Citations Affected: IC 22-3.
Synopsis: Worker's compensation. Conference committee report for ESB 576. Requires that all members of the worker's compensation board (board) be attorneys in good standing admitted to the practice of law in Indiana. Renames the position of executive secretary executive administrator. Requires a health care provider to file a claim for payment with the board not later than two years after the provider receives an initial written communication from an employer, the employer's insurance carrier, or an agent acting on behalf of the employer in response to the provider's submission of a bill for services. Requires a hospital or facility that is a medical service provider to pay a $60 filing fee for each application filed in a balance billing case. Provides that a filing fee is not required for an application filed for a denied or unpaid claim. Allows a provider to combine up to 10 individual claims into one application whenever all of the individual claims involve the same employer, insurance carrier, or billing review service, and the amount of each individual claim does not exceed $200. Allows the second injury fund to be used to pay certain fund liabilities. Authorizes the board to resolve claims using mediation. Requires an employer to provide a copy of an injury or disablement report to the board upon request. Requires an injury or disablement report within seven days after the first day of a disability arising from a work place injury or disablement by occupational disease (rather than the occurrence of the injury or disablement). Increases civil penalties for failure to: (1) post certain notices; (2) file certain records; or (3) comply with IC 22-3-3-7 or IC 22-3-7-16 (concerning the determination and payment of compensation or benefits). Permits the board to request evidence of worker's compensation and occupational diseases compensation coverage from an employer. Establishes a civil penalty of $50 per employee per day for an employer's failure to provide proof of coverage. Requires the board to waive a civil penalty assessed whenever an employer provides proof of coverage by the twentieth day after the board provides written notice of the employer's failure to provide evidence of the coverage. Allows the board, after notice and a hearing, to post on the board's web site the name of an employer who fails or refuses to provide proof of coverage or pay a civil penalty assessed for the failure or refusal to provide coverage. Provides that an employer's name may not be removed from the board's web site until the employer provides proof of coverage and pays the civil penalties assessed. Requires that civil penalties be deposited in the worker's compensation supplemental administrative fund, instead of the state general fund.
Increases criminal penalties for an employer's failure to insure or otherwise provide adequate
security for the employer's worker's compensation and occupational disease liabilities and for
violating any other worker's compensation or occupational disease laws. Provides that a court
may temporarily order an employer that fails or refuses to pay worker's compensation or
occupational disease benefits when due to cease doing business until the employer furnishes to
the board proof of insurance or other assurances to establish that the employer has the ability to
meet all worker's compensation and occupational disease liabilities. Allows the owner of a sole
proprietorship who is an independent contractor and does not elect worker's compensation and
occupational disease coverage to obtain a certification of exemption. Urges the legislative
council to assign to the pension management oversight commission (commission) the task of
studying whether to increase the benefit schedules for worker's compensation and occupational
disease compensation. Urges the legislative council to assign to the commission or another
committee the task of studying whether to amend the definition of "pecuniary liability" to
establish the charge for services or products provided by a medical services facility as equal to
a percentage determined using the Medicare program reimbursement methodologies, models,
and values or weights, including the coding, billing, and reporting payment polices in effect on
the date a service or product is provided. Requires, if the commission or another committee is
assigned the topics, that the commission or committee issue a final report containing the
commission's or committee's findings and recommendations, including any recommended
legislation, not later than November 1, 2011. Makes conforming and technical corrections. (This
conference committee report: (1) rewords a provision that allows the assessment of a civil
penalty for failure to comply with IC 22-3-3-7 or IC 22-3-7-16; (2) adds a definition for
"medical services facility" from HB 1485; (3) allows the legislative council to select the
committee to assign the study of whether to amend the definition of "pecuniary liability"
as applied to the charges of a medical services facility; and (4) removes a provision urging
the legislative council to assign to the pension management oversight commission whether
to change the statute of limitations for making a claim for occupational disease
compensation.)
Effective: Upon passage; July 1, 2011.
