Title 21, Labor And Industrial Relations

§386-174 Appropriation. So much of the state insurance fund as may be necessary is hereby appropriated and shall, with the approval of the governor, be expended to pay claims found to be due under section 386-171 for services performed under the authorized direction of a public o…

C. Public Board Members, Reserve Police Officers, Police Chaplains, Volunteer Firefighters, Volunteer Boating Enforcement Officers, Volunteer Conservation and Resources Enforcement Officers, and Reserve Public Safety Law Enforcement Officers §386-181 Generally. (a) As used in thi…

PART VI. SELF-INSURANCE GROUPS §386-191 Scope. This part shall apply to workers' compensation self-insurance groups. This part shall not apply to public employees or governmental entities. Groups which are issued a certificate of approval by the insurance commissioner shall not b…

§386-192 Definitions. For the purpose of this part: "Administrator" means an individual, partnership, or corporation engaged by a workers' compensation self-insurance group's board of trustees to carry out the policies established by the group's board of trustees and to provide d…

§386-193 Authority to act as workers' compensation self-insurance group. No person, association, or other entity shall act as a workers' compensation self-insurance group unless it has been issued a certificate of approval by the insurance commissioner. [L 1986, c 304, pt of §1]

§386-194 Qualifications for initial approval and continued authority to act as a workers' compensation self-insurance group. (a) A proposed workers' compensation self-insurance group shall file with the insurance commissioner its application for a certificate of approval accompan…

§386-195 Certificate of approval; termination. (a) The certificate of approval issued by the insurance commissioner to a workers' compensation self-insurance group authorizes the group to provide workers' compensation benefits. The certificate of approval shall remain in effect u…

§386-196 Examinations. The insurance commissioner may examine the affairs, transactions, accounts, records, and assets and liabilities of each group as often as the insurance commissioner deems advisable. The expense of examinations shall be assessed against the group in the same…

§386-197 Board of trustees; membership, powers, duties, and prohibitions. Each group shall be operated by a board of trustees, which shall consist of not less than five persons whom the members of a group elect for stated terms of office. At least two-thirds of the trustees shall…

§386-198 Group membership; termination, liability. (a) An employer joining a workers' compensation self-insurance group after the group has been issued a certificate of approval shall submit an application for membership to the board of trustees or its administrator and enter int…

§386-199 Service companies. (a) No service company or its employees, officers, or directors shall be an employee, officer, or director of, or have either a direct or indirect financial interest in, an administrator. No administrator or its employees, officers, or directors shall …

§386-2 Definitions relating to family relationships. "Brother" or "sister" includes a half brother or half sister, a stepbrother or stepsister, and a brother or sister by adoption. "Child" includes a posthumous child, adopted child, stepchild, child born to parents not married to…

§386-200 Licensing of producer. Except for a salaried employee of a group, its administrator, or its service company, any person soliciting membership in a workers' compensation self-insurance group shall be licensed as a producer under chapter 431:9A. [L 1986, c 304, pt of §1; a…

§386-201 Financial statements and other reports. (a) Each group shall submit to the insurance commissioner a statement of financial condition audited by an independent certified public accountant on or before the last day of the sixth month following the end of the group's fiscal…

§386-202 Misrepresentation prohibited. No person shall make a material misrepresentation or omission of a material fact in connection with the solicitation of membership of a group. [L 1986, c 304, pt of §1]

§386-203 Investments. Funds not needed for current obligations may be invested by the board of trustees in accordance with sections 431-281 to 431-312. [L 1986, c 304, pt of §1]

§386-204 Rates and reporting of rates. (a) Every workers' compensation self-insurance group shall adhere to the uniform classification system, uniform experience rating plan, and manual rules filed with the insurance commissioner by an advisory organization designated by the insu…

§386-205 Refunds. (a) Any moneys for a fund year in excess of the amount necessary to fund all obligations for that fund year may be declared to be refundable by the board of trustees not less than twelve months after the end of the fund year. (b) Each member shall be given a wri…

§386-206 Premium payment; reserves. (a) Each group shall establish to the satisfaction of the insurance commissioner a premium payment plan which shall include an initial payment by each member of at least twenty-five per cent of that member's annual premium before the start of t…

§386-207 Deficits and insolvencies. (a) If the assets of a group are at any time insufficient to enable the group to discharge its legal liabilities and other obligations and to maintain the reserves required of it under this chapter, the group shall forthwith make up the deficie…

§386-208 Guaranty mechanism. In the event of a liquidation pursuant to section 386-207, after exhausting the security required pursuant to section 386-194(b)(2), the insurance commissioner shall levy an assessment against all groups to assure prompt payment of benefits. The asses…

§386-209 Monetary penalties. After notice and opportunity for a hearing, the insurance commissioner may impose a monetary penalty on any person or group found to be in violation of any provision of this chapter or any rule adopted thereunder. The monetary penalty shall not exceed…

PART II. COMPENSATION A. Medical and Rehabilitation Benefits §386-21 Medical care, services, and supplies. (a) Immediately after a work injury sustained by an employee and so long as reasonably needed the employer shall furnish to the employee all medical care, services, and supp…

