Enrolled Copy S.B. 190
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Workers' Compensation Modifications
2025 GENERAL SESSION
STATE OF UTAH
Chief Sponsor: Scott D. Sandall
House Sponsor: James A. Dunnigan
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LONG TITLE
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General Description:
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This bill amends the Workers' Compensation Act.
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Highlighted Provisions:
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This bill:
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▸ defines terms;
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▸ expands the Labor Commission's authority to disclosures by health care providers;
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▸ expands the Labor Commission's authority over fees for health care providers;
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▸ expands the prohibition of balance billing for workers' compensation claims to health care
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providers; and
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▸ makes technical changes.
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Money Appropriated in this Bill:
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None
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Other Special Clauses:
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None
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Utah Code Sections Affected:
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AMENDS:
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34A-2-407, as last amended by Laws of Utah 2021, Chapter 64
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Be it enacted by the Legislature of the state of Utah:
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Section 1. Section 34A-2-407 is amended to read:
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34A-2-407 . Reporting of industrial injuries -- Regulation of health care
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providers.
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(1) As used in this section[, "physician" is as defined in Section 34A-2-111.] :
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(a) "Balance billing" means charging an individual, on whose behalf a workers' S.B. 190 Enrolled Copy
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compensation insurance carrier or self-insured employer is obligated to pay covered
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medical services under this chapter or Chapter 3, Utah Occupational Disease Act, the
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amount calculated by subtracting the amount the workers' compensation insurance
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carrier or self-insured employer reimburses the health care provider for covered
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medical services from the amount the health care provider charges for the covered
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medical services.
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(b) "Covered medical services" means medical services provided by a health care
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provider that are covered by workers' compensation medical benefits under this
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chapter or Chapter 3, Utah Occupational Disease Act.
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(c) "Health care provider" means the same as that term is defined in Section 34A-2-111.
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(d) "Hospital" means the same as that term is defined in Section 26B-2-219.
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(e) "Physician" means the same as that term is defined in Section 34A-2-111.
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(f) "Self-insured employer" means the same as that term is defined in Section
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34A-2-201.5.
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(2)(a) An employee sustaining an injury arising out of and in the course of employment
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shall provide notification to the employee's employer promptly of the injury.
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(b) If the employee is unable to provide the notification required by Subsection (2)(a),
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the following may provide notification of the injury to the employee's employer:
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(i) the employee's next of kin; or
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(ii) the employee's attorney.
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(c) [An employee claiming benefits under this chapter or Chapter 3, Utah Occupational
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Disease Act, shall comply with rules adopted by the commission regarding disclosure
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of medical records of the employee medically relevant to the industrial accident or
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occupational disease claim.] An employee claiming benefits under this chapter, or
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Chapter 3, Utah Occupational Disease Act, shall comply with the commission's
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requirements for disclosure of medical records for a work-related injury claim.
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(3)(a) An employee is barred for any claim of benefits arising from an injury if the
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employee fails to notify within the time period described in Subsection (3)(b):
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(i) the employee's employer in accordance with Subsection (2); or
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(ii) the division.
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(b) [The ] An employee shall provide the notice required by Subsection (3)(a) [shall be
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made ]within:
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(i) 180 days [of] after the day on which the injury occurs; or
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(ii) in the case of an occupational hearing loss, the time period specified in Section
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34A-2-506.
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(4) The following [constitute] constitutes notification of injury from the employee, the
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employee's next of kin, or the employee's attorney, as required by Subsection (2):
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(a) an employer's report once filed with:
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(i) the division; or
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(ii) the employer's workers' compensation insurance carrier;
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(b) a physician's injury report once filed with:
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(i) the division;
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(ii) the employer; or
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(iii) the employer's workers' compensation insurance carrier;
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(c) a workers' compensation insurance carrier's report filed with the division; or
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(d) the payment of any medical or disability benefits by:
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(i) the employer; or
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(ii) the employer's workers' compensation insurance carrier.
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(5)(a) An employer and the employer's workers' compensation insurance carrier, if any,
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shall file a report in accordance with the rules made under Subsection (5)(b) of a:
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(i) work-related fatality; or
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(ii) work-related injury resulting in:
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(A) medical treatment;
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(B) loss of consciousness;
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(C) loss of work;
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(D) restriction of work; or
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(E) transfer to another job.