MR. SPEAKER:
Your Conference Committee appointed to confer with a like committee from the Senate
upon Engrossed House Amendments to Engrossed Senate Bill No. 576 respectfully reports
that said two committees have conferred and agreed as follows to wit:
that the Senate recede from its dissent from all House amendments and that
the Senate now concur in all House amendments to the bill and that the bill
be further amended as follows:
Delete everything after the enacting clause and insert the following:
June 30, 2011, a health care provider must file an application for
adjustment of a claim for a health care provider's fee with the
board not later than two (2) years after the receipt of an initial
written communication from the employer, the employer's
insurance carrier, if any, or an agent acting on behalf of the
employer after the health care provider submits a bill for services.
To offset a part of the board's expenses related to the
administration of health care provider reimbursement disputes, a
hospital or facility that is a medical service provider (as defined in
IC 22-3-6-1) shall pay a filing fee of sixty dollars ($60) in a balance
billing case. The filing fee must accompany each application filed
with the board. If an employer, an employer's insurance carrier,
or an agent acting on behalf of the employer denies or fails to pay
any amount on a claim submitted by a hospital or facility that is a
medical service provider, a filing fee is not required to accompany
an application that is filed for the denied or unpaid claim. A health
care provider may combine up to ten (10) individual claims into
one (1) application whenever:
(1) all individual claims involve the same employer, insurance
carrier, or billing review service; and
(2) the amount of each individual claim does not exceed two
hundred dollars ($200).
(e) The worker's compensation board may withhold the approval of
the fees of the attending physician in a case until the attending
physician files a report with the worker's compensation board on the
form prescribed by the board.
facts or circumstances that are necessary to determine liability within
the additional thirty (30) days. More than thirty (30) days of additional
time may be approved by the worker's compensation board upon the
filing of a petition by the employer or the employer's insurance carrier
that sets forth:
(1) the extraordinary circumstances that have precluded a
determination of liability within the initial sixty (60) days;
(2) the status of the investigation on the date the petition is filed;
(3) the facts or circumstances that are necessary to make a
determination; and
(4) a timetable for the completion of the remaining investigation.
An employer who fails to comply with this section is subject to a civil
penalty of fifty dollars ($50), to be assessed and collected by the board
upon notice and hearing. Civil penalties collected under this section
shall be deposited in the state general fund. under IC 22-3-4-15.
(c) Once begun, temporary total disability benefits may not be
terminated by the employer unless:
(1) the employee has returned to any employment;
(2) the employee has died;
(3) the employee has refused to undergo a medical examination
under section 6 of this chapter or has refused to accept suitable
employment under section 11 of this chapter;
(4) the employee has received five hundred (500) weeks of
temporary total disability benefits or has been paid the maximum
compensation allowed under section 22 of this chapter; or
(5) the employee is unable or unavailable to work for reasons
unrelated to the compensable injury.
In all other cases the employer must notify the employee in writing of
the employer's intent to terminate the payment of temporary total
disability benefits and of the availability of employment, if any, on a
form approved by the board. If the employee disagrees with the
proposed termination, the employee must give written notice of
disagreement to the board and the employer within seven (7) days after
receipt of the notice of intent to terminate benefits. If the board and
employer do not receive a notice of disagreement under this section,
the employee's temporary total disability benefits shall be terminated.
Upon receipt of the notice of disagreement, the board shall immediately
contact the parties, which may be by telephone or other means, and
attempt to resolve the disagreement. If the board is unable to resolve
the disagreement within ten (10) days of receipt of the notice of
disagreement, the board shall immediately arrange for an evaluation of
the employee by an independent medical examiner. The independent
medical examiner shall be selected by mutual agreement of the parties
or, if the parties are unable to agree, appointed by the board under
IC 22-3-4-11. If the independent medical examiner determines that the
employee is no longer temporarily disabled or is still temporarily
disabled but can return to employment that the employer has made
available to the employee, or if the employee fails or refuses to appear
for examination by the independent medical examiner, temporary total
disability benefits may be terminated. If either party disagrees with the
opinion of the independent medical examiner, the party shall apply to
the board for a hearing under IC 22-3-4-5.
