PART II. 
COMPENSATION



 



A.  Medical
and Rehabilitation Benefits



 



Cross References



 



  Limitation on charges, see §431:10C-308.5.



 



§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 supplies as the nature of the injury requires.  The
liability for the medical care, services, and supplies shall be subject to the
deductible under section 386‑100.



(b)  Whenever medical care is needed, the
injured employee may select any physician or surgeon who is practicing on the
island where the injury was incurred to render medical care.  If the services
of a specialist are indicated, the employee may select any physician or surgeon
practicing in the State.  The director may authorize the selection of a
specialist practicing outside the State where no comparable medical attendance
within the State is available.  Upon procuring the services of a physician or surgeon,
the injured employee shall give proper notice of the employee's selection to
the employer within a reasonable time after the beginning of the treatment.  If
for any reason during the period when medical care is needed, the employee
wishes to change to another physician or surgeon, the employee may do so in
accordance with rules prescribed by the director.  If the employee is unable to
select a physician or surgeon and the emergency nature of the injury requires
immediate medical attendance, or if the employee does not desire to select a
physician or surgeon and so advises the employer, the employer shall select the
physician or surgeon.  The selection, however, shall not deprive the employee
of the employee's right of subsequently selecting a physician or surgeon for
continuance of needed medical care.



(c)  The liability of the employer for medical
care, services, and supplies shall be limited to the charges computed as set
forth in this section.  The director shall make determinations of the charges and
adopt fee schedules based upon those determinations.  Effective January 1,
1997, and for each succeeding calendar year thereafter, the charges shall not
exceed one hundred ten per cent of fees prescribed in the Medicare Resource
Based Relative Value Scale applicable to Hawaii as prepared by the United
States Department of Health and Human Services, except as provided in this
subsection.  The rates or fees provided for in this section shall be adequate
to ensure at all times the standard of services and care intended by this
chapter to injured employees.



If the director determines that an allowance
under the medicare program is not reasonable or if a medical treatment,
accommodation, product, or service existing as of June 29, 1995, is not covered
under the medicare program, the director, at any time, may establish an
additional fee schedule or schedules not exceeding the prevalent charge for
fees for services actually received by providers of health care services, to
cover charges for that treatment, accommodation, product, or service.  If no
prevalent charge for a fee for service has been established for a given service
or procedure, the director shall adopt a reasonable rate which shall be the
same for all providers of health care services to be paid for that service or
procedure.



The director shall update the schedules
required by this section every three years or annually, as required.  The
updates shall be based upon:



(1)  Future charges or additions prescribed in the
Medicare Resource Based Relative Value Scale applicable to Hawaii as prepared
by the United States Department of Health and Human Services; or



(2)  A statistically valid survey by the director of
prevalent charges for fees for services actually received by providers of
health care services or based upon the information provided to the director by
the appropriate state agency having access to prevalent charges for medical fee
information.



When a dispute exists between an insurer or
self-insured employer and a medical services provider regarding the amount of a
fee for medical services, the director may resolve the dispute in a summary
manner as the director may prescribe; provided that a provider shall not charge
more than the provider's private patient charge for the service rendered.



When a dispute exists between an employee and
the employer or the employer's insurer regarding the proposed treatment plan or
whether medical services should be continued, the employee shall continue to
receive essential medical services prescribed by the treating physician
necessary to prevent deterioration of the employee's condition or further
injury until the director issues a decision on whether the employee's medical
treatment should be continued.  The director shall make a decision within
thirty days of the filing of a dispute.  If the director determines that
medical services pursuant to the treatment plan should be or should have been
discontinued, the director shall designate the date after which medical
services for that treatment plan are denied.  The employer or the employer's
insurer may recover from the employee's personal health care provider qualified
pursuant to section 386-27, or from any other appropriate occupational or
non-occupational insurer, all the sums paid for medical services rendered after
the date designated by the director.  Under no circumstances shall the employee
be charged for the disallowed services, unless the services were obtained in
violation of section 386-98.  The attending physician, employee, employer, or
insurance carrier may request in writing that the director review the denial of
the treatment plan or the continuation of medical services.



(d)  The director, with input from stakeholders
in the workers' compensation system, including but not limited to insurers,
health care providers, employers, and employees, shall establish standardized
forms for health care providers to use when reporting on and billing for
injuries compensable under this chapter.  The forms may be in triplicate, or in
any other configuration so as to minimize, to the extent practicable, the need
for a health care provider to fill out multiple forms describing the same
workers' compensation case to the department, the injured employee's employer,
and the employer's insurer.



(e)  If it appears to the director that the
injured employee has wilfully refused to accept the services of a competent
physician or surgeon selected as provided in this section, or has wilfully
obstructed the physician or surgeon, or medical, surgical, or hospital services
or supplies, the director may consider such refusal or obstruction on the part
of the injured employee to be a waiver in whole or in part of the right to
medical care, services, and supplies, and may suspend the weekly benefit
payments, if any, to which the employee is entitled so long as the refusal or
obstruction continues.



(f)  Any funds as are periodically necessary to
the department to implement the foregoing provisions may be charged to and paid
from the special compensation fund provided by section 386-151.



(g)  In cases where the compensability of the
claim is not contested by the employer, the medical services provider shall
notify or bill the employer, insurer, or the special compensation fund for
services rendered relating to the compensable injury within two years of the
date services were rendered.  Failure to bill the employer, insurer, or the
special compensation fund within the two-year period shall result in the
forfeiture of the medical services provider's right to payment.  The medical [services]
provider shall not directly charge the injured employee for treatments relating
to the compensable injury. [L 1963, c 116, pt of §1; Supp, §97-20; am L 1967, c
16, §1; HRS §386-21; am L 1973, c 78, §1; am L 1979, c 132, §1; am L 1985, c
296, §15; gen ch 1985; am L 1987, c 120, §1; am L 1995, c 234, §7; am L 1996, c
260, §2; am L 1998, c 191, §1; am L 2006, c 191, §1; am L Sp 2009, c 26, §1]



 



Case Notes



 



  Offsets for workers' compensation benefits in pension plan
constituted forfeitures under ERISA.  504 F. Supp. 958.



  Workers' compensation benefits clearly intended to indemnify
workers for job related injury or disease, not to provide income lost on
retirement.  504 F. Supp. 958.



  Voluntary, involuntary medical attendance.  32 H. 503.



  A decision that finally adjudicates the matter of medical and
temporary disability benefits under §§386-31(b), 386-32(b), and this section is
an appealable final order under §91-14(a), even though the matter of permanent
disability benefits under §§386-31(a) and 386-32(a) has been left for later
determination.  89 H. 436, 974 P.2d 1026.



  There is no statutory authority granted to board to apportion
the medical treatment coverage afforded under this section between a
preexisting dental condition and the accident-induced temporomandibular joint
disorder; where substantial evidence in record indicated that the medical
treatment proposed was necessitated by the nature of the injury, the employer
was required to provide compensation for "all" medical treatment required. 
93 H. 116 (App.), 997 P.2d 42.



  Cited:  24 H. 731, 733.