reglab/statecodes huggingface dataset:
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 10 - Practice and Procedure › Subchapter 5 - Hearings Conducted by Administrative Law Judges and Commissioners › Part 7 - INITIAL AND SUBSEQUENT PROCEEDINGS › Section 810:10-5-49 - Rules of evidence

Current through Vol. 41, No. 20, July 1, 2024
(a)
Generally.
The Commission and Administrative Law Judges and are not bound by technical or statutory rules of evidence or procedure, 85A O.S. § 72(A).
(b)
Presentation of evidence.
At the hearing, an opportunity shall be afforded all parties to present evidence and argument with respect to matters and issues involved, although the argument may be restricted to a presentation in written form, to cross-examine witnesses who testify, and to submit rebuttal evidence. During a hearing, irrelevant, immaterial, or unduly repetitious evidence shall be excluded.
(c)
Taking official notice.
The Administrative Law Judge may take official notice of the law of Oklahoma and other jurisdictions, facts that are judicially cognizable, and generally recognized facts within the Commission's specialized knowledge; provided all parties shall be notified either before or during the hearing of the material so noticed, and they shall be afforded an opportunity to contest the facts so noticed.
(d)
Documents.
(1) A photographic copy of a document which is on file as part of the official records of the Commission will be received without further authentication.
(2) A photographic copy of a public record certified by the official custodian thereof will be received without further authentication. A written statement by such custodian of records that no record or entry of described character is found in his records shall be received as proof of absence of such record.
(3) A photographic copy of a document may be substituted for the original at the time the original is offered in evidence.
(4) A document may not be incorporated in the record by reference except by permission of the Commission or Administrative Law Judge. Any document so received must be precisely identified.
(5) The Commission or Administrative Law Judge may require that additional copies of exhibits be furnished for use by other parties of record.
(6) When evidence is offered which is contained in a book or document containing material not offered, the person offering the same shall extract or clearly identify the portion offered.
(7) The Commission or Administrative Law Judge may permit a party of record to offer a document as part of the record within a designated time after conclusion of the hearing.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 10 - Practice and Procedure › Subchapter 5 - Hearings Conducted by Administrative Law Judges and Commissioners › Part 7 - INITIAL AND SUBSEQUENT PROCEEDINGS › Section 810:10-5-50 - Setting of matters

Current through Vol. 41, No. 20, July 1, 2024
(a)
General.
All contested hearings to decide the rights of interested
				  persons under the AWCA shall be set before an Administrative Law Judge, except
				  as otherwise provided by law or this Title.
(b)
Exceptions.
The Commission
				  en banc shall hear appeals of decisions from Administrative Law Judges, 85A
				  O.S. § 78.
(c)
Show
				  cause hearings.
When a Commission Division contests a permit or license
				  holder's compliance with state workers' compensation laws or Commission rules,
				  the Division may cause notice to be issued to the permit or license holder to
				  appear before an Administrative Law Judge or an administrative hearing officer
				  designated by the Commission to show why the holder's permit or license should
				  be renewed or should not be cancelled or revoked. The notice shall contain a
				  date certain for the hearing. Failure to appear at the hearing may result in
				  the nonrenewal, cancellation or revocation of the permit or license.
				  Appearances at the hearing are governed by
				  810:10-1-9.
				  The permit or license holder is to bring all reports and payments for
				  delinquent assessments or other documentation pertinent to the hearing to the
				  show cause hearing. Evidence and witnesses may be presented at the
				  hearing.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 10 - Practice and Procedure › Subchapter 5 - Hearings Conducted by Administrative Law Judges and Commissioners › Part 7 - INITIAL AND SUBSEQUENT PROCEEDINGS › Section 810:10-5-51 - Assignment of Administrative Law Judge; notice of hearing

Current through Vol. 41, No. 20, July 1, 2024
(a) The Commission shall assign a claim for
				  compensation filed pursuant to
				  810:10-5-2
				  to an Administrative Law Judge who shall hold a hearing upon the request of an
				  interested party or on the judge's own motion.
(b) If a hearing is ordered, at least ten
				  (10) days' notice of the hearing shall be served on the claimant and other
				  interested parties, personally or by mail as prescribed in 85A O.S. §
				  71(B)(4). The date, time and location of the hearing shall be specified in the
				  notice. The hearing shall be held in Oklahoma City, Oklahoma or Tulsa,
				  Oklahoma, as provided in
				  810:10-5-48.
				  Objections to venue shall be filed and submitted to the assigned Administrative
				  Law Judge within seven (7) days of receipt of the first hearing docket
				  notice.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 10 - Practice and Procedure › Subchapter 5 - Hearings Conducted by Administrative Law Judges and Commissioners › Part 7 - INITIAL AND SUBSEQUENT PROCEEDINGS › Section 810:10-5-52 - Disqualification of assigned Administrative Law Judge

