Connecticut 2019 Regular Session

Connecticut House Bill HB06916 Compare Versions

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	7	+	General Assembly Committee Bill No. 6916
	8	+	January Session, 2019
	9	+	LCO No. 6224
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	12	+	Referred to Committee on LABOR AND PUBLIC EMPLOYEES
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	14	+
	15	+	Introduced by:
	16	+	(LAB)
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4		-	House Bill No. 6916
5		-
6		-	Special Act No. 19-10
7		-
8		-
9		-	AN ACT ESTABLISHING A TASK FORCE TO STUD Y REMEDIES
10		-	AND POTENTIAL LIABILITY FOR UNREASONABLY CONTESTED
11		-	OR DELAYED WORKERS' COMPENSATION CLAIMS.
	20	+	AN ACT EXPANDING REM EDIES AND POTENTIAL LIABILITY FOR
	21	+	UNREASONABLY CONTEST ED OR DELAYED WORKER S'
	22	+	COMPENSATION CLAIMS.
12	23		Be it enacted by the Senate and House of Representatives in General
13	24		Assembly convened:
14	25
15		-	Section 1. (Effective from passage) (a) There is established a task force
16		-	to (1) identify the extent of unreasonably contested or delayed
17		-	workers' compensation claims, (2) study methods to expand remedies
18		-	regarding potential liability for unreasonably contested or delayed
19		-	workers' compensation claims, and (3) clarify the law regarding bad
20		-	faith handling of workers' compensation claims. Such study shall
21		-	include, but need not be limited to, an examination of: (A) How such
22		-	claims are handled when an injured worker is covered by employee
23		-	benefit health insurance, (B) whether an employee benefit plan should
24		-	make payments during the time period the Workers' Compensation
25		-	Commission takes to determine whether the worker's injury is work
26		-	related, (C) how claims are handled when an injured worker's
27		-	employer does not provide an employee benefit health insurance plan,
28		-	(D) the Workers' Compensation Commissioner's authority to fine an
29		-	insurance company for unreasonably contested claims or undue delay,
30		-	particularly when such undue delay may cause permanent injury to an
31		-	employee, (E) delays caused by the failure of medical professionals to
32		-	follow the Professional Guide for Attorneys, Physicians and Other House Bill No. 6916
	26	+	Section 1. Section 31-300 of the general statutes is repealed and the 1
	27	+	following is substituted in lieu thereof (Effective October 1, 2019): 2
	28	+	(a) As soon as may be after the conclusion of any hearing, but no 3
	29	+	later than one hundred twenty days after such conclusion, the 4
	30	+	commissioner shall send to each party a written copy of the 5
	31	+	commissioner's findings and award. The commissioner shall, as part of 6
	32	+	the written award, inform the employee or the employee's dependent, 7
	33	+	as the case may be, of any rights the individual may have to an annual 8
	34	+	cost-of-living adjustment or to participate in a rehabilitation program 9
	35	+	administered by the Department of Rehabilitation Services under the 10
	36	+	provisions of this chapter. The commissioner shall retain the original 11
	37	+	findings and award in said commissioner's office. If no appeal from the 12
	38	+	decision is taken by either party within twenty days thereafter, such 13
	39	+	award shall be final and may be enforced in the same manner as a 14
	40	+	judgment of the Superior Court. The court may issue execution upon 15 Committee Bill No. 6916
33	41
34		-	Special Act No. 19-10 2 of 5
35	42
36		-	Health Care Practitioners Guidelines for Cooperation, or to provide
37		-	respondents with a complete and accurate medical history, including,
38		-	but not limited to, all relevant medical records requested, (F) whether
39		-	benefits are paid to injured workers or on behalf of injured workers
40		-	without prejudice during a period of contest, and the frequency with
41		-	which (i) said benefits are reimbursed in cases in which the underlying
42		-	injury is deemed not compensable, (ii) the treatment paid for without
43		-	prejudice is deemed unreasonable or unnecessary, or (iii) indemnity
44		-	was paid during a period of time in which the injured worker is
45		-	deemed to have been capable of working and work was available, (G)
46		-	remedies when an undue delay in payment causes unnecessarily long
47		-	delays in medical treatment, resulting in loss of employment, (H) types
48		-	of systems that may be created to obtain data regarding reasonable
49		-	treatment and recovery timeframes, and (I) best methods to prevent
50		-	unfair claim-handling practices that violate the Connecticut Unfair
51		-	Insurance Practices Act, as amended from time to time, including, but
52		-	not limited to, the following: (i) Misrepresenting pertinent facts or
53		-	insurance policy provisions relating to coverages at issue; (ii) failing to
54		-	acknowledge and act with reasonable promptness upon