[§386-21.1] Medical care, services, and supplies for controverted claims. In the event of a controverted claim, the injured employee's private health care plan shall pay for or provide medical care, services, and supplies in accordance with the private health care contract. When …

[§386-21.2] Treatment plans. (a) A physician may transmit a treatment plan to an employer by mail or facsimile; provided that the physician shall send the treatment plan to an address or facsimile number provided by the employer. (b) Beginning January 1, 2021, an employer shall a…

[§386-21.4] Cervical and lumbar spinal injuries; treatment plan not required. During the first sixty days after an injury, an employee may obtain the following medical care or services without a treatment plan:

[§386-21.5] Publication of fees by prepaid health care plan contractors. (a) A prepaid health care plan contractor as defined in section 393-3 shall provide the director upon request with a schedule of all the maximum allowable medical fees. (b) Pursuant to section 386-21(c), the…

§386-21.7 Prescription drugs; pharmaceuticals. (a) Notwithstanding any other provision to the contrary, immediately after a work injury is sustained by an employee and so long as reasonably needed, the employer shall furnish to the employee all prescription drugs as the nature of…

§386-21.9 Medical care, services, and supplies for firefighters suffering from cancer. If a claim for leukemia, multiple myeloma, non-Hodgkin lymphoma, or cancer of the lung, brain, stomach, esophagus, intestines, rectum, kidney, bladder, prostate, breast, female reproductive org…

§386-210 Cease and desist orders. (a) After notice and opportunity for a hearing, the insurance commissioner may issue an order requiring a person or group to cease and desist from engaging in an act or practice found to be in violation of any provision of this chapter or any rul…

§386-211 Revocation of certificate of approval. (a) After notice and opportunity for a hearing, the insurance commissioner may revoke a group's certificate of approval if the group: (b) In addition, the insurance commissioner may revoke a group's certificate of approval if, after…

§386-212 Notice and hearing. The insurance commissioner in the administration of this chapter shall comply with chapters 91 and 92 when applicable. [L 1986, c 304, pt of §1]

§386-213 Rules. The insurance commissioner shall adopt rules in accordance with chapter 91 for the purposes of this chapter. [L 1986, c 304, pt of §1]

§386-214 Severability. If any provision of this chapter, or the application thereof, to any person or circumstance, is subsequently held to be invalid, the invalidity shall not affect other provisions or applications of this chapter. [L 1986, c 304, pt of §1]

§386-22 Artificial member and other aids. Where an injury results in the amputation of an arm, hand, leg, or foot, or the enucleation of an eye, or the loss of natural or artificial teeth, or the loss of vision which may be partially or wholly corrected by the use of lenses, the …

§386-23 Services of attendant. When the director of labor and industrial relations finds that the service of an attendant for the injured employee is constantly necessary the director may award a monthly sum of not more than the product of four times the effective maximum weekly …

§386-23.5 Services of attendant, allowance adjustments. (a) When the maximum allowed for procurement of services of an attendant as provided in section 386-23 is changed by law, any employee who has been totally and continuously disabled and has been awarded and is receiving a su…

§386-23.6 Weekly benefit adjustments for recipients of services of attendants. Any permanently and totally disabled employee awarded and receiving compensation under section 386-23 or 386-23.5, but:

§386-24 Medical rehabilitation. The medical services and supplies to which an employee suffering a work injury is entitled shall include such services, aids, appliances, apparatus, and supplies as are reasonably needed for the employee's greatest possible medical rehabilitation. …

§386-25 Vocational rehabilitation. (a) The purposes of vocational rehabilitation are to restore an injured worker's earnings capacity as nearly as possible to that level that the worker was earning at the time of injury and to return the injured worker to suitable gainful employm…

§386-26 Guidelines on frequency of treatment and reasonable utilization of health care and services. The director shall issue guidelines for the frequency of treatment and for reasonable utilization of medical care and services by health care providers that are considered necessa…

§386-27 Qualification and duties of health care providers. (a) All health care providers rendering health care and services under this chapter shall be qualified by the director and shall remain qualified by satisfying the requirements established in this section. The director sh…

[§386-28] Opioid therapy; qualifying injured employees; informed consent process. (a) Beginning on July 1, 2019, any health care provider authorized to prescribe opioids shall adopt and maintain a written policy or policies that include execution of a written agreement to engage …

[§386-29] Qualifying injured employees; initial concurrent prescriptions; opioids and benzodiazepines. (a) Initial concurrent prescriptions for opioids and benzodiazepines shall not be for longer than seven consecutive days unless a supply of longer than seven days is determined …

§386-3 Injuries covered. (a) If an employee suffers personal injury either by accident arising out of and in the course of the employment or by disease proximately caused by or resulting from the nature of the employment, the employee's employer or the special compensation fund s…

[§386-3.5] Negotiation for benefit coverage. (a) Notwithstanding any provision of law to the contrary, any employer may determine the benefits and coverage of a policy required under this chapter through collective bargaining with an appropriate bargaining unit; provided that the…