Employers must explain injured workers’ choices and protect access to care

Employers must tell injured workers about their provider choices and may not pressure them to use a specific provider or clinic. The rules apply when an employer receives notice of a worker’s injury. Coercion includes threats, retaliation, or improper pressure. An employer may provide on-site care if the worker chooses it. A state-insured employer may face a penalty of $250 to $2,500 for each violation; a pattern of violations may affect its participation in a retrospective rating program. A violation by a self-insured employer is treated under the cited rules. Section 5 takes effect January 1, 2028.

The department or self-insured employer must help a worker find a network provider; if none is found, the worker may seek care from a nonnetwork provider. This applies if no network provider within 25 miles of the worker’s home is willing to treat the worker or serve as the attending provider. The worker must notify the department or self-insured employer and sign a declaration that no willing network provider is available within 25 miles of home. After receiving the signed declaration, the department or self-insured employer has 10 calendar days to find a willing network provider. If none is found, the worker may choose a nonnetwork provider within 25 miles who agrees to the department’s payment rules; the worker may begin treatment once these conditions are met, even before the provider completes an agreement or application. Section 5 takes effect January 1, 2028.

The utilization review provider must complete a treatment review and send its recommendation within 10 business days after receiving all information needed to make the recommendation, or the treatment must be authorized. The deadline applies to utilization reviews of treatment for workers’ compensation claims. If it is unclear whether the treatment is related to the worker’s injury or occupational disease, the department must decide that issue by order. Section 5 takes effect January 1, 2028. When work-relatedness is in question, the department must issue its order within 30 days after the review deadline.

The department may hire claims managers to bring caseloads to a recommended average of 141 claims per manager and may adjust caseloads to match the national average after studying it. The authority covers claims managers handling workers’ compensation claims. Hiring under this section is subject to state spending allotments, but no appropriation is required. Funds may be used only to hire and retain managers needed to meet the stated caseloads. If the department hires additional managers, it must reduce their caseloads and review cases more often. The department may hire toward the 141-claim average under this section. The first national-average study is due beginning July 1, 2031, and may be repeated no more than once every five years.

The department or self-insured employer must continue paying for cancer monitoring when cancer is an accepted diagnosis. This applies to workers whose cancer is an accepted diagnosis in their claim. Monitoring must follow the frequency recommended by the worker’s treating oncologist and include necessary diagnostic studies and medical consultations. This applies to treatment decisions made on or after January 1, 2028.