55		-	communications with respect to claims arising out of and in the course
56		-	of employment under insurance policies and third -party
57		-	administration contracts; (iii) failing to adopt and implement
58		-	reasonable standards for the prompt investigation of claims arising out
59		-	of and in the course of employment to which such insurance policies
60		-	and third-party administration contracts shall respond; (iv) refusing to
61		-	pay benefits without conducting a reasonable and timely investigation
62		-	based upon all available information; (v) failing to affirm or deny
63		-	coverage of benefits within a reasonable time after submission of a
64		-	request for such benefits has been submitted; (vi) not attempting in
65		-	good faith to effectuate prompt, fair and equitable provision of benefits
66		-	for claims in which liability has become reasonably clear; (vii)
67		-	attempting to settle claims on the basis of an application that was
68		-	altered without notice to or knowledge or consent of the insured; (viii) House Bill No. 6916
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70		-	Special Act No. 19-10 3 of 5
	47	+	any uncontested or final award of a commissioner in the same manner 16
	48	+	as in cases of judgments rendered in the Superior Court; and, upon the 17
	49	+	filing of an application to the court for an execution, the commissioner 18
	50	+	in whose office the award is on file shall, upon the request of the clerk 19
	51	+	of said court, send to the clerk a certified copy of such findings and 20
	52	+	award. In cases where, through the fault or neglect of the employer or 21
	53	+	insurer, adjustments of compensation have been unduly delayed, or 22
	54	+	where through such fault or neglect, payments have been unduly 23
	55	+	delayed, the commissioner [may] shall include in the award interest at 24
	56	+	the rate prescribed in section 37-3a and a reasonable attorney's fee in 25
	57	+	the case of undue delay in adjustments of compensation and [may] 26
	58	+	shall include in the award in the case of undue delay in payments of 27
	59	+	compensation, interest at twelve per cent per annum and a reasonable 28
	60	+	attorney's fee. Payments not commenced within thirty-five days after 29
	61	+	the filing of a written notice of claim shall be presumed to be unduly 30
	62	+	delayed unless a notice to contest the claim is filed in accordance with 31
	63	+	section 31-297. In cases where there has been delay in either 32
	64	+	adjustment or payment, which delay has not been due to the fault or 33
	65	+	neglect of the employer or insurer, whether such delay was caused by 34
	66	+	appeals or otherwise, the commissioner [may] shall allow interest at 35
	67	+	such rate, not to exceed the rate prescribed in section 37-3a, as may be 36
	68	+	fair and reasonable, taking into account whatever advantage the 37
	69	+	employer or insurer, as the case may be, may have had from the use of 38
	70	+	the money, the burden of showing that the rate in such case should be 39
	71	+	less than the rate prescribed in section 37-3a to be upon the employer 40
	72	+	or insurer. In cases where the claimant prevails and the commissioner 41
	73	+	finds that the employer or insurer has unreasonably contested liability, 42
	74	+	the commissioner [may] shall allow to the claimant a reasonable 43
	75	+	attorney's fee. No employer or insurer shall discontinue or reduce 44
	76	+	payment on account of total or partial incapacity under any such 45
	77	+	award, if it is claimed by or on behalf of the injured person that such 46
	78	+	person's incapacity still continues, unless such employer or insurer 47
	79	+	notifies the commissioner and the employee of such proposed 48
	80	+	discontinuance or reduction in the manner prescribed in section 31-296 49
	81	+	and the commissioner specifically approves such discontinuance or 50 Committee Bill No. 6916
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72		-	making known to beneficiaries of such insurance policies or third-
73		-	party contracts of administration pursuant to this section a policy of
74		-	appealing from decisions of a workers' compensation commissioner or
75		-	administrative law judge in favor of such beneficiaries for the purpose
76		-	of compelling the acceptance of settlements or compromises in an
77		-	amount less than the amount awarded in decisions; (ix) delaying the
78		-	investigation or payment of claims by requiring a beneficiary or health
79		-	care provider to submit a preliminary claim report and then requiring
80		-	the subsequent submission of formal proof-of-loss forms, both of
81		-	which submissions contain substantially the same information; or (x)
82		-	failing to promptly provide a reasonable written explanation for the
83		-	denial of a claim or for an offer of a compromise and settlement in
84		-	relation to the facts or applicable law.
