Title 85A, Title 85A — Workers' Compensation

A. Any benefits payable to an injured employee under this act shall be reduced in an amount equal to, dollar-for-dollar, the amount of benefits the injured employee has previously received for the same medical services or period of disability, whether those benefits were paid und…

- Permanent partial disability - Permanent total disability. A. Temporary Total Disability. 1. If the injured employee is temporarily unable to perform his or her job or any alternative work offered by the employer, he or she shall be entitled to receive compensation equal to sev…

A. An injured employee who is entitled to receive permanent partial disability compensation under Section 45 of this title shall receive compensation for each part of the body in accordance with the number of weeks for the scheduled loss set forth below. 1. Arm amputated at the e…

A. Time of death. If death does not result within one (1) year from the date of the accident or within the first three (3) years of the period for compensation payments fixed by the compensation judgment, a rebuttable presumption shall arise that the death did not result from the…

When an injury or death is sustained by a minor employed in violation of federal or state statutes relating to minimum ages for employment of minors, disability or death benefits provided for by this act shall be doubled; provided, however, such penalty shall not apply when the m…

Notwithstanding any other provision of this act, no compensation for temporary total disability shall be payable to an injured employee for any week for which the injured employee receives unemployment insurance benefits under the laws of this state or the unemployment insurance …

A. The rights and remedies granted to an employee subject to the provisions of the Administrative Workers’ Compensation Act shall be exclusive of all other rights and remedies of the employee, his or her legal representative, dependents, next of kin, or anyone else claiming right…

- Fee schedule - Formulary. A. The employer shall promptly provide an injured employee with medical, surgical, hospital, optometric, podiatric, chiropractic and nursing services, along with any medicine, crutches, ambulatory devices, artificial limbs, eyeglasses, contact lenses, …

The employer shall pay one hundred percent (100%) of the medical expenses, subject to the Fee Schedule, with no maximum dollar or duration limits for all compensable injuries. Added by Laws 2013, c. 208, § 51, eff. Feb. 1, 2014.

The employer shall not be liable for any of the payments for medical services and supplies under this act if the Commission determines that there was not a compensable injury. Added by Laws 2013, c. 208, § 52, eff. Feb. 1, 2014.

A. An injured employee claiming to be entitled to benefits under this act shall submit to physical examination and treatment by another qualified physician, designated or approved by the Commission, as the Commission may require from time to time if reasonable and necessary. B. I…

Except in cases of hernia, which are specifically covered by Section 61 of this act, where an injured employee unreasonably refuses to submit to a surgical operation which has been advised by at least two qualified physicians and where the recommended operation does not involve u…

A. If an employer or carrier believes that a charge for medical services or supplies under this act is unreasonable, it may submit the charge to the Commission for review. If the Commission determines that the charge is unreasonable, it may amend the charges to reflect the Fee Sc…

A. If the employer has previously contracted with a certified workplace medical plan, the employer shall select for the injured employee a treating physician or chiropractor from the physicians or chiropractors listed within the network of the certified workplace medical plan. Th…

A. If an injured employee misses two or more scheduled appointments for treatment, he or she shall no longer be eligible to receive benefits under this act, unless his or her absence was: 1. Caused by extraordinary circumstances beyond the employee's control as determined by the …

A. 1. Every hospital or other person furnishing the injured employee with medical services shall permit its records to be copied by and shall furnish full written information to the Commission, the Workers' Compensation Fraud Investigation Unit, the employer, the carrier, and the…

A. 1. Compensation under this act based on the employee's average weekly wage shall be computed by dividing the employee's gross earnings by the number of full weeks of employment with the employer, up to a maximum of fifty-two (52) weeks. 2. If the injured employee was working o…

A. 1. a. Any person or entity who makes any material false statement or representation, who willfully and knowingly omits or conceals any material information, or who employs any device, scheme, or artifice, or who aids and abets any person for the purpose of: (1) obtaining any b…

The Physician Advisory Committee may recommend the adoption of a method or system to evaluate permanent disability that shall deviate from, or be used in place of or in combination with the Guides. Such recommendation shall be made to the Workers' Compensation Commission which ma…

A. A hernia is not a compensable injury unless the injured employee can prove by a preponderance of the evidence that it meets the definition of "compensable injury" under this act and: 1. The occurrence of the hernia followed as the result of sudden effort, severe strain, or the…

A. Notwithstanding the provisions of Section 45 of this title, if an employee suffers a nonsurgical soft tissue injury, temporary total disability compensation shall not exceed eight (8) weeks, regardless of the number of parts of the body to which there is a nonsurgical soft tis…

A. Within ten (10) days after the date of receipt of notice or of knowledge of injury or death, the employer shall send to the Workers' Compensation Commission a report setting forth: 1. The name, address, and business of the employer; 2. The name, address, and occupation of the …

A. Any person or entity may make written application to the State Commissioner of Health to have a workplace medical plan certified that provides management of quality treatment to injured employees for injuries and diseases compensable under this act. Each application for certif…

A. If an employee suffers from an occupational disease as defined in this section and is disabled or dies as a result of the disease, the employee, or, in case of death, his or her dependents, shall be entitled to compensation as if the disability or death were caused by injury a…

A. As used in this act, unless the context otherwise requires: 1. "Asbestosis" means the characteristic fibrotic condition of the lungs caused by the inhalation of asbestos dust; and 2. "Silicosis" means the characteristic fibrotic condition of the lungs caused by the inhalation …