Current through Vol. 41, No. 20, July 1, 2024
(a) Any party who feels that a fair and
				  impartial administrative hearing or other hearing cannot be received from the
				  Administrative Law Judge to whom the matter is assigned, shall make written
				  motion requesting the judge to withdraw from the case. That application shall
				  set forth specific reasons constituting good cause for the motion. The
				  Administrative Law Judge may withdraw by written order without further
				  proceeding and immediately refer the matter to the Executive Director for
				  reassignment.
(b) Any party
				  aggrieved by an order of an Administrative Law Judge who refused to grant a
				  written request to disqualify, or transfer a claim to the Executive Director
				  for reassignment, may seek corrective relief by invoking the jurisdiction of
				  the Commission en banc in the manner and within the time provided by 85A O.S.
				  § 78, with appeal possible thereafter to the Oklahoma Supreme Court if the
				  relief sought by the petitioner was denied by the Commission en banc.
(c) An order of the assigned Administrative
				  Law Judge or the Commission en banc which is favorable to the moving party may
				  not be reviewed in any tribunal either by appeal or in any other procedural
				  framework.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 10 - Practice and Procedure › Subchapter 5 - Hearings Conducted by Administrative Law Judges and Commissioners › Part 7 - INITIAL AND SUBSEQUENT PROCEEDINGS › Section 810:10-5-53 - Hearings

Current through Vol. 41, No. 20, July 1, 2024
(a) All hearings
				  shall be conducted in a fair, impartial and expeditious manner. Administrative
				  Law Judges shall hear claims sitting without a jury, 85A O.S. §
				  27(A).
(b) Every Administrative Law
				  Judge appointed by the Commission shall have the power to:
(1) refer a matter to mediation as provided
				  in 85A O.S. § 110 and Subchapter 3 of this Chapter;
(2) administer oaths and
				  affirmations;
(3) regulate the
				  course of the hearing;
(4)
				  facilitate discovery as provided in
				  810:10-5-31;
(5) receive written stipulations and
				  agreements of the parties;
(6) rule
				  on the admissibility of evidence and objections thereto;
(7) determine the relevancy, materiality,
				  weight and credibility of evidence;
(8) hold conferences for settlement or
				  simplification of the issues;
(9)
				  dispose of procedural requests, motions, or similar matters, and objections
				  thereto;
(10) issue orders,
				  including interlocutory orders for the proper and expeditious handling of the
				  case;
(11) grant further hearings
				  per 85A O.S. § 72(C) for the purpose of introducing additional evidence;
				  and
(12) take such other action as
				  authorized by law or this Section, or as may facilitate the orderly conduct and
				  disposition of the hearing.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 10 - Practice and Procedure › Subchapter 5 - Hearings Conducted by Administrative Law Judges and Commissioners › Part 7 - INITIAL AND SUBSEQUENT PROCEEDINGS › Section 810:10-5-54 - Judgment or award of the Administrative Law Judge

Current through Vol. 41, No. 20, July 1, 2024
The Administrative Law Judge shall issue written findings
					 of fact and conclusions of law within thirty (30) days of submission of the
					 case by the parties. The order shall be signed by the judge and include a
					 certificate of service to all parties and attorneys of record. The order shall
					 be filed with the Clerk of the Commission.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 10 - Practice and Procedure › Subchapter 5 - Hearings Conducted by Administrative Law Judges and Commissioners › Part 9 - POST ORDER RELIEF › Section 810:10-5-66 - Appeal of Commission Administrative Law Judge order

Current through Vol. 41, No. 20, July 1, 2024
(a)
Request for Review.
Any
				  party aggrieved by a judgment or award of an Administrative Law Judge, which
				  party for purposes of this Section shall be known as the "appellant", may
				  appeal the order to the Commission en banc by filing an original and three (3)
				  copies of a Request for Review with the Commission within ten (10) days of when
				  the order was issued as reflected by the file-stamped date on the order. The
				  Request for Review shall:
(1) be in
				  writing;
(2) include a copy of the
				  order being appealed;
(3) clearly
				  and concisely rebut each issue in the Administrative Law Judge's order that the
				  appellant wants reviewed, and state the relief sought. General allegations of
				  error do not suffice. Allegations of error concerning matters not included in a
				  timely filed Request for Review shall be deemed waived;
(4) be served on all other parties of record,
				  which for purposes of this Section shall be known as the "respondents";
(5) have a certificate of service
				  setting forth the manner of such service as required by
				  810:10-1-7;
(6) be accompanied by a designation of record
				  filed by the appealing party and a copy submitted to the Commission reporter
				  and all parties in the case concurrently with or before filing a Request for
				  Review in all actions which are appealed to the Commission en banc. The cost of
				  preparing the transcript shall be advanced immediately by the designating
				  party. The transcript shall be prepared and sent to all parties to the appeal
				  within thirty (30) days from the date the designation of record is filed; and
(7) be accompanied by a
				  non-refundable filing fee in the sum of One Hundred Seventy-five Dollars
				  ($175.00) pursuant to 85A O.S. § 78(B).
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 10 - Practice and Procedure › Subchapter 5 - Hearings Conducted by Administrative Law Judges and Commissioners › Part 9 - POST ORDER RELIEF › Section 810:10-5-68 - Enforcement of compensation judgment or award