85		-	(b) The task force shall consist of the following members:
86		-	(1) Two appointed by the speaker of the House of Representatives,
87		-	one of whom is an attorney and a member of the Connecticut Trial
88		-	Lawyers Association who has experience in workers' compensation
89		-	cases and one of whom is an attorney and a member of the
90		-	Connecticut Defense Lawyers Association who primarily represents
91		-	respondents in workers' compensation cases;
92		-	(2) Two appointed by the president pro tempore of the Senate, one
93		-	of whom is a representative of physicians who treat workers'
94		-	compensation claims patients and one of whom is a physician who
95		-	performs respondents' medical examinations in workers'
96		-	compensation cases;
97		-	(3) Two appointed by the majority leader of the House of
98		-	Representatives, one of whom shall be a member of the General
99		-	Assembly and one of whom is an injured worker;
100		-	(4) Two appointed by the majority leader of the Senate, one of House Bill No. 6916
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102		-	Special Act No. 19-10 4 of 5
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104		-	whom shall be a member of the Workers' C ompensation Legal
105		-	Advisory Panel or the Workers' Compensation Medical Advisory
106		-	Panel, whomever of which is available for any scheduled meeting, and
107		-	one of whom is a member of the Connecticut State Medical Society;
108		-	(5) Two appointed by the minority leader of the House of
109		-	Representatives, one of whom shall be a representative of the business
110		-	community and one of whom is an injured worker;
111		-	(6) Two appointed by the minority leader of the Senate, one of
112		-	whom shall represent a workers' compensation insurance carrier and
113		-	one of whom shall be a representative of industry;
114		-	(7) The chairperson of the Workers' Compensation Commission, or
115		-	the chairperson's designee;
116		-	(8) The Insurance Commissioner, or the commissioner's designee;
117		-	(9) The Commissioner of Social Services, or the commissioner's
118		-	designee; and
119		-	(10) The Commissioner of Administrative Services, or the
120		-	commissioner's designee.
121		-	(c) Any member of the task force appointed under subdivision (1),
122		-	(2), (5) or (6) of subsection (b) of this section may be a member of the
123		-	General Assembly.
124		-	(d) All appointments to the task force shall be made not later than
125		-	August 1, 2019. Any vacancy shall be filled by the appointing
126		-	authority.