(d) An employer is not required to continue the payment of
temporary total disability benefits for more than fourteen (14) days
after the employer's proposed termination date unless the independent
medical examiner determines that the employee is temporarily disabled
and unable to return to any employment that the employer has made
available to the employee.
(e) If it is determined that as a result of this section temporary total
disability benefits were overpaid, the overpayment shall be deducted
from any benefits due the employee under section 10 of this chapter
and, if there are no benefits due the employee or the benefits due the
employee do not equal the amount of the overpayment, the employee
shall be responsible for paying any overpayment which cannot be
deducted from benefits due the employee.
date set by the board. If the amount to the credit of the second injury
fund on or before November 1 of any year exceeds one hundred
thirty-five percent (135%) of the previous year's disbursements, the
assessment allowed under this subsection shall not be assessed or
collected during the ensuing year. But when on or before November 1
of any year the amount to the credit of the fund is less than one hundred
thirty-five percent (135%) of the previous year's disbursements, the
payments of not more than two and one-half percent (2.5%) of the total
amount of all worker's compensation paid to injured employees or their
beneficiaries under IC 22-3-2 through IC 22-3-6 for the calendar year
next preceding that date shall be resumed and paid into the fund. The
board may not use an assessment rate greater than twenty-five
hundredths of one percent (0.25%) above the amount recommended by
the study performed before the assessment.
(d) The board shall assess all employers for the liabilities, including
administrative expenses, of the second injury fund. The assessment
also must provide for the repayment of all loans made to the second
injury fund for the purpose of paying valid claims. The following
applies to assessments under this subsection:
(1) The portion of the total amount that must be collected from
self-insured employers equals:
(A) the total amount of the assessment as determined by the
board; multiplied by
(B) the quotient of:
(i) the total paid losses on behalf of all self-insured
employers during the preceding calendar year; divided by
(ii) the total paid losses on behalf of all self-insured
employers and insured employers during the preceding
calendar year.
(2) The portion of the total amount that must be collected from
insured employers equals:
(A) the total amount of the assessment as determined by the
board; multiplied by
(B) the quotient of:
(i) the total paid losses on behalf of all insured employers
during the preceding calendar year; divided by
(ii) the total paid losses on behalf of all self-insured
employers and insured employers during the preceding
calendar year.
(3) The total amount of insured employer assessments under
subdivision (2) must be be collected by the insured employers'
worker's compensation insurers. The amount of employer
assessments each insurer shall collect equals:
(A) the total amount of assessments allocated to insured
employers under subdivision (2); multiplied by
(B) the quotient of:
(i) the worker's compensation premiums paid by employers
to the carrier during the preceding calendar year; divided by
(ii) the worker's compensation premiums paid by employers
to all carriers during the preceding calendar year.
(4) For purposes of the computation made under subdivision (3),
"premium" means the direct written premium.
(5) The amount of the assessment for each self-insured employer
equals:
(A) the total amount of assessments allocated to self-insured
employers under subdivision (1); multiplied by
(B) the quotient of:
(i) the paid losses attributable to the self-insured employer
during the preceding calendar year; divided by
(ii) paid losses attributable to all self-insured employers
during the preceding calendar year.
An employer that has ceased to be a self-insurer continues to be liable
for prorated assessments based on paid losses made by the employer in
the preceding calendar year during the period that the employer was
self-insured.
(e) The board may employ a qualified employee or enter into a
contract with an actuary or another qualified firm that has experience
in calculating worker's compensation liabilities. Not later than
December 1 of each year, the actuary or other qualified firm shall
calculate the recommended funding level of the fund and inform the
board of the results of the calculation. If the amount to the credit of the
fund is less than the amount required under subsection (c), the board
may conduct an assessment under subsection (c). The board shall pay
the costs of the contract under this subsection with money in the fund.