Current through Vol. 41, No. 20, July 1, 2024
(a)
Enforcement.
A final
				  compensation judgment or award issued by the Commission or an Administrative
				  Law Judge which has not been complied with by the employer or insurance carrier
				  may be enforced as provided in 85A O.S. § 79.
(b)
Certification of Awards.
An
				  application for an order directing certification to district court of any
				  workers' compensation award may be heard after notice to the respondent and
				  insurance carrier has been given at least ten (10) days before the scheduled
				  trial thereon. At such trial the respondent and insurance carrier shall be
				  afforded an opportunity to show good cause why the application should not be
				  granted.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 10 - Practice and Procedure › Subchapter 5 - Hearings Conducted by Administrative Law Judges and Commissioners › Part 9 - POST ORDER RELIEF › Section 810:10-5-69 - Nunc pro tunc orders

Current through Vol. 41, No. 20, July 1, 2024
Any party may file a motion to request a nunc pro tunc
					 change to an order issued by the Commission. No nunc pro tunc change may be
					 made in any order without an adversary hearing set upon notice to all parties
					 or written stipulation of consent signed by all parties.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 10 - Practice and Procedure › Subchapter 5 - Hearings Conducted by Administrative Law Judges and Commissioners › Part 11 - CONTEMPT › Section 810:10-5-75 - Contempt procedure

Current through Vol. 41, No. 20, July 1, 2024
(a)
Commencement.
A cause filed for contempt for disobedience to or
				  violation of law or a rule, order or judgment of the Commission shall be
				  commenced by the filing of a verified complaint, which must be copied to all
				  opposing parties.
(b)
Complaint.
The complaint shall state:
(1) The name of the person, firm, trust,
				  corporation, limited liability company or association against whom the
				  complaint is made.
(2) Each law,
				  rule or order of which violation is charged.
(3) In general terms, the acts or omissions
				  constituting the violation of which complaint is made. If complaint is made of
				  more than one violation, each violation shall be separately stated.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 10 - Practice and Procedure › Subchapter 5 - Hearings Conducted by Administrative Law Judges and Commissioners › Part 13 - DISMISSALS › Section 810:10-5-85 - Dismissals

Current through Vol. 41, No. 20, July 1, 2024
(a)
Generally.
Except as otherwise required by law, unless good cause is shown, dismissal of a complaint shall be without prejudice.
(b)
Untimely prosecution or failure to prosecute claim.
Pursuant to 85A O.S. § 69(A)(4), the Commission, on motion and after notice and hearing, shall dismiss a claim for compensation with prejudice to the refiling of a claim if the employee does not:
(1) make a good-faith request for a hearing to resolve a dispute regarding the right to receive benefits, including medical treatment, under the AWCA within six (6) months of the date the claim is filed, or
(2) receive or seek benefits, including medical treatment, under the AWCA for a period of six (6) months.
(3) The Commission may set such claims on a disposition docket.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 10 - Practice and Procedure › Subchapter 5 - Hearings Conducted by Administrative Law Judges and Commissioners › Part 15 - SETTLEMENTS › Section 810:10-5-95 - Joint petition settlements

Current through Vol. 41, No. 20, July 1, 2024
(a) Under 85A O.S. § 87 and 85A O.S. § 115, upon and after the filing of a claim for compensation, or, in the absence of a claim for compensation, the filing of the applicable Employer's First Notice of Injury or FROI per 810:10-1-4(a)  in a claim involving a pro se employee, the parties may engage in a compromise and release of any and all liability which is claimed to exist under the AWCA on account of the injury or occupational disease or illness, subject to approval by the Commission, an Administrative Law Judge, or a Benefit Review Officer.
(b) The parties in interest to a claim for compensation may settle upon and determine any and all issues and matters by agreement, subject to the terms and conditions of this Section.
(c) Any agreement submitted to the Commission, Administrative Law Judge or Benefit Review Officer of the Commission's Counselor Division, for approval shall be set forth in a Commission prescribed CC-Joint Petition Settlement, or electronic equivalent. Nothing in this rule shall preclude the Multiple Injury Trust Fund from compromising a claim as authorized by 85A O.S. § 32(F).
(d) No CC-Joint Petition Settlement agreement shall be binding on the parties in interest unless it is approved by the Commission pursuant to 85A O.S. § 22, Administrative Law Judge of the Commission pursuant to 85A O.S. § 115, or a Commission Benefit Review Officer pursuant to 85A O.S. § 70. The CC-Joint Petition Settlement, including any attached appendix as provided in 85A O.S. § 115(B), identifying the outstanding issues that are subject to the Commission's continuing jurisdiction and possible reopen, shall be approved unless it is determined that:
(1) The agreement is unfair, unconscionable, or improper as a matter of law; or
(2) The agreement is the result of an intentional misrepresentation of a material fact; or
(3) The agreement, if for permanent disability, is not supported by competent medical evidence as required by 85A O.S. § 2(33).
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 10 - Practice and Procedure › Subchapter 5 - Hearings Conducted by Administrative Law Judges and Commissioners › Part 17 - FEES › Section 810:10-5-105 - Fees