127		-	(e) The speaker of the House of Representatives and the president
128		-	pro tempore of the Senate shall select the chairpersons of the task force
129		-	from among the members of the task force. Such chairpersons shall
130		-	schedule the first meeting of the task force, which shall be held not House Bill No. 6916
	88	+	reduction in writing. The commissioner shall render the decision 51
	89	+	within fourteen days of receipt of such notice and shall forward to all 52
	90	+	parties to the claim a copy of the decision not later than seven days 53
	91	+	after the decision has been rendered. If the decision of the 54
	92	+	commissioner finds for the employer or insurer, the injured person 55
	93	+	shall return any wrongful payments received from the day designated 56
	94	+	by the commissioner as the effective date for the discontinuance or 57
	95	+	reduction of benefits. Any employee whose benefits for total incapacity 58
	96	+	are discontinued under the provisions of this section and who is 59
	97	+	entitled to receive benefits for partial incapacity as a result of an 60
	98	+	award, shall receive those benefits commencing the day following the 61
	99	+	designated effective date for the discontinuance of benefits for total 62
	100	+	incapacity. In any case where the commissioner finds that the 63
	101	+	employer or insurer has discontinued or reduced any such payment 64
	102	+	without having given such notice and without the commissioner 65
	103	+	having approved such discontinuance or reduction in writing, the 66
	104	+	commissioner shall allow the claimant a reasonable attorney's fee 67
	105	+	together with interest at the rate prescribed in section 37-3a on the 68
	106	+	discontinued or reduced payments. 69
	107	+	(b) The provisions of subsection (a) of section 31-284 with respect to 70
	108	+	the exclusivity of remedy between the employee and the employer 71
	109	+	shall not apply to an action by an employee against an insurer or third-72
	110	+	party administrator for breach of the covenant of good faith and fair 73
	111	+	dealing in the handling of claims under this chapter or for a violation 74
	112	+	of chapter 704 or 735a or section 38a-815 or 42-110b. A claimant for 75
	113	+	benefits under this chapter is a third-party beneficiary of a contract of 76
	114	+	insurance for an employer's liability for benefits under this chapter and 77
	115	+	of a contract for a third-party administration of claims for benefits 78
	116	+	under this chapter, and such insurer or third-party administrator owes 79
	117	+	to such a claimant a duty of good faith and fair dealing and a duty not 80
	118	+	to contest benefits unreasonably nor to delay benefits unreasonably. 81
	119	+	The provisions of chapters 704 and 735a do not preempt a common-82
	120	+	law action for breach of this covenant of good faith and fair dealing 83
	121	+	and exhaustion of administrative remedies under this chapter is not 84 Committee Bill No. 6916
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132		-	Special Act No. 19-10 5 of 5
133	123
134		-	later than sixty days after the effective date of this section.
135		-	(f) The administrative staff of the joint standing committee of the
136		-	General Assembly having cognizance of matters relating to labor shall
137		-	serve as administrative staff of the task force.
138		-	(g) Not later than January 1, 2020, the task force shall submit a
139		-	report on its findings and recommendations to the joint standing
140		-	committee of the General Assembly having cognizance of matters
141		-	relating to labor, in accordance with the provisions of section 11-4a of
142		-	the general statutes. The task force shall terminate on the date that it
143		-	submits such report or January 1, 2020, whichever is later.
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	128	+	required prior to the filing of such action, provided benefits awarded 85
	129	+	or penalties imposed pursuant to chapter 568 shall be credited against 86
	130	+	any duplicative damages awarded pursuant to such action. Damages 87
	131	+	in successful actions against an insurer or third-party administrator 88
	132	+	under this subsection may include, but need not be limited to, 89
	133	+	demonstrable economic damages, damages for mental or physical 90
	134	+	injury, pain or suffering arising from the misconduct of the insurer or 91
	135	+	third-party administrator and attorneys' fees. 92
	136	+	(c) No insurer, third-party administrator or organization authorized 93
	137	+	to handle workers' compensation claims pursuant to chapter 568 shall 94
	138	+	be allowed to seek indemnification from any employer or organization 95
	139	+	as a result of a claim brought pursuant to this section. 96
	140	+	(d) No insurer, third-party administrator or organization authorized 97
	141	+	to handle workers' compensation claims pursuant to chapter 568 shall 98
	142	+	seek increases in premium or agreed-upon compensation due to any 99
	143	+	claim brought pursuant to this section. 100
	144	+	This act shall take effect as follows and shall amend the following
	145	+	sections:
	146	+
	147	+	Section 1 October 1, 2019 31-300
	148	+
	149	+	LAB Joint Favorable
144	150