SF 2398

as introduced - 89th Legislature (2015 - 2016) Posted on 03/22/2016 04:05pm

A bill for an act
relating to workers' compensation; adopting recommendations of the Workers'
Compensation Advisory Council; amending Minnesota Statutes 2014, sections
176.081, subdivisions 1, 3; 176.471, subdivisions 3, 5; 176.511, subdivisions
2, 3; 176.571, subdivision 1; Minnesota Statutes 2015 Supplement, section
176.135, subdivision 7a.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

ARTICLE 1

WORKERS' COMPENSATION COURT OF APPEALS PROPOSALS

Section 1.

Minnesota Statutes 2014, section 176.081, subdivision 1, is amended to read:

Subdivision 1.

Limitation of fees.

(a) A fee for legal services of 20 percent of the
first $130,000 of compensation awarded to the employee is the maximum permissible fee
and does not require approval by the commissioner, compensation judge, or any other
party. All fees, including fees for obtaining medical or rehabilitation benefits, must be
calculated according to the formula under this subdivision, except as otherwise provided
in clause (1) or (2).

(1) The contingent attorney fee for recovery of monetary benefits according to the
formula in this section is presumed to be adequate to cover recovery of medical and
rehabilitation benefit or services concurrently in dispute. Attorney fees for recovery of
medical or rehabilitation benefits or services shall be assessed against the employer or
insurer only if the attorney establishes that the contingent fee is inadequate to reasonably
compensate the attorney for representing the employee in the medical or rehabilitation
dispute. In cases where the contingent fee is inadequate the employer or insurer is liable
for attorney fees based on the formula in this subdivision or in clause (2).

For the purposes of applying the formula where the employer or insurer is liable for
attorney fees, the amount of compensation awarded for obtaining disputed medical and
rehabilitation benefits under sections 176.102, 176.135, and 176.136 shall be the dollar
value of the medical or rehabilitation benefit awarded, where ascertainable.

(2) The maximum attorney fee for obtaining a change of doctor or qualified
rehabilitation consultant, or any other disputed medical or rehabilitation benefit for which
a dollar value is not reasonably ascertainable, is the amount charged in hourly fees for the
representation or $500, whichever is less, to be paid by the employer or insurer.

(3) The fees for obtaining disputed medical or rehabilitation benefits are included
in the $26,000 limit in paragraph (b). An attorney must concurrently file all outstanding
disputed issues. An attorney is not entitled to attorney fees for representation in any
issue which could reasonably have been addressed during the pendency of other issues
for the same injury.

(b) All fees for legal services related to the same injury are cumulative and may
not exceed $26,000. If multiple injuries are the subject of a dispute, the commissioner,
compensation judge, or court of appeals shall specify the attorney fee attributable to
each injury.

(c) If the employer or the insurer or the defendant is given written notice of claims
for legal services or disbursements, the claim shall be a lien against the amount paid
or payable as compensation. Subject to the foregoing maximum amount for attorney
fees, up to 20 percent of the first $130,000 of periodic compensation awarded to the
employee may be withheld from the periodic payments for attorney fees or disbursements
if the payor of the funds clearly indicates on the check or draft issued to the employee for
payment the purpose of the withholding, the name of the attorney, the amount withheld,
and the gross amount of the compensation payment before withholding. In no case
shall fees be calculated on the basis of any undisputed portion of compensation awards.
Allowable fees under this chapter shall be based solely upon genuinely disputed claims or
portions of claims, including disputes related to the payment of rehabilitation benefits or
to other aspects of a rehabilitation plan. The existence of a dispute is dependent upon a
disagreement after the employer or insurer has had adequate time and information to take
a position on liability. Neither the holding of a hearing nor the filing of an application for a
hearing alone may determine the existence of a dispute. Except where the employee is
represented by an attorney in other litigation pending at the department or at the Office
of Administrative Hearings, a fee may not be charged after June 1, 1996, for services
with respect to a medical or rehabilitation issue arising under section 176.102, 176.135,
or 176.136 performed before the employee has consulted with the department and the
department certifies that there is a dispute and that it has tried to resolve the dispute.

(d) An attorney who is claiming legal fees for representing an employee in a workers'
compensation matter shall file a statement of attorney fees with the commissioner deleted text begin , deleted text end new text begin or
new text end compensation judge before whom the matter was heard deleted text begin , or Workers' Compensation Court
of Appeals on cases before the court deleted text end . A copy of the signed retainer agreement shall also
be filed. The employee and insurer shall receive a copy of the statement. The statement
shall be on a form prescribed by the commissioner and shall report the number of hours
spent on the case.

(e) Employers and insurers may not pay attorney fees or wages for legal services
of more than $26,000 per case.

