KRS § 342.020 — KY Code / Title XXVII / Chapter 342 / Section 342.020
342.020 Medical treatment at expense of employer -- Duration of employer's obligation -- Continuation of benefits -- Selection of physician and hospital -- Payment -- Managed health care system -- Artificial members and braces -- Waiver of privilege -- Disclosure of interest in referrals -- Urine drug screenings -- Pharmacist services and procedures
Status: in_force

342.020 Medical treatment at expense of employer -- Duration of employer's

obligation -- Continuation of benefits -- Selection of physician and hospital --

Payment -- Managed health care system -- Artificial members and braces --

Waiver of privilege -- Disclosure of interest in referrals -- Urine drug

screenings -- Pharmacist services and procedures.

(1) In addition to all other compensation provided in this chapter, the employer shall

pay for the cure and relief from the effects of an injury or occupational disease the

medical, surgical, and hospital treatment, including nursing, medical, and surgical

supplies and appliances, as may reasonably be required at the time of the injury and

thereafter for the length of time set forth in this section, or as may be required for

the cure and treatment of an occupational disease.

(2) In claims resulting in an award of permanent total disability or resulting from an

injury described in subsection (9) of this section, the employer's obligation to pay

the benefits specified in this section shall continue for so long as the employee is

disabled regardless of the duration of the employee's income benefits.

(3) (a) In all permanent partial disability claims not involving an injury described in

subsection (9) of this section, the employer's obligation to pay the benefits

specified in this section shall continue for seven hundred eighty (780) weeks

from the date of injury or date of last exposure.

(b) In all permanent partial disability claims not involving an injury described in

subsection (9) of this section, the commissioner shall, in writing, advise the

employee of the right to file an application for the continuation of benefits as

described in this section. This notice shall be made to the employee seven

hundred fifty-four (754) weeks from the date of injury or last exposure.

(c) An employee shall receive a continuation of benefits as described in this

section for additional time beyond the period provided in paragraph (a) of this

subsection as long as continued medical treatment is reasonably necessary and

related to the work injury or occupational disease if:

1. An application is filed within seventy-five (75) days prior to the

termination of the seven hundred eighty (780) week period;

2. The employee demonstrates that continued medical treatment is

reasonably necessary and related to the work injury or occupational

disease; and

3. An administrative law judge determines and orders that continued

benefits are reasonably necessary and related to the work injury or

occupational disease for additional time beyond the original seven

hundred eighty (780) week period provided in paragraph (a) of this

subsection.

(d) If the administrative law judge determines that medical benefits are not

reasonably necessary or not related to the work injury or occupational disease,

or if an employee fails to make proper application for continued benefits

within the time period provided in paragraph (c) of this subsection, any future

medical treatment shall be deemed to be unrelated to the work injury and the

employer's obligation to pay medical benefits shall cease permanently.

(4) In the absence of designation of a managed health care system by the employer, the

employee may select medical providers to treat his injury or occupational disease.

Even if the employer has designated a managed health care system, the injured

employee may elect to continue treating with a physician who provided emergency

medical care or treatment to the employee. The employer, insurer, or payment

obligor acting on behalf of the employer, shall make all payments for services

rendered to an employee directly to the provider of the services within thirty (30)

days of receipt of a statement for services. The commissioner shall promulgate

administrative regulations establishing conditions under which the thirty (30) day

period for payment may be tolled. The provider of medical services shall submit the

statement for services within forty-five (45) days of the day treatment is initiated

and every forty-five (45) days thereafter, if appropriate, as long as medical services

are rendered. Except as provided in subsection (7) of this section, in no event shall a

medical fee exceed the limitations of an adopted medical fee schedule or other

limitations contained in KRS 342.035, whichever is lower. The commissioner may

promulgate administrative regulations establishing the form and content of a

statement for services and procedures by which disputes relative to the necessity,

effectiveness, frequency, and cost of services may be resolved.

(5) Notwithstanding any provision of the Kentucky Revised Statutes to the contrary,

medical services and treatment provided under this chapter shall not be subject to

copayments or deductibles.

(6) Employers may provide medical services through a managed health care system.

The managed health care system shall file with the Department of Workers' Claims

a plan for the rendition of health care services for work-related injuries and

occupational diseases to be approved by the commissioner pursuant to

administrative regulations promulgated by the commissioner.

(7) All managed health care systems rendering medical services under this chapter shall

include the following features in plans for workers' compensation medical care:

(a) Copayments or deductibles shall not be required for medical services rendered

in connection with a work-related injury or occupational disease;

(b) The employee shall be allowed choice of provider within the plan;

(c) The managed health care system shall provide an informal procedure for the

expeditious resolution of disputes concerning rendition of medical services;

(d) The employee shall be allowed to obtain a second opinion, at the employer's

expense, from an outside physician if a managed health care system physician

recommends surgery;

(e) The employee may obtain medical services from providers outside the

managed health care system, at the employer's expense, when treatment is

unavailable through the managed health care system;

(f) The managed health care system shall establish procedures for utilization

review of medical services to assure that a course of treatment is reasonably

necessary; diagnostic procedures are not unnecessarily duplicated; the

frequency, scope, and duration of treatment is appropriate; pharmaceuticals

are not unnecessarily prescribed; and that ongoing and proposed treatment is

not experimental, cost ineffective, or harmful to the employee; and

(g) Statements for services shall be audited regularly to assure that charges are not

duplicated and do not exceed those authorized in the applicable fee schedules.

