SENATE DOCKET, NO. 1684        FILED ON: 1/16/2015

SENATE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 976

The Commonwealth of Massachusetts

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PRESENTED BY:

James B. Eldridge

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To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
Court assembled:

The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:

An Act increasing injured workers’ access to medical care and workers’ compensation benefits.

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PETITION OF:

SENATE DOCKET, NO. 1684        FILED ON: 1/16/2015

SENATE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 976

The Commonwealth of Massachusetts

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In the One Hundred and Eighty-Ninth General Court
(2015-2016)

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An Act increasing injured workers’ access to medical care and workers’ compensation benefits.

Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:
 

SECTION 1.  Section 6 of chapter 23E of the General Laws, as appearing in the 2012 Official Edition, is hereby amended by striking out, in line 69, the word “or,” and  inserting after the words “fifty-two” in line 70, the following words:-

, a denial based solely on a dispute over the existence of an employment relationship, or a dispute limited to the determination of the employee’s average weekly wages under section 1(1) of chapter 152

SECTION 2.  Section 1 of chapter 152 of the General Laws, as appearing in the 2012 Official Edition, is hereby amended by inserting after the word “wages,” in line 21, the following words:-              

.  In determining the employee’s average weekly wages, all available evidence of the employee’s paid wages, wages earned and required to be paid even if not actually received by the employee, and hours worked shall be considered.  Where the injured employee earned less than the wages required to be paid under chapter 149, chapter 151, or any other local, state, or federal law, the employee’s average weekly wages shall be calculated as if the employee had earned wages in compliance with the law

SECTION 3.  Section 1 of chapter 152 of the General Laws, as appearing in the 2012 Official Edition, is hereby further amended by striking out, in line 176, the word “twenty,” and inserting, after the word “rate” ,” in line 176, the following word:-

thirty

SECTION 4.  Section 7 of chapter 152 of the General Laws is amended by inserting, in line 16, after the word “case,” the following words:-

In determining whether to commence payment of weekly benefits, the insurer, including in cases where the insurer is the Trust Fund or the Commonwealth, shall consider all information and evidence provided by both the employer and the employee.  The insurer shall not refuse to commence payment of weekly benefits on grounds that the employer has failed to respond, to provide certain information, or otherwise to participate.  Where the employer has failed to respond, to provide information, or otherwise to participate, the insurer shall make its determination based on the information and evidence provided by the employee; provided, however, that the insurer does not waive any defenses if it commences payment on this basis.

SECTION 5.  Chapter 152 of the General Laws, as appearing in the 2012 Official Edition, is hereby amended by inserting after section 11D, the following section:-

Section 11E.  Interpretation.

Where the injured employee’s primary language is not English, the department shall provide a qualified interpreter for a conciliation held under section 10 of chapter 152, a conference held under section 10A of chapter 152, a hearing held under section 11 of chapter 152, or an impartial medical exam held under section 11A of chapter 152.

SECTION 6.  Section 15A of chapter 152 of the General Laws, as appearing in the 2012 Official Edition, is hereby amended by inserting after the word “insurers,” in line 2, the following words:-

counting and including the Trust Fund

SECTION 7.  Section 15A of chapter 152 of the General Laws, as appearing in the 2012 Official Edition, is hereby further amended by striking out, in line 6, the words “as may be selected by a single member of the board” and inserting after the word “or,” in line 6, the following words:-

, in the absence of a mutual agreement, the Trust Fund,

SECTION 8.  Section 15A of chapter 152 of the General Laws, as appearing in the 2012 Official Edition, is hereby further amended by striking out, in line 11, the words “selected by the single member as aforesaid” and inserting after the word “or” in line 11, the following words:-

the Trust Fund

SECTION 9.  Section 22 of chapter 152, as appearing in the 2012 Official Edition, is hereby amended by striking out, in line 9, the words “may be given in the manner therein provided or in such other manner as may be approved by the department” and inserting after the word “section,” in line 6, the following words:-