A. Except as otherwise provided in this section, notice of disability resulting from an occupational disease or cumulative trauma shall be the same as in cases of accidental injury. B. Written notice shall be given to the employer of an occupational disease or cumulative trauma b…

A. Unless an employee gives oral or written notice to the employer within thirty (30) days of the date an injury occurs, the rebuttable presumption shall be that the injury was not work- related. Such presumption must be overcome by a preponderance of the evidence. B. Unless an e…

A. Time for Filing. 1. A claim for benefits under this act, other than an occupational disease, shall be barred unless it is filed with the Workers' Compensation Commission within one (1) year from the date of the injury or, if the employee has received benefits under this title …

A. An employer may not retaliate against an employee when the employee has in good faith: 1. Filed a claim under this act; 2. Retained a lawyer for representation regarding a claim under this act; 3. Instituted or caused to be instituted any proceeding under the provisions of thi…

The Commission is authorized and directed to promulgate rules to establish and implement a preliminary conference procedure designed to accomplish the following objectives: 1. To provide the claimant an opportunity to confer with a legal advisor on the staff of the Commission to …

construction. A. Notice. Within ten (10) days after a claim for compensation has been filed, the Workers' Compensation Commission shall notify the employer and any other interested person of the filing of the claim. B. Hearing. 1. The Commission shall assign the claim to an admin…

Evidence. A. Conduct of Hearing or Inquiry. 1. In making an investigation or inquiry or conducting a hearing, the administrative law judges and the Commission shall not be bound by technical or statutory rules of evidence or by technical or formal rules of procedure, except as pr…

A. The Commission shall have the power to preserve and enforce order during any proceeding before it, to issue subpoenas for and administer oaths to and compel the attendance and testimony of witnesses, and require the production of books, papers, documents, and other evidence. B…

In any proceeding for the enforcement of a claim for compensation, there shall be a rebuttable presumption that: 1. The Commission has jurisdiction; 2. Sufficient notice was given; and 3. The injury was not occasioned by the willful intention of the injured employee to bring abou…

The Commission may cause depositions of witnesses to be taken in such manner as it may direct. Added by Laws 2013, c. 208, § 75, eff. Feb. 1, 2014.

Each witness who appears in obedience to a subpoena shall be entitled to the same fees as witnesses in a civil action in the district court. Added by Laws 2013, c. 208, § 76, eff. Feb. 1, 2014.

If the Commission is a party to or is otherwise interested in a court proceeding under this act, it may employ attorneys to appear on its behalf. If requested by the Commission, it shall be the duty of the Attorney General or the prosecuting attorneys of the different districts t…

A. Any party feeling aggrieved by the judgment, decision, or award made by the administrative law judge may, within ten (10) days of issuance, appeal to the Workers' Compensation Commission. After hearing arguments, the Commission may reverse or modify the decision only if it det…

If any employer fails to comply with a final compensation judgment or award, any beneficiary of the judgment or award, or the Commission, may file a certified copy of the judgment or award in the office of the district court clerk of any county in this state where any property of…

A. No agreement by an employee to waive his or her right to compensation shall be valid. No contract, regulation, or device shall operate to relieve the employer or carrier, in whole or in part, from any liability created by this act, except as specifically provided in this act. …

A. A final order for permanent disability is a final adjudication of all issues pending in the claim unless reserved in the order or by operation of law. Except where a joint petition settlement has been approved, the Workers' Compensation Commission may review any compensation j…

If the court having jurisdiction over the claim or compensation judgment proceedings determines that the proceedings have been commenced or continued without reasonable grounds, the cost of the proceedings shall be assessed against the party who has commenced or continued the pro…

A. 1. a. Each party shall be responsible for its legal services and litigation expenses. Fees for legal services may be reviewed by the Workers' Compensation Commission. b. An attorney representing an injured employee may only recover attorney fees up to ten percent (10%) of any …

A. 1. Every claim, request for benefits, controversion of benefits, request for a hearing, pleading, motion, and other paper of a party represented by an attorney shall be signed by at least one attorney of record in his or her individual name, whose address shall be stated. A pa…

A. Compensation shall be paid by check, by electronic funds transfer, issuance of debit cards, or by state warrant. Payment shall be made payable to the order of the person entitled to the compensation and paid directly to the person entitled to the compensation. B. If the compen…

Clean claims for services rendered under this act are payable within thirty (30) days after receipt by the employer unless disputed as to compensability or amount. "Clean claim" means a claim that has no defect or impropriety, including a lack of any required substantiating docum…

A. 1. Each employer desiring to controvert an employee's right to compensation may file with the Workers' Compensation Commission on or before the fifteenth day following notice of the alleged injury or death a statement on a form prescribed by the Commission that the right to co…

If the employer or carrier and the injured employee desire to settle the claim, they shall file a joint petition for settlement with the Workers' Compensation Commission. After the joint petition has been filed, the Commission shall order that all workers' compensation claims bet…

A. In any case where an employer changes insurance carriers or where the employer having been self-insured, becomes insured or, having been insured, is approved to be self-insured, and the only dispute in a claim against that employer is the proper source of payment of benefits, …

If the employer has made advance payments for compensation, the employer shall be entitled to be reimbursed out of any unpaid installment or installments of compensation due. If the injured employee receives full wages during disability, he or she shall not be entitled to compens…