(f) An assessment collected under subsection (c) on an employer
who is not self-insured must be assessed through a surcharge based on
the employer's premium. An assessment collected under subsection (c)
does not constitute an element of loss, but for the purpose of collection
shall be treated as a separate cost imposed upon insured employers. A
premium surcharge under this subsection must be collected at the same
time and in the same manner in which the premium for coverage is
collected, and must be shown as a separate amount on a premium
statement. A premium surcharge under this subsection must be
excluded from the definition of premium for all purposes, including the
computation of insurance producer commissions or premium taxes.
However, an insurer may cancel a worker's compensation policy for
nonpayment of the premium surcharge. A cancellation under this
subsection must be carried out under the statutes applicable to the
nonpayment of premiums.
(g) The sums shall be paid by the board to the treasurer of state, to
be deposited in a special account known as the second injury fund. The
funds are not a part of the general fund of the state. Any balance
remaining in the account at the end of any fiscal year shall not revert
to the general fund. The funds shall be used only for the payment of
fund liabilities described in subsection (d) and awards of
compensation ordered by the board and chargeable against the fund
pursuant to this section, and shall be paid for that purpose by the
treasurer of state upon award or order of the board.
(h) If an employee who is entitled to compensation under IC 22-3-2
through IC 22-3-6 either:
(1) exhausts the maximum benefits under section 22 of this
chapter without having received the full amount of award granted
to the employee under section 10 of this chapter; or
(2) exhausts the employee's benefits under section 10 of this
chapter;
then such employee may apply to the board, who may award the
employee compensation from the second injury fund established by this
section, as follows under subsection (i).
(i) An employee who has exhausted the employee's maximum
benefits under section 10 of this chapter may be awarded additional
compensation equal to sixty-six and two-thirds percent (66 2/3%) of the
employee's average weekly wage at the time of the employee's injury,
not to exceed the maximum then applicable under section 22 of this
chapter, for a period of not to exceed one hundred fifty (150) weeks
upon competent evidence sufficient to establish:
(1) that the employee is totally and permanently disabled from
causes and conditions of which there are or have been objective
conditions and symptoms proven that are not within the physical
or mental control of the employee; and
(2) that the employee is unable to support the employee in any
gainful employment, not associated with rehabilitative or
vocational therapy.
(j) The additional award may be renewed during the employee's total
and permanent disability after appropriate hearings by the board for
successive periods not to exceed one hundred fifty (150) weeks each.
The provisions of this section apply only to injuries occurring
subsequent to April 1, 1950, for which awards have been or are in the
future made by the board under section 10 of this chapter. Section 16
of this chapter does not apply to compensation awarded from the
second injury fund under this section.
(k) All insurance carriers subject to an assessment under this section
are required to provide to the board:
(1) not later than January 31 each calendar year; and
(2) not later than thirty (30) days after a change occurs;
the name, address, and electronic mail address of a representative
authorized to receive the notice of an assessment.
upon request. Within seven (7) days after the occurrence first day of
a disability that arises from a workplace injury and the employer's
knowledge thereof, of the disability, as provided in IC 22-3-3-1, of any
injury to an employee causing and that causes an employee's death
or absence from work for more than one (1) day, a report thereof shall
be made in writing and mailed to the employer's insurance carrier or,
if the employer is self insured, delivered to the worker's compensation
board in the manner provided in subsections (b) and (c). The insurance
carrier shall deliver the report to the worker's compensation board in
the manner provided in subsections (b) and (c) not later than seven (7)
days after receipt of the report or fourteen (14) days after the
employer's knowledge of the injury, whichever is later. An employer or
insurance carrier that fails to comply with this subsection is subject to
a civil penalty of fifty dollars ($50), to be assessed and collected by the
board. Civil penalties collected under this section shall be deposited in
the state general fund. under section 15 of this chapter.
(b) All insurance carriers, companies who carry risk without
insurance, and third party administrators reporting accident information
to the board in compliance with subsection (a) shall
(1) report the information using electronic data interchange
standards prescribed by the board. no later than June 30, 1999; or
(2) in the alternative, the reporting entity shall have an
implementation plan approved by the board no later than June 30,
2000, that provides for the ability to report the information using
electronic data interchange standards prescribed by the board no
later than December 31, 2000.