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(b)(i)(A) [An employer or the employer's workers' compensation insurance
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carrier, if any, shall file a report required by Subsection (5)(a), and any
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subsequent reports of a previously reported injury as may be required by the
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commission, within the time limits and in the manner established by rule by the
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commission made after consultation with the workers' compensation advisory
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council and in accordance with Title 63G, Chapter 3, Utah Administrative
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Rulemaking Act. ] The commission may require additional reports for a
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previously reported injury by rule made after consulting with the workers'
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compensation advisory council and in accordance with Title 63G, Chapter 3,
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Utah Administrative Rulemaking Act.
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(B) An employer or the employer's workers' compensation insurance carrier, if
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any, shall file the report required by Subsection (5)(a) and any other report of a
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previously reported injury within the time limits and in the manner the
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commission establishes.
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(ii) A rule made under this Subsection (5)(b) shall:
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[(i)] (A) be reasonable; and
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[(ii)] (B) take into consideration the practicality and cost of complying with the
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rule.
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(c) [A] An employer is not required to file a report [is not required to be filed under this
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Subsection (5) ]for a minor injury, such as a cut or scratch that requires first aid
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treatment only, unless:
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(i) a treating physician files a report with the division in accordance with Subsection
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(9); or
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(ii) a treating physician is required to file a report with the division in accordance
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with Subsection (9).
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(6) An employer and [its] the employer's workers' compensation insurance carrier, if any,
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required to file a report under Subsection (5) shall provide the employee with:
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(a) a copy of the report submitted to the division; and
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(b) a statement, as prepared by the division, of the employee's rights and responsibilities
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related to the industrial injury.
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(7) An employer shall maintain a record in a manner [prescribed by ]the commission
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provides by rule of all:
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(a) work-related fatalities; or
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(b) work-related injuries resulting in:
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(i) medical treatment;
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(ii) loss of consciousness;
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(iii) loss of work;
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(iv) restriction of work; or
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(v) transfer to another job.
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(8)(a) Except as provided in Subsection (8)(b), an employer or a workers' compensation
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insurance carrier [who] that refuses or neglects to make a report, maintain a record, or
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file a report as required by this section is subject to a civil assessment:
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(i) imposed by the division, subject to the requirements of Title 63G, Chapter 4,
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Administrative Procedures Act; and
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(ii) that may not exceed $500.
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(b) An employer or workers' compensation insurance carrier is not subject to the civil
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assessment under this Subsection (8) if:
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(i) the employer or workers' compensation insurance carrier submits a report later
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than required by this section; and
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(ii) the division finds that the employer or workers' compensation insurance carrier
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has shown good cause for submitting a report later than required by this section.
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(c)(i) [A ] The division shall deposit a civil assessment collected under this
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Subsection (8) [shall be deposited ]into the Uninsured Employers' Fund created in
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Section 34A-2-704[ to be used for a purpose specified in Section 34A-2-704].
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(ii) The administrator of the Uninsured Employers' Fund shall [collect] receive and
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distribute the money [required to be deposited into the Uninsured Employers'
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Fund under this Subsection (8)(c) in accordance with Section 34A-2-704.] in
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accordance with Section 34A-2-704.
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(9)(a) A [physician attending] health care provider treating an injured employee shall
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comply with rules [established by ]the commission establishes in accordance with
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Title 63G, Chapter 3, Utah Administrative Rulemaking Act, regarding:
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(i) fees for [physician's] covered medical services, other than a hospital's covered
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medical services;
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(ii) fees for a hospital's covered medical services, which, if the commission
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establishes, shall be based on Medicare reimbursement rates;
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[(ii)] (iii) disclosure of medical records of the employee medically relevant to the
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employee's [industrial accident or occupational disease] work-related injury claim;
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[(iii)] (iv) reports to the division regarding:
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(A) the condition and treatment of an injured employee; or
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(B) any other matter concerning employees with industrial cases that the [
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physician ] health care provider is treating; and
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[(iv)] (v) rules made under Section 34A-2-407.5.