Current through Vol. 41, No. 20, July 1, 2024
Fees payable to the Commission include:
(1) A fee of One Thousand Dollars
				  ($1,000.00), payable by each carrier writing worker's compensation insurance in
				  this state, upon securing a license to transact business in this state [85A
				  O.S. § 29(A)];
(2) A fee of
				  One Thousand Dollars ($1,000.00), payable by each self-insurer at the time it
				  is approved to self-insure its obligations under the AWCA [85A O.S. §
				  29(B)];
(3) An annual fee of One
				  Thousand Dollars ($1,000.00), payable by third-party administrators [85A O.S.
				  § 29(C)];
(4) A fee of One
				  Hundred Seventy-five Dollars ($175.00), payable by a party appealing an order
				  or award of an Administrative Law Judge to the Commission en banc [85A O.S.
				  § 78(B)];
(5) A fee of One
				  Hundred Dollars ($100.00), for compiling and transmitting a record for appeal
				  of a Commission order to the Oklahoma Supreme Court, payable by the appealing
				  party [85A O.S. § 78(D)];
(6)
				  A fee of One Hundred Forty Dollars ($140.00), payable by the employer in the
				  event any award becomes final against the employer. [85A O.S. § 118(A)].
				  Ten Dollars ($10.00) of the fee is payable by the Commission to the credit of
				  the Attorney General's Workers' Compensation Fraud Unit Revolving Fund;
(7) A fee of One Hundred Thirty
				  Dollars ($130.00), payable by the worker if the reopen request is to reopen on
				  a change of condition for the worse, or payable by the employer or insurance
				  carrier if the reopen request is to reopen on a change of condition for the
				  better [85A O.S. § 118(B)];
(8) A fee of One Dollar ($1.00) per page,
				  payable as a copy charge [85A O.S. § 119(A)];
(9) A fee of One Dollar ($1.00) per search
				  request for prior claims records, not to exceed One Dollar ($1.00) per claims
				  record of a particular worker [85A O.S. § 120(B)];
(10) A fee of Forty-five Dollars ($45.00),
				  plus postage, if any, for a Commission handbook [85A O.S. § 20(B)];
				  and
(11) A fee of Fifty Dollars
				  ($50.00), payable by any individual or business entity filing an Affidavit of
				  Exempt Status or a renewal thereof [85A O.S., § 36(D)]; and
(12) Such other fees as may be allowed by law
				  or this Title.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 15 - Medical Services › Subchapter 1 - General Provisions › Section 810:15-1-1 - Purpose

Current through Vol. 41, No. 20, July 1, 2024
This Chapter establishes procedures and standards governing
				  medical matters over which the Commission has responsibility under the
				  Administrative Workers' Compensation Act, 85A O.S., §§ 1, et
				  seq.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 15 - Medical Services › Subchapter 3 - Workers' Compensation Fee Schedule › Section 810:15-3-1 - Purpose

Current through Vol. 41, No. 20, July 1, 2024
Workers' compensation fee schedules are intended to establish
				  presumptively fair and reasonable charges for health care services and supplies
				  which may be covered under the AWCA.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 15 - Medical Services › Subchapter 3 - Workers' Compensation Fee Schedule › Section 810:15-3-2 - Applicability of 2012 workers' compensation fee schedule

Current through Vol. 41, No. 20, July 1, 2024
(a) The Oklahoma workers' compensation fee schedule developed and adopted by the Workers' Compensation Court Administrator effective January 1, 2012 for health care services and supplies rendered on and after that date to an injured employee for a compensable work-related injury (the "2012 fee schedule"), shall remain in full force and effect, unless and until superseded by a fee schedule that is adopted by the Commission and approved by the Oklahoma Legislature, in accordance with 85A O.S. § 50(H), or as otherwise provided by law. Specific provisions contained in the AWCA as implemented in this Chapter take precedence over any conflicting provision adopted by or utilized in the 2012 fee schedule with respect to injuries occurring on and after February 1, 2014. [See also 810:15-53 (relating to the Commission's adoption of a closed formulary) and 810:15-7-2 (relating to urine drug screen guidelines)].
(b) The current fee schedule may be viewed at the Commission's main offices and is available on the Commission's website at
http://www.wcc.ok.gov
.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 15 - Medical Services › Subchapter 3 - Workers' Compensation Fee Schedule › Section 810:15-3-3 - Allowable reimbursement for advanced practice registered nurses

Current through Vol. 41, No. 20, July 1, 2024
A certified advanced practice registered nurse (APRN) shall be allowed eighty-five percent (85%) of the fee schedule allowance for Evaluation and Management services and other services performed within the advanced practice registered nurse's license and certification, subject to the conditions and procedures set forth in General Ground Rule 13 of the current fee schedule. When billing for services provided by an APRN, use the modifier (-NP).
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 15 - Medical Services › Subchapter 5 - Pharmaceutical Benefits › Section 810:15-5-1 - Pharmaceutical services