(h) A schedule of fees for all medical services to be provided under this chapter

which shall not be subject to the limitations on medical fees contained in this

chapter.

(i) Restrictions on provider selection imposed by a managed health care system

authorized by this chapter shall not apply to emergency medical care.

(8) Except for emergency medical care, medical services rendered pursuant to this

chapter shall be under the supervision of a single treating physician or physicians'

group having the authority to make referrals, as reasonably necessary, to appropriate

facilities and specialists. The employee may change his designated physician one (1)

time and thereafter shall show reasonable cause in order to change physicians.

(9) When a compensable injury or occupational disease results in the amputation or

partial amputation of an arm, hand, leg, or foot, or the loss of hearing, or the

enucleation of an eye or loss of teeth, or permanent total or permanent partial

paralysis, the employer shall pay for, in addition to the other medical, surgical, and

hospital treatment enumerated in subsection (1) and this subsection, a modern

artificial member and, where required, proper braces as may reasonably be required

at the time of the injury and thereafter during disability.

(10) Upon motion of the employer, with sufficient notice to the employee for a response

to be filed, if it is shown to the satisfaction of the administrative law judge by

affidavits or testimony that, because of the physician selected by the employee to

treat the injury or disease, or because of the hospital selected by the employee in

which treatment is being rendered, that the employee is not receiving proper

medical treatment and the recovery is being substantially affected or delayed; or that

the funds for medical expenses are being spent without reasonable benefit to the

employee; or that because of the physician selected by the employee or because of

the type of medical treatment being received by the employee that the employer will

substantially be prejudiced in any compensation proceedings resulting from the

employee's injury or disease; then the administrative law judge may allow the

employer to select a physician to treat the employee and the hospital or hospitals in

which the employee is treated for the injury or disease. No action shall be brought

against any employer subject to this chapter by any person to recover damages for

malpractice or improper treatment received by any employee from any physician,

hospital, or attendant thereof.

(11) An employee who reports an injury alleged to be work-related or files an application

for adjustment of a claim shall execute a waiver and consent of any physician-

patient, psychiatrist-patient, or chiropractor-patient privilege with respect to any

condition or complaint reasonably related to the condition for which the employee

claims compensation. Notwithstanding any other provision in the Kentucky Revised

Statutes, any physician, psychiatrist, chiropractor, podiatrist, hospital, or health care

provider shall, within a reasonable time after written request by the employee,

employer, workers' compensation insurer, special fund, uninsured employers' fund,

or the administrative law judge, provide the requesting party with any information

or written material reasonably related to any injury or disease for which the

employee claims compensation.

(12) When a provider of medical services or treatment, required by this chapter, makes

referrals for medical services or treatment by this chapter, to a provider or entity in

which the provider making the referral has an investment interest, the referring

provider shall disclose that investment interest to the employee, the commissioner,

and the employer's insurer or the party responsible for paying for the medical

services or treatment, within thirty (30) days from the date the referral was made.

(13) (a) Except as provided in paragraphs (b) and (c) of this subsection, the employer,

insurer, or payment obligor shall not be liable for urine drug screenings of

patients in excess of:

1. One (1) per year for a patient considered to be low-risk;

2. Two (2) per year for a patient considered to be moderate-risk; and

3. Four (4) per year for patients considered to be high-risk;

based upon the screening performed by the treating medical provider and

other pertinent factors.

(b) The employer, insurer, or payment obligor may be liable for urine drug

screening at each office visit for patients that have exhibited aberrant behavior

documented by multiple lost prescriptions, multiple requests for early refills of

prescriptions, multiple providers prescribing or dispensing opioids or opioid

substitutes as evidenced by the electronic monitoring system established in

KRS 218A.202 or a similar system, unauthorized dosage escalation, or

apparent intoxication.

(c) The employer, insurer, or payment obligor may request additional urine drug

screenings which shall not count toward the maximum number of drug

screenings enumerated in paragraph (a) of this subsection.

(d) The commissioner shall promulgate administrative regulations related to urine

drug screenings as part of the practice parameters or treatment guidelines

required under KRS 342.035.

(14) (a) As used in this subsection, "practice of pharmacy" has the same meaning as in

KRS 315.010.

(b) In addition to all other compensation that may be reimbursed to a pharmacist

under this chapter, the employer, insurer, or payment obligor shall be liable

for the reimbursement of a pharmacist for a service or procedure at a rate not

less than that provided to other nonphysician practitioners if the service or

procedure:

1. Is within the scope of the practice of pharmacy;

2. Would otherwise be compensable under this chapter if the service or

procedure were provided by a:

a. Physician;

b. Advanced practice registered nurse; or

c. Physician assistant; and

3. Is performed by the pharmacist in strict compliance with laws and

administrative regulations related to the pharmacist's license.