination;
b. Demonstrate to the commissioner there is
no qualified independent medical provider available within the 50-mile radius
who will perform the examination;
c. Demonstrate that unique circumstances
exist that would make scheduling an independent medical examination outside the
50-mile radius necessary;
d. Obtain
the waiver prior to the scheduling of the examination;
e. State that the concurrence to the request
has been sought from the opposing party;
f. State that the opposing party objects,
consents or takes no position to the request;
g. State all attempts that were made to
contact the opposing party, if unable to contact or elicit a response;
and
h. Receive a response from the
commissioner within 10 days of the request;
(5) Not schedule more than 2 examinations
within a year's time, unless they have obtained a waiver from the commissioner
as follows:
a. Demonstrate that the injured
workers condition requires an independent medical examination by a practitioner
in a different specialty; or.
b.
Demonstrate that a change in the injured workers condition has occurred since
the last independent medical examination that necessitates a review of the
current treatment; or
c. Indicate
that an intervening incident has occurred since the last independent medical
examination that requires additional review of current treatment or;
d. Demonstrate that unique circumstances
exists that would make scheduling an additional examination
necessary.
e. Obtain the waiver
prior to the scheduling of the examination;
f. State that concurrence to the request has
been sought from opposing party;
g.
State if opposing party objects, consents, or takes or takes no position to the
request;
h. State all attempts
that were made to contact opposing party, if unable to contact or elicit a
response; and
i. Receive a response
from the commissioner within 10 days of receipt of the request; and
(6) Determine that the health care
provider is certified by the appropriate specialty board as recognized by the
American Board of Medical Specialties or the health care provider shall have
obtained the approval of the commissioner for those specialties not recognized
by such board by fulfilling requirements substantially similar to those of the
American Board of Medical Specialties.
(i) Failure to comply with (h), above, shall
preclude the carrier from suspending benefits for the employee's failure to
comply.
#2256, eff 1-2-83; ss by #2935, eff 12-27-84, EXPIRED:
12-27-90
New. #5041, eff 1-9-91; ss by
#5235, eff 9-27-91, EXPIRED: 9-27-97
New. #6631, INTERIM, eff 11-16-97,
EXPIRED: 3-16-98
New. #6806, eff 7-18-98); ss by
#8682, INTERIM, eff 7-15-06, EXPIRED: 1-11-07
New. #9019, eff
11-1-07