Current through Vol. 41, No. 20, July 1, 2024
(a)
Prescriptions.
A doctor providing care to an injured employee
				shall prescribe for the employee medically necessary prescription drugs and
				over-the-counter medication alternatives as clinically appropriate and
				applicable in accordance with state law and as provided by this
				Section.
(b)
OTC
				medications.
When prescribing an OTC medication alternative to a
				prescription drug, the doctor shall indicate on the prescription the
				appropriate strength of the medication and the approximate quantity of the OTC
				medication that is reasonably required by the nature of the compensable injury.
				The doctor shall prescribe OTC medications in lieu of a prescription drug when
				clinically appropriate.
(c)
Generic prescriptions.
The doctor shall prescribe generic
				prescription drugs when available and clinically appropriate. If in the medical
				judgment of the prescribing doctor a brand name drug is necessary, the doctor
				must specify on the prescription that brand name drugs be dispensed in
				accordance with applicable state and federal law, and must maintain
				documentation justifying the use of the brand name drug, in the patient's
				medical record.
(d)
Use of
				formulary.
When prescribing, the doctor shall choose medications and
				drugs from the formulary adopted by the Commission.
(e)
Statement of medical
				necessity.
The insurance carrier, employee or pharmacist may request a
				statement of medical necessity from the prescribing doctor. The prescribing
				doctor shall provide the statement of medical necessity to the requesting party
				no later than the fourteenth working day after receipt of a request.
(f)
Explanation of benefits.
In
				addition to other requirements regarding explanation of benefits (EOB) provided
				in the Oklahoma workers' compensation fee schedule, at the time an insurance
				carrier denies payment for medications for any reason related to medical
				necessity or reasonableness of health care, the insurance carrier shall also
				send the EOB to the injured employee and the prescribing doctor.
(g)
Billing and reimbursement.
Billing, reimbursement methodologies and the maximum allowable reimbursement
				for pharmaceutical services are subject to 85A O.S., § 50 and the Oklahoma
				workers' compensation fee schedule in effect on the date of service, unless the
				services are provided pursuant to a certified workplace medical plan or a
				written contract between the insurance carrier and provider as provided in 85A
				O.S., § 55(B).
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 15 - Medical Services › Subchapter 5 - Pharmaceutical Benefits › Section 810:15-5-2 - Closed formulary

Current through Vol. 41, No. 20, July 1, 2024
The Commission hereby adopts a closed formulary as defined in
				  810:15-1-2 for
				  workers' compensation claims with a date of injury on and after February 1,
				  2014.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 15 - Medical Services › Subchapter 5 - Pharmaceutical Benefits › Section 810:15-5-3 - Requirements for use of closed formulary

Current through Vol. 41, No. 20, July 1, 2024
(a)
Applicability.
The closed
				formulary adopted pursuant to
				810:15-5-2
				applies to all drugs that are prescribed and dispensed for outpatient use for
				claims with a date of injury on or after February 1, 2014.
(b)
Preauthorization for claims subject
				to the Commission's closed formulary.
Preauthorization is only required
				for drugs that are excluded from the closed formulary, as defined in this
				Chapter.
(c)
Preauthorization
				request.
The preauthorization request must include the prescribing
				doctor's drug regimen plan of care, and the anticipated dosage or range of
				dosages for the drugs. Failure to request preauthorization entitles an
				insurance carrier or employer to deny payment for the drug in question. If the
				insurance carrier or employer fails to respond to a preauthorization request
				within three (3) days, the request shall be deemed approved.
(d)
Preauthorization of intrathecal
				drug delivery systems.
(1) An
				intrathecal drug delivery system requires preauthorization and the
				preauthorization request must include the prescribing doctor's drug regimen
				plan of care, and the anticipated dosage or range of dosages for the
				administration of pain medication.
(2) Refills of an intrathecal drug delivery
				system with drugs excluded from the closed formulary, which are billed using
				Healthcare Common Procedure Coding System (HCPCS) Level II J codes, require
				preauthorization on an annual basis. Preauthorization for these refills is also
				required whenever:
(A) the medications,
				dosage or range of dosages, or the drug regime proposed by the prescribing
				doctor differs from the medications, dosage or range of dosages, or drug regime
				previously preauthorized by that prescribing doctor; or
(B) there is a change in prescribing
				doctor.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 15 - Medical Services › Subchapter 5 - Pharmaceutical Benefits › Section 810:15-5-4 - Medical Interlocutory Order