shall be given by providing to employees a printed copy of the notice as approved by the department and by posting a copy of the notice in a visible location utilized by and accessible to all employees of the insured person.  The notice shall include information on unlawful employer retaliation, discrimination, and fraud under chapter 152.  Where an employee’s primary language is not English or where the employee prefers to receive written information in a language other than English, the insured person shall provide the notice both in English and the employee’s primary or preferred language.  The insured person shall inform all newly hired employees of their option to receive the notice in a language other than English.  The posted notice shall be posted in English and in all other primary or preferred languages of current employees.  At the outset of the policy period and whenever any of the information provided on the notice changes, the insurer shall provide to each insured person

(a) a printed copy of the notice in all languages in which the notice is produced by the department;

(b) a link to the page of the department’s website where the notice as approved by the department is posted; and

(c) a summary in writing of the insured person’s obligations to provide a printed copy and to post the notice as provided in this section

SECTION 10.  Section 30 of chapter 152 of the General Laws, as appearing in the 2012 Official Edition, is hereby amended by striking out, in line 3, the following words:-

together with the expenses necessarily incidental to such services,

SECTION 11.  Section 30 of chapter 152 of the General Laws, as appearing in the 2012 Official Edition, is hereby further amended by inserting, in line 5, after the word “hospitalized,” the following words:-

The insurer further shall furnish the services necessarily incidental to the adequate and reasonable health care services provided to an injured employee, including but not limited to interpretation, transportation, and other services necessary to allow the injured employee to obtain effective and timely health care services.  The insurer, including in cases where the insurer is the Trust Fund or the Commonwealth, shall arrange and pay directly for these necessarily incidental services upon the request of the injured employee or the health care provider, and otherwise shall reimburse expenses for these services.  Transportation services shall include door-to-door regulated taxi or equivalent transportation services where the injured employee cannot readily obtain private or public transportation.

SECTION 12.  Section 34 of chapter 152 of the General Laws, as appearing in the 2012 Official Edition, is hereby amended by inserting after the word “is,” in line 5, the following word:-

(a)

SECTION 13.  Section 34 of chapter 152 of the General Laws, as appearing in the 2012 Official Edition, is hereby further amended by striking out, in line 7, the word “his” and inserting after the word “to,” in line seven, the following words:-

the employee’s

SECTION 14.  Section 34 of chapter 152 of the General Laws, as appearing in the 2012 Official Edition, is hereby further amended by inserting after the word “wage,” in line 7, the following words:-

; (b) less than fifty percent of the average weekly wage in the commonwealth but equal to or greater than the minimum weekly compensation rate, in which case said weekly compensation shall be equal to eighty percent of the employee’s average weekly wage; or (c) less than seventy percent of the average weekly wage in the commonwealth but equal to or greater than fifty percent of the average weekly wage in the commonwealth, in which case said weekly compensation shall be equal to seventy percent of the employee’s average weekly wage.

SECTION 15.  Section 65 of chapter 152 of the General Laws, as appearing in the 2012 Official Edition, is hereby amended by striking out, in line 19, the word “and” and  inserting after the words “thirty-seven A,” in line 20, the following words:-

, and (h) payment of compensation under section 15A; provided, however, that the Trust Fund shall recover such payment from any other insurer eventually determined to be liable to pay the compensation

SECTION 16.  Section 65 of chapter 152 of the General Laws, as appearing in the 2012 Official Edition, is hereby further amended by inserting after the word “provided” in line 24, the following words:-

.  The Trust Fund shall make payment of weekly benefits and adequate and reasonable health care services within fourteen days of an initial written claim for weekly benefits on a form prescribed by the department in cases where the dispute or disputes are limited to (i) the existence of an employment relationship, (ii) a question of which of multiple insurers, including the Trust Fund, are liable, or (iii) a question of whether the employer is insured; provided, however, that the Trust Fund shall recover such payment from any other insurer eventually determined to be liable for such payments or may recover payment from the employee if such benefits and services eventually are denied.