Prior to the June 30, 2000, and December 31, 2000, deadlines, the
reporting entity may continue to report accidents to the board by mail
in compliance with subsection (a).
(c) The report shall contain the name, nature, and location of the
business of the employer, the name, age, sex, wages, occupation of the
injured employee, the date and hour of the accident causing the alleged
injury, the nature and cause of the injury, and such other information
as may be required by the board.
(d) A person who violates any provision of this article, except
IC 22-3-5-1, IC 22-3-7-34(b), or IC 22-3-7-34(c), commits a Class C
infraction. misdemeanor. A person who violates IC 22-3-5-1,
IC 22-3-7-34(b), or IC 22-3-7-34(c) commits a Class A infraction.
misdemeanor. The worker's compensation board in the name of the
state may seek relief from any court of competent jurisdiction to enjoin
any violation of this article.
(e) The venue of all actions under this section lies in the county in
which the employee was injured. The prosecuting attorney of the
county shall prosecute all such violations upon written request of the
worker's compensation board. Such violations shall be prosecuted in
the name of the state.
(f) In an action before the board against an employer who at the time
of the injury to or occupational disease of an employee had failed to
comply with IC 22-3-5-1, IC 22-3-7-34(b), or IC 22-3-7-34(c), the
board may award to the employee or the dependents of a deceased
employee:
($50).
(c) For the second unrelated violation of the same offense listed
in subsection (a), the board may assess a civil penalty not to exceed
one hundred fifty dollars ($150).
(d) For the third or subsequent unrelated violation of the same
offense listed in subsection (a), the board may assess a civil penalty
not to exceed three hundred dollars ($300).
(e) Civil penalties collected under this section shall be deposited
in the worker's compensation supplemental administrative fund
established by IC 22-3-5-6.
purpose of carrying out the administrative purposes and functions of
the worker's compensation board.
(b) The fund consists of:
(1) fees collected from employers under sections 1 through 2 of
this chapter; and from
(2) fees collected under IC 22-3-2-14.5, IC 22-3-3-5(d),
IC 22-3-7-17(g), and IC 22-3-7-34.5; and
(3) civil penalties assessed under IC 22-3-4-15, section 2.5 of
this chapter, and IC 22-3-7-34.3.
(c) The fund shall be administered by the worker's compensation
board. Money in the fund is annually appropriated to the worker's
compensation board and shall be used for all expenses incurred by the
worker's compensation board.
(b) (d) The money in the fund is not to be used to replace funds
otherwise appropriated to the board. Money in the fund at the end of
the state fiscal year does not revert to the state general fund.
charitable, religious, educational, or other nonprofit corporation,
is an employee of the corporation under IC 22-3-2 through
IC 22-3-6. An officer of a corporation who is the sole officer of
the corporation is an employee of the corporation under IC 22-3-2
through IC 22-3-6, but may elect not to be an employee of the
corporation under IC 22-3-2 through IC 22-3-6. If an officer
makes this election, the officer must serve written notice of the
election on the corporation's insurance carrier and the board. An
officer of a corporation who is the sole officer of the corporation
may not be considered to be excluded as an employee under
IC 22-3-2 through IC 22-3-6 until the notice is received by the
insurance carrier and the board.
(2) An executive officer of a municipal corporation or other
governmental subdivision or of a charitable, religious,
educational, or other nonprofit corporation may, notwithstanding
any other provision of IC 22-3-2 through IC 22-3-6, be brought
within the coverage of its insurance contract by the corporation by
specifically including the executive officer in the contract of
insurance. The election to bring the executive officer within the
coverage shall continue for the period the contract of insurance is
in effect, and during this period, the executive officers thus
brought within the coverage of the insurance contract are
employees of the corporation under IC 22-3-2 through IC 22-3-6.
(3) Any reference to an employee who has been injured, when the
employee is dead, also includes the employee's legal
representatives, dependents, and other persons to whom
compensation may be payable.