Current through Vol. 41, No. 20, July 1, 2024
(a) The purpose of this Section is to provide
				a prescribing doctor or pharmacy an ability to obtain a medical interlocutory
				order (MIO) in instances where preauthorization denials of a previously
				prescribed and dispensed drug excluded from the closed formulary poses an
				unreasonable risk of a medical emergency as defined in
				810:15-1-2.
(b) An MIO will be issued if the request for
				an MIO contains the following information:
(1) injured employee name;
(2) date of birth of injured
				employee;
(3) prescribing doctor's
				name;
(4) name of drug and
				dosage;
(5) MIO requestor's name
				(pharmacy or prescribing doctor);
(6) MIO requestor's contact
				information;
(7) a statement that a
				preauthorization request for a previously prescribed and dispensed drug, which
				is excluded from the closed formulary, has been denied by the insurance
				carrier;
(8) a statement that the
				preauthorization denial poses an unreasonable risk of a medical emergency as
				defined in
				810:15-1-2;
(9) a statement that the potential medical
				emergency has been documented in the preauthorization process;
(10) a statement that the insurance carrier
				has been notified that a request for an MIO is being submitted to the
				Commission; and
(11) a signature
				and the following certification by the MIO requestor for Paragraphs (7) through
				(11) of this Subsection, "I hereby certify under penalty of perjury that the
				previously listed conditions have been met."
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 15 - Medical Services › Subchapter 7 - Treatment Guidelines › Section 810:15-7-1 - Treatment guidelines

Current through Vol. 41, No. 20, July 1, 2024
(a)
				Health care not subject to a certified workplace medical plan shall be provided
				using the ODG in effect at the time of treatment as the primary standard of
				reference for determining the frequency and extent of services presumed to be
				medically necessary and appropriate for compensable injuries under the AWCA,
				and in resolving such matters in the event a dispute arises; provided, per 85A
				O.S., § 16(B), a doctor providing care to an injured employee shall
				prescribe for the employee medically necessary prescription drugs and
				over-the-counter alternatives as clinically appropriate and recommended by the
				ODG, and as provided in Subchapter 5 of this Chapter.
(b) Health care provided by a certified
				workplace medical plan shall be in accordance with the plan's treatment
				guidelines. Pursuant to 85A O.S., § 64(B)(1), the plan's treatment
				guidelines shall be consistent with the ODG in effect at the time of
				treatment.
(c) Oklahoma Treatment
				Guidelines (OTG) adopted by the Physician Advisory Committee pursuant to 85
				O.S., § 373(B)(6), effective April 2, 2012, for the prescription and
				dispensing of any controlled substance included in Schedule II of the Uniform
				Controlled Dangerous Substances Act, and pursuant to 85 O.S., § 373(B)(5),
				effective June 24, 2013, for medical treatment for injuries to the spine, are
				not applicable for care of injured employees with a work-related injury
				occurring on or after February 1, 2014. These OTG shall be superceded by any
				"Physician Advisory Committee Guidelines" (PACG) adopted by the Physician
				Advisory Committee pursuant to 85A O.S., § 17(B). The PACG shall be
				adopted only for:
(1) medical treatment not
				addressed by the latest edition of the ODG; and
(2) the prescription and dispensing of any
				controlled substance included in Schedule II of the Uniform Controlled
				Dangerous Substances Act if not addressed by the latest edition of the
				ODG.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 15 - Medical Services › Subchapter 7 - Treatment Guidelines › Section 810:15-7-2 - Controlled substance monitoring and drugs of abuse testing for chronic pain management

Current through Vol. 41, No. 20, July 1, 2024
One presumptive drug test is allowable at each individual
				  office visit for chronic pain management. Definitive drug testing following a
				  suspected abnormality on the presumptive drug test is permissible for not more
				  than forty (40) individual definitive drug tests every twelve (12
				  months).
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 15 - Medical Services › Subchapter 9 - Independent Medical Examiners › Section 810:15-9-1 - Qualifications

Current through Vol. 41, No. 20, July 1, 2024
(a) The Commission shall maintain a list of private physicians to serve as independent medical examiners. The list shall be placed on the Commission's website at
http://www.wcc.ok.gov
.
(b) To be eligible for appointment by the Commission to the list of qualified independent medical examiners, and for retention on the list, the physician must:
(1) have a valid, unrestricted professional license as a physician which is not probationary;
(2) have at least three (3) years' experience and competency in the physician's specific field of expertise and in the treatment of work-related injuries;
(3) be knowledgeable of workers' compensation principles and the workers' compensation system in Oklahoma, as demonstrated by prior experience, and attending educational programming, on the Official Disability Guidelines, if a treating physician, and/or in the American Medical Association's "Guides to the Evaluation of Permanent Impairment, " if a rating physician, or other continuing education courses related to workers' compensation topics;
(4) have in force and effect health care provider professional liability insurance from a domestic, foreign or alien insurer authorized to transact insurance in Oklahoma. The per claim and aggregate limits of the insurance must be at least One Million Dollars ($1,000,000.00); and
(5) have no felony conviction under federal or state law within seven (7) years before the date of the physician's application to serve as a qualified independent medical examiner.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 15 - Medical Services › Subchapter 9 - Independent Medical Examiners › Section 810:15-9-2 - Application and appointment process