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[(b) A physician who is associated with, employed by, or bills through a hospital is
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subject to Subsection (9)(a).]
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[(c) A hospital providing services for an injured employee is not subject to the
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requirements of Subsection (9)(a) except for rules made by the commission that are
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described in Subsection (9)(a)(ii) or (iii) or Section 34A-2-407.5.]
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[(d)] (b) The commission's schedule of fees may reasonably differentiate [remuneration
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to be ] compensation paid to health care providers [of health services] for covered
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medical services based on:
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(i) the severity of the employee's condition;
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(ii) the nature of the treatment necessary; and
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(iii) the facilities or equipment specially required to deliver that treatment.
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[(e)] (c) This Subsection (9) does not prohibit a contract with a health care provider of [
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health services] covered medical services relating to the pricing of goods and covered
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medical services.
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(d) A health care provider may not engage in balance billing.
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(10) A health care provider treating an injured employee shall provide a copy of the initial
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report filed under Subsection [(9)(a)(iii) shall be furnished ] (9)(a)(iv) to:
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(a) the division;
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(b) the employee; and
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(c)(i) the employer; or
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(ii) the employer's workers' compensation insurance carrier.
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[(11)(a) As used in this Subsection (11):]
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[(i) "Balance billing" means charging a person, on whose behalf a workers'
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compensation insurance carrier or self-insured employer is obligated to pay
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medical benefits under this chapter or Chapter 3, Utah Occupational Disease Act,
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for the difference between what the workers' compensation insurance carrier or
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self-insured employer reimburses the hospital for covered medical services and
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what the hospital charges for those covered medical services.]
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[(ii) "Covered medical services" means medical services provided by a hospital that
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are covered by workers' compensation medical benefits under this chapter or
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Chapter 3, Utah Occupational Disease Act.]
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[(iii) "Self-insured employer" means the same as that term is defined in Section
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34A-2-201.5.]
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[(b) Subject to Subsection (11)(d), a workers' compensation insurance carrier or
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self-insured employer may contract, either in writing or by mutual oral agreement,
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with a hospital to establish reimbursement rates.]
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[(c) Subject to Subsection (11)(d), for the time period beginning on May 8, 2018, and
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ending on July 1, 2021, a workers' compensation insurance carrier or self-insured
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employer that is reimbursing a hospital for covered medical services shall reimburse
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the hospital:]
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[(i) in accordance with a contract described in Subsection (11)(b); or]
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[(ii)(A) if the hospital is located in a county of the first, second, or third class, as
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classified in Section 17-50-501, at 75% of the billed hospital fees for the
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covered medical services; or]
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[(B) if the hospital is located in a county of the fourth, fifth, or sixth class, as
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classified in Section 17-50-501, at 85% of the billed hospital fees for the
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covered medical services.]
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[(d) A hospital may not engage in balance billing. ]
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[(12)] (11)(a) Subject to appellate review under Section 34A-1-303, the commission has
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exclusive jurisdiction to hear and determine:
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(i) whether goods [provided to ]or services [rendered ] provided to an employee are
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compensable [pursuant to] under this chapter or Chapter 3, Utah Occupational
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Disease Act, including:
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(A) [medical, nurse, or hospital ] covered medical services;
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(B) medicines; and
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(C) artificial means, appliances, or prosthesis;
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(ii) except for amounts charged or paid under Subsection [(11)] (9)(c), the
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reasonableness of the amounts charged or paid for a good or service described in
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Subsection [(12)(a)(i)] (11)(a)(i); and
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(iii) collection issues related to a good or service described in Subsection [(12)(a)(i)]
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(11)(a)(i).
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(b) Except as provided in Subsection [(12)(a)] (11)(a), Subsection 34A-2-211(6), or
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Section 34A-2-212, a person may not maintain a cause of action in any forum within
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this state other than the commission for collection or payment for goods or covered
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medical services described in Subsection [(12)(a)] (11)(a) that are compensable under
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this chapter or Chapter 3, Utah Occupational Disease Act.
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Section 2. Effective Date.
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This bill takes effect on May 7, 2025.
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