(4) An owner of a sole proprietorship may elect to include the
owner as an employee under IC 22-3-2 through IC 22-3-6 if the
owner is actually engaged in the proprietorship business. If the
owner makes this election, the owner must serve upon the owner's
insurance carrier and upon the board written notice of the
election. No owner of a sole proprietorship may be considered an
employee under IC 22-3-2 through IC 22-3-6 until the notice has
been received. If the owner of a sole proprietorship:
(A) is an independent contractor in the construction trades and
does not make the election provided under this subdivision,
the owner must obtain an affidavit a certificate of exemption
under IC 22-3-2-14.5; or
(B) is an independent contractor and does not make the
election provided under this subdivision, the owner may
obtain a certificate of exemption under IC 22-3-2-14.5.
(5) A partner in a partnership may elect to include the partner as
an employee under IC 22-3-2 through IC 22-3-6 if the partner is
actually engaged in the partnership business. If a partner makes
this election, the partner must serve upon the partner's insurance
carrier and upon the board written notice of the election. No
partner may be considered an employee under IC 22-3-2 through
IC 22-3-6 until the notice has been received. If a partner in a
partnership:
(A) is an independent contractor in the construction trades and
does not make the election provided under this subdivision,
the partner must obtain an affidavit a certificate of exemption
under IC 22-3-2-14.5; or
(B) is an independent contractor and does not make the
election provided under this subdivision, the partner may
obtain a certificate of exemption under IC 22-3-2-14.5.
(6) Real estate professionals are not employees under IC 22-3-2
through IC 22-3-6 if:
(A) they are licensed real estate agents;
(B) substantially all their remuneration is directly related to
sales volume and not the number of hours worked; and
(C) they have written agreements with real estate brokers
stating that they are not to be treated as employees for tax
purposes.
(7) A person is an independent contractor in the construction
trades and not an employee under IC 22-3-2 through IC 22-3-6 if
the person is an independent contractor under the guidelines of
the United States Internal Revenue Service.
(8) An owner-operator that provides a motor vehicle and the
services of a driver under a written contract that is subject to
IC 8-2.1-24-23, 45 IAC 16-1-13, or 49 CFR 376 to a motor carrier
is not an employee of the motor carrier for purposes of IC 22-3-2
through IC 22-3-6. The owner-operator may elect to be covered
and have the owner-operator's drivers covered under a worker's
compensation insurance policy or authorized self-insurance that
insures the motor carrier if the owner-operator pays the premiums
as requested by the motor carrier. An election by an
owner-operator under this subdivision does not terminate the
independent contractor status of the owner-operator for any
purpose other than the purpose of this subdivision.
(9) A member or manager in a limited liability company may elect
to include the member or manager as an employee under
IC 22-3-2 through IC 22-3-6 if the member or manager is actually
engaged in the limited liability company business. If a member or
manager makes this election, the member or manager must serve
upon the member's or manager's insurance carrier and upon the
board written notice of the election. A member or manager may
not be considered an employee under IC 22-3-2 through IC 22-3-6
until the notice has been received.
(10) An unpaid participant under the federal School to Work
Opportunities Act (20 U.S.C. 6101 et seq.) is an employee to the
extent set forth in IC 22-3-2-2.5.
(11) A person who enters into an independent contractor
agreement with a nonprofit corporation that is recognized as tax
exempt under Section 501(c)(3) of the Internal Revenue Code (as
defined in IC 6-3-1-11(a)) to perform youth coaching services on
a part-time basis is not an employee for purposes of IC 22-3-2
through IC 22-3-6.
(c) "Minor" means an individual who has not reached seventeen
(17) years of age.
(1) Unless otherwise provided in this subsection, a minor
employee shall be considered as being of full age for all purposes
of IC 22-3-2 through IC 22-3-6.