Current through Vol. 41, No. 20, July 1, 2024
(a)
Appointment.
Appointment of
				physicians to the list of qualified independent medical examiners, and
				maintenance and periodic validation of such list shall be by the Commission.
				Physician appointments shall be for a two-year period.
(b)
Application for appointment.
To request appointment to the list of qualified independent medical examiners,
				a physician shall:
(1) Submit a signed and
				completed Commission prescribed IME Application and Physician Disclosure forms
				to the following address: Oklahoma Workers' Compensation Commission, Attention:
				HEALTH SERVICES DIVISION, 1915 North Stiles Avenue, Oklahoma City, Oklahoma
				73105. Illegible, incomplete or unsigned applications and disclosures will not
				be considered by the Commission and shall be returned. A copy of the IME
				Application and Physician Disclosure forms may be obtained from the Commission
				at the address set forth in this Paragraph, or from the Commission's website at
http://www.wcc.ok.gov
;
(2) Submit a current curriculum vitae,
				together with the IME Application and Physician Disclosure forms, to the
				address set forth in the preceding Paragraph; and
(3) Verify that the physician, if appointed,
				will:
(A) provide independent, impartial and
				objective medical findings in all cases that come before the
				physician;
(B) decline a request to
				serve as an independent medical examiner only for good cause shown;
(C) conduct an examination, if necessary,
				within forty-five (45) calendar days from the date of the order appointing the
				examiner, unless otherwise approved by the Commission, when necessary to render
				findings on the questions and issues submitted;
(D) prepare a written report in accordance
				with Commission rules which addresses the issues set out in the order of
				appointment;
(E) submit the report
				to the parties and the Commission within fourteen (14) calendar days of a
				required examination of the claimant and/or completion of necessary tests, or
				within fourteen (14) calendar days after receipt of necessary records and
				information if no examination and/or tests are required;
(F) accept as payment in full for services
				rendered as an independent medical examiner the fees established pursuant to
				810:15-9-5;
(G) submit to a review pursuant to
				810:15-9-3 and 85A
				O.S., § 112(H);
(H) submit
				annually to the Commission written verification of valid health care provider
				professional liability insurance as and if required in
				810:15-9-1;
(I) notify the Commission in writing upon any
				change affecting the physician's qualifications as provided in
				810:15-9-1;
				and
(J) comply with all applicable
				statutes and Commission rules.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 15 - Medical Services › Subchapter 9 - Independent Medical Examiners › Section 810:15-9-3 - Revocation

Current through Vol. 41, No. 20, July 1, 2024
(a) Removal of a
				physician from the list of qualified independent medical examiners shall be by
				request of the independent medical examiner or by the Commission after notice
				and opportunity for hearing.
(b)
				The Commission may remove a physician from the list of qualified independent
				medical examiners for cause, including, but not limited to the following
				grounds:
(1) a material misrepresentation on
				the IME Application or Physician Disclosure forms;
(2) refusal or substantial failure to notify
				the Commission of any change affecting the physician's qualifications as
				provided in
				810:15-9-1;
				or
(3) refusal or substantial
				failure to comply with this Subchapter, 85A O.S., § 112, or other
				applicable Commission rules and statutes.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 15 - Medical Services › Subchapter 9 - Independent Medical Examiners › Section 810:15-9-4 - Requests for assignment

Current through Vol. 41, No. 20, July 1, 2024
(a)
				Appointment of an independent medical examiner from the Commission's list of
				independent medical examiners is governed by this Section. Appointments shall
				take into account the specialty, availability and location of the examiner. The
				independent medical examiner selected shall be certified by a recognized
				specialty board in the area or areas appropriate to the condition under
				review.
(b) Requests for the
				appointment of an independent medical examiner may be set for a prehearing
				conference, at the discretion of the Commission.
(c) An independent medical examiner may be
				appointed on any issue before the Commission, including to determine if further
				medical treatment is needed following a full duty release on all body parts by
				the treating physician. If surgery is recommended by a treating physician, upon
				written request of the employer made on a CC-Form-13 filed within twenty (20)
				days of receipt of the treating physician's report, an independent medical
				examiner who is qualified to perform the type of surgery recommended shall be
				appointed to determine the reasonableness and necessity of the surgery. The
				twenty-day request deadline may be waived by agreement of the parties or for
				good cause shown.
(d) The parties
				shall send the employee's medical records to the independent medical examiner
				by regular mail within ten (10) calendar days of receipt of the Commission
				order assigning the examiner. If necessary, the independent medical examiner
				may contact persons in whose possession the records or information is located
				solely for the purpose of obtaining such records or information.
(e) An independent medical examiner's opinion
				is binding unless there is clear and convincing evidence to the contrary.
				Deviations by the Commission from the independent medical examiner's opinion
				must be explained.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 15 - Medical Services › Subchapter 9 - Independent Medical Examiners › Section 810:15-9-6 - Renewal process

Current through Vol. 41, No. 20, July 1, 2024
(a) The
				Commission shall notify the independent medical examiner of the end of the
				examiner's two-year qualification period at least sixty (60) calendar days
				before the expiration of that period and shall apprise the examiner how to
				access the IME Application and Physician Disclosure forms for reapplication as
				an independent medical examiner.
(b) Criteria for reapplication shall be
				governed by
				810:15-9-1 and
				810:15-9-2.
				If a curriculum vitae (CV) was previously submitted with a request for
				independent medical examiner status, the physician does not have to resubmit
				the physician's CV, unless there have been material changes that would have
				bearing upon the applicant's qualifications.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 15 - Medical Services › Subchapter 11 - Medical Case Management › Section 810:15-11-1 - Qualifications