(f) An attorney must file a statement of attorney fees within 12 months of the date
the attorney has submitted the written notice specified in paragraph (c). If the attorney
has not filed a statement of attorney fees within the 12 months, the attorney must send a
renewed notice of lien to the insurer. If 12 months have elapsed since the last notice of
lien has been received by the insurer and no statement of attorney fees has been filed, the
insurer must release the withheld money to the employee, except that before releasing the
money to the employee, the insurer must give the attorney 30 days' written notice of the
pending release. The insurer must not release the money if the attorney files a statement of
attorney fees within the 30 days.

Sec. 2.

Minnesota Statutes 2014, section 176.081, subdivision 3, is amended to read:

Subd. 3.

Review.

A party that is dissatisfied with deleted text begin its deleted text end attorney fees new text begin awarded by the
commissioner or a compensation judge new text end may file deleted text begin an application deleted text end new text begin a petition new text end for review by the
Workers' Compensation Court of Appeals. The deleted text begin application deleted text end new text begin petition new text end shall state the basis for
the need of review and whether or not a hearing is requested. A copy of the deleted text begin application
deleted text end new text begin petition new text end shall be served new text begin by the court new text end upon the deleted text begin party's deleted text end attorney deleted text begin by the court administrator
and if a hearing is requested by either party, the matter shall be set for hearing deleted text end new text begin awarded
or denied attorney fees new text end . deleted text begin The notice of hearing shall be served upon known interested
parties. deleted text end The Workers' Compensation Court of Appeals shall have the authority to raise
the issue of the attorney fees at any time upon its own motion and shall have continuing
jurisdiction over attorney fees.

Sec. 3.

Minnesota Statutes 2014, section 176.471, subdivision 3, is amended to read:

Subd. 3.

Service of writ deleted text begin and bond deleted text end ; filing fee.

To effect a review upon certiorari,
the party shall serve a writ of certiorari deleted text begin and a bond deleted text end upon the administrator of the Workers'
Compensation Court of Appeals within the 30-day period referred to in subdivision 1. The
party shall also at this time pay to the deleted text begin administrator deleted text end new text begin clerk of the appellate courts new text end the fee
prescribed by rule deleted text begin 103.01 deleted text end new text begin 116.03 new text end of the Rules of Civil Appellate Procedure deleted text begin which shall be
disposed of in the manner provided by that rule deleted text end .

Sec. 4.

Minnesota Statutes 2014, section 176.471, subdivision 5, is amended to read:

Subd. 5.

Bond.

deleted text begin The bond required by subdivision 3 shall be executed in such
amount and with such sureties as the Workers' Compensation Court of Appeals directs
and approves. The bond shall be conditioned to pay the cost of the review. deleted text end new text begin The Workers'
Compensation Court of Appeals may, upon motion of any respondent and a showing that
extraordinary circumstances warrant the requirement of a cost bond, order that a bond be
provided as prescribed by rule 107.02 of the Rules of Civil Appellate Procedure.
new text end

Sec. 5.

Minnesota Statutes 2014, section 176.511, subdivision 2, is amended to read:

Subd. 2.

Disbursements, taxation.

The commissioner or compensation judge, or
deleted text begin on appeal deleted text end the Workers' Compensation Court of Appeals new text begin on cases before the court new text end , may
award the prevailing party reimbursement for actual and necessary disbursements. deleted text begin These
deleted text end Disbursements shall be taxed upon deleted text begin five deleted text end new text begin ten new text end days' written notice to adverse parties.

Sec. 6.

Minnesota Statutes 2014, section 176.511, subdivision 3, is amended to read:

Subd. 3.

Attorney fee, allowance.

Where deleted text begin upon an appeal to the Workers'
Compensation Court of Appeals, deleted text end new text begin (1) new text end an award of compensation is affirmed, or modified
and affirmed, deleted text begin or deleted text end new text begin (2) new text end an order disallowing compensation is reversed, new text begin or (3) a petition to
vacate an award is granted, new text end the Workers' Compensation Court of Appeals may include in
its award deleted text begin as an incident to its review on appeal deleted text end an amount to cover a reasonable attorney
fee deleted text begin , deleted text end or deleted text begin it deleted text end may allow deleted text begin the deleted text end new text begin an attorney new text end fee in a proceeding to tax disbursements.

If the employer or insurer files a notice of discontinuance of an employee's benefits
and an administrative conference is held to resolve the dispute, but the employer or insurer
fails to attend the administrative conference, the commissioner or compensation judge
may order the employer or insurer to pay the employee's attorney fees as a cost under this
section if the employee's benefits are continued.