(2) If the employee is a minor who, at the time of the accident, is
employed, required, suffered, or permitted to work in violation of
IC 20-33-3-35, the amount of compensation and death benefits,
as provided in IC 22-3-2 through IC 22-3-6, shall be double the
amount which would otherwise be recoverable. The insurance
carrier shall be liable on its policy for one-half (1/2) of the
compensation or benefits that may be payable on account of the
injury or death of the minor, and the employer shall be liable for
the other one-half (1/2) of the compensation or benefits. If the
employee is a minor who is not less than sixteen (16) years of age
and who has not reached seventeen (17) years of age and who at
the time of the accident is employed, suffered, or permitted to
work at any occupation which is not prohibited by law, this
subdivision does not apply.
(3) A minor employee who, at the time of the accident, is a
student performing services for an employer as part of an
approved program under IC 20-37-2-7 shall be considered a
full-time employee for the purpose of computing compensation
for permanent impairment under IC 22-3-3-10. The average
weekly wages for such a student shall be calculated as provided
in subsection (d)(4).
(4) The rights and remedies granted in this subsection to a minor
under IC 22-3-2 through IC 22-3-6 on account of personal injury
or death by accident shall exclude all rights and remedies of the
minor, the minor's parents, or the minor's personal
representatives, dependents, or next of kin at common law,
statutory or otherwise, on account of the injury or death. This
subsection does not apply to minors who have reached seventeen
(17) years of age.
(d) "Average weekly wages" means the earnings of the injured
employee in the employment in which the employee was working at the
time of the injury during the period of fifty-two (52) weeks
immediately preceding the date of injury, divided by fifty-two (52),
except as follows:
(1) If the injured employee lost seven (7) or more calendar days
during this period, although not in the same week, then the
earnings for the remainder of the fifty-two (52) weeks shall be
divided by the number of weeks and parts thereof remaining after
the time lost has been deducted.
(2) Where the employment prior to the injury extended over a
period of less than fifty-two (52) weeks, the method of dividing
the earnings during that period by the number of weeks and parts
thereof during which the employee earned wages shall be
followed, if results just and fair to both parties will be obtained.
Where by reason of the shortness of the time during which the
employee has been in the employment of the employee's employer
or of the casual nature or terms of the employment it is
impracticable to compute the average weekly wages, as defined
in this subsection, regard shall be had to the average weekly
amount which during the fifty-two (52) weeks previous to the
injury was being earned by a person in the same grade employed
at the same work by the same employer or, if there is no person so
employed, by a person in the same grade employed in the same
class of employment in the same district.
(3) Wherever allowances of any character made to an employee
in lieu of wages are a specified part of the wage contract, they
shall be deemed a part of the employee's earnings.
(4) In computing the average weekly wages to be used in
calculating an award for permanent impairment under
IC 22-3-3-10 for a student employee in an approved training
program under IC 20-37-2-7, the following formula shall be used.
Calculate the product of:
(A) the student employee's hourly wage rate; multiplied by
(B) forty (40) hours.
The result obtained is the amount of the average weekly wages for
the student employee.
(e) "Injury" and "personal injury" mean only injury by accident
arising out of and in the course of the employment and do not include
a disease in any form except as it results from the injury.
(f) "Billing review service" refers to a person or an entity that
reviews a medical service provider's bills or statements for the purpose
of determining pecuniary liability. The term includes an employer's
worker's compensation insurance carrier if the insurance carrier
performs such a review.
(g) "Billing review standard" means the data used by a billing
review service to determine pecuniary liability.
(h) "Community" means a geographic service area based on ZIP
code districts defined by the United States Postal Service according to
the following groupings:
(1) The geographic service area served by ZIP codes with the first
three (3) digits 463 and 464.
(2) The geographic service area served by ZIP codes with the first
three (3) digits 465 and 466.
(3) The geographic service area served by ZIP codes with the first
three (3) digits 467 and 468.
(4) The geographic service area served by ZIP codes with the first
three (3) digits 469 and 479.
(5) The geographic service area served by ZIP codes with the first
three (3) digits 460, 461 (except 46107), and 473.
(6) The geographic service area served by the 46107 ZIP code and
ZIP codes with the first three (3) digits 462.
(7) The geographic service area served by ZIP codes with the first
three (3) digits 470, 471, 472, 474, and 478.