Current through Vol. 41, No. 20, July 1, 2024
(a) The Commission
				shall maintain a list of private medical case managers to serve as independent
				medical case managers. The list shall be placed on the Commission's website at
http://www.wcc.ok.gov
.
(b) To be eligible for appointment by the
				Commission to the list of qualified independent medical case managers, and for
				retention on the list, the applicant must:
(1) be a registered nurse with a current,
				active unencumbered license from the Oklahoma Board of Nursing, or possess one
				or more of the following certifications:
(A)
				Certified Disability Management Specialist (CDMS);
(B) Certified Case Manager (CCM);
(C) Certified Rehabilitation Registered Nurse
				(CRRN);
(D) Case Manager -
				Certified (CMC);
(E) Certified
				Occupational Health Nurse (COHN); or
(F) Certified Occupational Health Nurse
				Specialist (COHN-S);
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 15 - Medical Services › Subchapter 11 - Medical Case Management › Section 810:15-11-2 - Application and appointment process

Current through Vol. 41, No. 20, July 1, 2024
(a)
Appointment.
Appointment of
				applicants to the list of qualified independent medical case managers, and
				maintenance and periodic validation of such list shall be by the Commission.
				Medical case manager appointments to the list shall be for a two year
				period.
(b)
Application for
				appointment.
To request appointment to the list of qualified medical
				case managers, an applicant shall:
(1) Submit
				a signed and completed Commission prescribed MCM Application form to the
				following address: Oklahoma Workers' Compensation Commission, Attention: HEALTH
				SERVICES DIVISION, 1915 North Stiles Avenue, Oklahoma City, Oklahoma, 73105.
				Illegible and incomplete or unsigned applications will not be considered by the
				Commission and shall be returned. A copy of the MCM Application form may be
				obtained from the Commission at the address set forth in this Paragraph, or
				from the Commission's website at
http://www.wcc.ok.gov
;
(2) Submit a current resume, together with
				the MCM Application form, to the Commission; and
(3) Verify that the applicant, if appointed,
				will:
(A) provide independent, impartial and
				objective medical case management services in all cases assigned to the case
				manager;
(B) decline a request to
				serve as a medical case manager only for good cause shown;
(C) meet with the claimant and appear at any
				appointments with treating physicians, as directed by the Commission, and when
				necessary to report findings or respond to questions and issues submitted by
				the Commission;
(D) submit an
				initial written report to the parties and Commission within twenty (20)
				calendar days from the date of the order appointing the case manager, or sooner
				as the particular circumstances of the medical care or treatment or inquiries
				from the Commission may necessitate. Progress reports shall be submitted as the
				particular circumstances of each case warrant, or as directed by the
				Commission;
(E) notify the
				Commission in writing upon any change affecting the medical case manager's
				qualifications as provided by statute or in
				810:15-11-1;
				and
(F) comply with all applicable
				statutes, Commission rules, and orders in the case assigned.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 15 - Medical Services › Subchapter 11 - Medical Case Management › Section 810:15-11-3 - Revocation

Current through Vol. 41, No. 20, July 1, 2024
(a) Removal of a
				case manager from the list of qualified independent medical case managers shall
				be at the request of the case manager, or by the Commission after notice and
				opportunity for hearing.
(b)
				Grounds for removal include, but are not limited to:
(1) a material misrepresentation on the MCM
				Application for appointment to the list of qualified independent medical case
				managers;
(2) refusal or
				substantial failure to notify the Commission of any change affecting the case
				manager's qualifications as provided by statute or
				810:15-11-1;
				or
(3) refusal or substantial
				failure to comply with this Subchapter, or other applicable Commission rules,
				statutes or orders in the specific case assigned.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 15 - Medical Services › Subchapter 11 - Medical Case Management › Section 810:15-11-4 - Requests for assignment

Current through Vol. 41, No. 20, July 1, 2024
(a)
				For cases not covered by a certified workplace medical plan, and where the
				employer, insurance company, or own risk employer does not provide case
				management, the Commission may grant case management on the request of any
				party or when the Commission determines that case management is appropriate.
				Nothing in this Section shall limit the Commission's ability to appoint a case
				manager by agreement of the parties, or as otherwise allowed by law.
(b) If the parties to a dispute cannot agree
				on an independent medical case manager of their own choosing, the Commission
				may appoint one from the list of qualified independent medical case managers
				maintained by the Commission.
(c)
				In order to be eligible for appointment in any given case, a qualified medical
				case manager:
(1) shall not have a financial
				interest in the claimant's award; and
(2) shall not have any financial interest in
				the employer's or insurer's business, nor regularly contract with or serve as a
				case manager for the employer, insurer, or employer's own risk group, or a
				certified workplace medical plan with which the employer or employer's own risk
				group contracts.