Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 15 - WORKERS COMPENSATION MEDICAL FEE SCHEDULE & EXHIBIT A › Subchapter 3 - TREATMENT › Section 12-15-42 - Consultations

Current through June, 2024
(a) A consultation includes those services
				rendered by another physician whose opinion or advice is requested in the
				evaluation and treatment of an injured employee's injury. A consultation may be
				requested by the attending physician, the injured employee, the employer, or
				the director. Consultation referrals shall be to a physician with expertise and
				experience on the subject and upon authorization by the employer or upon order
				of the director. The attending physician shall provide the consultant with all
				available medical information.
(b)
				When requesting consideration for consultation, the attending physician shall
				obtain permission from the employer prior to initiating such referral. The
				name, business address, discipline, and specialty of the consulting physician
				and the reasons for the consultation shall be submitted in writing to the
				employer at least seven calendar days prior to referral.
(c) Whenever a request for consultation is
				received, the employer shall respond within seven calendar days after postmark
				of such request, giving authorization or stating in writing the reason for
				refusal, to the attending physician, the injured employee, and the director.
				The refusal shall explicitly state that failure to request a review by the
				director of the employer's denial within fourteen calendar days after postmark
				of the employer's denial shall be construed as acceptance of the employer's
				denial. If a request for consultation with the same medical specialty has been
				denied, the attending physician may not resubmit the same request for
				consultation with the same medical specialty for forty-five calendar days after
				postmark of the employer's denial. Failure by the employer to respond within
				seven calendar days shall constitute approval of the request.
(d) The attending physician or the injured
				employee may request in writing that the director review the employer's denial
				of the request for consultation. The request for review shall be filed with the
				director, copying the employer, within fourteen calendar days after postmark of
				the employer's denial. A copy of the denied consultation request shall be
				submitted with the request for review. Failure to file a request for review of
				the employer's denial to the director within fourteen calendar days after
				postmark of the employer's denial shall be deemed acceptance of the employer's
				denial, and the attending physician may not resubmit the same request for
				consultation with the same medical specialty for forty-five calendar days after
				postmark of the employer's denial. The director shall hold a hearing on the
				request for review, and issue a decision approving or denying the request for
				consultation based on the evidence presented (inclusive of records on file).
				The decision shall be final unless appealed pursuant to section
				386-87,
				HRS. The appeal shall not stay the director's decision.
(e) When consultation is required immediately
				because the condition is life-threatening or could cause serious harm, the
				attending physician shall notify the employer as soon as possible.
(f) The consultant shall provide a copy of
				the consultation report to the attending physician and the employer within
				fourteen calendar days of the date of the examination.
(g) When the consulting physician assumes the
				continuing care of the patient, this subsequent service will no longer be
				considered a consultation. If the industrial injury or condition necessitates
				the concurrent medical services and skills in accordance with section 12-15-40
				of two or more physicians, each physician shall be entitled to the listed fee
				for services rendered.
(h) Fees for
				consultations requested by the attending physician, the injured employee, or
				the employer shall be paid by the employer. Fees for consultations requested by
				the director shall be paid from funds appropriated by the legislature for use
				by the department.
(i) For groups
				of physicians or hospitals with satellite clinics, when service is rendered by
				a member of a group and the patient is referred to another physician in the
				group for consultation, fees for such consultation may be allowed.