Opinion ID: 1125139
Heading Depth: 3
Heading Rank: 2

Heading: Frequency of Treatment

Text: Alaska law requires a doctor to submit a treatment plan to the employer if treatment exceeds the statutorily-mandated treatment frequencies. Alaska Statute 23.30.095(c) provides in part: When a claim is made for a course of treatment requiring continuing and multiple treatments of a similar nature, in addition to the notice, the physician or health care provider shall furnish a written treatment plan if the course of treatment will require more frequent outpatient visits than the standard treatment frequency [1] for the nature and degree of the injury and the type of treatments. The treatment plan shall be furnished to the employee and the employer within 14 days after treatment begins. The treatment plan must include objectives, modalities, frequency of treatments, and reasons for the frequency of treatments. If the treatment plan is not furnished as required under this subsection, neither the employer nor the employee may be required to pay for treatments that exceed the frequency standard. The board shall adopt regulations establishing standards for frequency of treatment. (Emphasis added.) The Board has also adopted exceptions to the standard treatment frequency. These are found in 8 Alaska Administrative Code (AAC) 45.082(g): The board will, in its discretion, require the employer to pay for treatments that exceed the frequency standards in (f) of this section only if the board finds that (1) the written treatment plan was given to the employer and employee within 14 days after the treatments began; (2) the treatments improved or are likely to improve the employee's conditions; and (3) a preponderance of the medical evidence supports a conclusion that the board's frequency standards are unreasonable considering the nature of the employee's injury. We reviewed and upheld these regulations in Chiropractors for Justice v. State, 895 P.2d 962, 965 (Alaska 1995). It is undisputed that ACE was not provided with a treatment plan within fourteen days of the treatment. The Board found it did not have the discretion to allow more frequent treatments, because Grove's medical providers had not complied with the statute. Grove argues, however, that ACE may not invoke the statutory treatment limits because it initially denied that Grove was entitled to benefits. [2] The superior court concluded that Grove's argument was unsupported by the statutory scheme and that he had offered no evidence of contrary legislative intent. The superior court was correct. Nothing in the statute or the regulations promulgated by the Board supports the contention that frequency standards may be waived when the employer initially disputes benefits. The Board has defined the circumstances under which the frequency standards may be waived. Grove's treatments are not within these circumstances. Grove relies on Romualdo Velonza v. Caterair International, Alaska Workers' Compensation Board Case No. 9218565 (June 9, 1994) to support his argument. The case does not support Grove's argument. In Caterair, the Board excused failure to give notice of treatment because of the controversion. However, the Board awarded compensation only for those treatments which fell within the standards established in 8 AAC 45.082(f). [3] The Board cannot allow more frequent treatment without the submission of a treatment plan following the procedure provided for in 8 AAC 45.082(g). The employer's original decision to controvert the claim is not relevant to the application of the frequency standards. Grove's position, if adopted, would put the burden on the employer to object to the frequency of an employee's medical treatments, if they exceed the statutory standard. The statute is clear that it is the employee's health care provider who must take steps if the statutory frequency of that treatment is exceeded. Grove argues that the Board erred by failing to find that Dr. Moran and H & W submitted the equivalent of a treatment plan to ACE and its insurers. Dr. Moran submitted Physician's Reports, which are billing forms prepared by the Department of Labor. H & W also prepared progress reports for Dr. Moran, which were submitted to ACE's insurance carrier. The statute requires that the treatment plan include objectives, modalities, frequency of treatments, and reasons for the frequency of treatments. AS 23.30.095(c). The Board did not err in determining that the reports do not meet the definition of a treatment plan required by the statute.