Sec. 7. new text begin EFFECTIVE DATE.
new text end

new text begin Sections 1 to 6 are effective the day following final enactment.
new text end

ARTICLE 2

WORKERS' COMPENSATION DEPARTMENT PROPOSALS

Section 1.

Minnesota Statutes 2015 Supplement, section 176.135, subdivision 7a,
is amended to read:

Subd. 7a.

Electronic transactions.

(a) For purposes of this subdivision, the
following terms have the meanings given:

(1) "workers' compensation payer" means a workers' compensation insurer and an
employer, or group of employers, that is self-insured for workers' compensation;

(2) "clearinghouse" has the meaning given in section 62J.51, subdivision 11a; and

(3) "electronic transactions" means the health care administrative transactions
described in section 62J.536.

(b) In addition to the requirements of section 62J.536, workers' compensation payers
and health care providers must comply with the requirements in paragraphs (c) to (e).

(c) No later than January 1, 2016, each workers' compensation payer must place
the following information in a prominent location on its Web site or otherwise provide
the information to health care providers:

(1) the name of each clearinghouse with which the workers' compensation payer has
an agreement to exchange or transmit electronic transactions, along with the identification
number each clearinghouse has assigned to the payer in order to route electronic
transactions through intermediaries or other clearinghouses to the payer;

(2) information about how a health care provider can obtain the claim number
assigned by the workers' compensation payer for an employee's claim and how the
provider should submit the claim number in the appropriate field on the electronic bill to
the payer; and

(3) the name, phone number, and e-mail address of contact persons who can answer
questions related to electronic transactions on behalf of the workers' compensation payer
and the clearinghouses with which the payer has agreements.

(d) No later than deleted text begin July 1, 2016 deleted text end new text begin January 1, 2017 new text end :

(1) health care providers must electronically submit copies of medical records or
reports that substantiate the nature of the charge and its relationship to the work injury
using the deleted text begin most recently approved deleted text end new text begin ASC X12N 5010 new text end version of the ASC X12N 275
transaction ("Additional Information to Support Health Care Claim or Encounter"),
according to the requirements in the corresponding implementation guide. The ASC X12N
275 transaction is the only one that shall be used to electronically submit attachments
unless a national standard is adopted by federal law or rule. If a new version of the
attachment transaction is approved, it must be used one year after the approval date;

(2) workers' compensation payers and all clearinghouses receiving or transmitting
workers' compensation bills must accept attachments using the ASC X12N 275 transaction
and must respond with the deleted text begin most recently approved deleted text end new text begin ASC X12N 5010 version of the new text end ASC
X12 electronic acknowledgment for the attachment transaction. If a new version of the
acknowledgment transaction is approved, it must be used one year after the approval
date; and

(3) if a different national claims attachment or acknowledgment requirement is
adopted by federal law or rule, it will replace the ASC X12N 275 transaction, and the new
standard must be used on the date that it is required by the federal law or rule.

(e) No later than September 1, 2015, workers' compensation payers must provide
the patient's name and patient control number on or with all payments made to a provider
under this chapter, whether payment is made by check or electronic funds transfer. The
information provided on or with the payment must be sufficient to allow providers to
match the payment to specific bills. If a bulk payment is made to a provider for more than
one patient, the check or electronic funds transfer statement must also specify the amount
being paid for each patient. For purposes of this paragraph, the patient control number is
located on the electronic health care claim 837 transaction, loop 2300, segment CLM01,
and on the electronic health care claim payment/advice 835 transaction, loop 2100, CLP01.

(f) The commissioner may assess a monetary penalty of $500 for each violation of
this section, not to exceed $25,000 for identical violations during a calendar year. Before
issuing a penalty for a first violation of this section, the commissioner must provide written
notice to the noncompliant payer, clearinghouse, or provider that a penalty may be issued
if the violation is not corrected within 30 days. Penalties under this paragraph are payable
to the commissioner for deposit in the assigned risk safety account.

Sec. 2.

Minnesota Statutes 2014, section 176.571, subdivision 1, is amended to read:

Subdivision 1.

Preliminary investigation.

When the head of a department has filed
a report or the commissioner of administration has otherwise received information of
the occurrence of an injury to a state employee for which liability to pay compensation
may exist, the commissioner of administration shall make a preliminary investigation to
determine the question of probable liability.

In making this investigation, the commissioner of administration may require the
assistance of the head of any department or any employee of the state. The commissioner
of deleted text begin management and budget deleted text end new text begin administration new text end may require that all facts be furnished which
appear in the records of any state department bearing on the issue.

Sec. 3. new text begin EFFECTIVE DATE.
new text end

new text begin Sections 1 and 2 are effective the day following enactment.
new text end