(8) The geographic service area served by ZIP codes with the first
three (3) digits 475, 476, and 477.
(i) "Medical service provider" refers to a person or an entity that
provides medical services, treatment, or supplies to an employee under
IC 22-3-2 through IC 22-3-6.
(j) "Pecuniary liability" means the responsibility of an employer or
the employer's insurance carrier for the payment of the charges for each
specific service or product for human medical treatment provided
under IC 22-3-2 through IC 22-3-6 in a defined community, equal to or
less than the charges made by medical service providers at the eightieth
percentile in the same community for like services or products.
An officer of a corporation who is the sole officer of the
corporation may elect not to be an employee of the corporation
under this chapter. If an officer makes this election, the officer
must serve written notice of the election on the corporation's
insurance carrier and the board. An officer of a corporation who
is the sole officer of the corporation may not be considered to be
excluded as an employee under this chapter until the notice is
received by the insurance carrier and the board.
(c) As used in this chapter, "minor" means an individual who has
not reached seventeen (17) years of age. A minor employee shall be
considered as being of full age for all purposes of this chapter.
However, if the employee is a minor who, at the time of the last
exposure, is employed, required, suffered, or permitted to work in
violation of the child labor laws of this state, the amount of
compensation and death benefits, as provided in this chapter, shall be
double the amount which would otherwise be recoverable. The
insurance carrier shall be liable on its policy for one-half (1/2) of the
compensation or benefits that may be payable on account of the
disability or death of the minor, and the employer shall be wholly liable
for the other one-half (1/2) of the compensation or benefits. If the
employee is a minor who is not less than sixteen (16) years of age and
who has not reached seventeen (17) years of age, and who at the time
of the last exposure is employed, suffered, or permitted to work at any
occupation which is not prohibited by law, the provisions of this
subsection prescribing double the amount otherwise recoverable do not
apply. The rights and remedies granted to a minor under this chapter on
account of disease shall exclude all rights and remedies of the minor,
the minor's parents, the minor's personal representatives, dependents,
or next of kin at common law, statutory or otherwise, on account of any
disease.
(d) This chapter does not apply to casual laborers as defined in
subsection (b), nor to farm or agricultural employees, nor to household
employees, nor to railroad employees engaged in train service as
engineers, firemen, conductors, brakemen, flagmen, baggagemen, or
foremen in charge of yard engines and helpers assigned thereto, nor to
their employers with respect to these employees. Also, this chapter
does not apply to employees or their employers with respect to
employments in which the laws of the United States provide for
compensation or liability for injury to the health, disability, or death by
reason of diseases suffered by these employees.
(e) As used in this chapter, "disablement" means the event of
becoming disabled from earning full wages at the work in which the
employee was engaged when last exposed to the hazards of the
occupational disease by the employer from whom the employee claims
compensation or equal wages in other suitable employment, and
"disability" means the state of being so incapacitated.
(f) For the purposes of this chapter, no compensation shall be
payable for or on account of any occupational diseases unless
disablement, as defined in subsection (e), occurs within two (2) years
after the last day of the last exposure to the hazards of the disease
except for the following:
Service according to the following groupings:
(1) The geographic service area served by ZIP codes with the first
three (3) digits 463 and 464.
(2) The geographic service area served by ZIP codes with the first
three (3) digits 465 and 466.
(3) The geographic service area served by ZIP codes with the first
three (3) digits 467 and 468.
(4) The geographic service area served by ZIP codes with the first
three (3) digits 469 and 479.
(5) The geographic service area served by ZIP codes with the first
three (3) digits 460, 461 (except 46107), and 473.
(6) The geographic service area served by the 46107 ZIP code and
ZIP codes with the first three (3) digits 462.
(7) The geographic service area served by ZIP codes with the first
three (3) digits 470, 471, 472, 474, and 478.
(8) The geographic service area served by ZIP codes with the first
three (3) digits 475, 476, and 477.
(k) As used in this chapter, "medical service provider" refers to a
person or an entity that provides medical services, treatment, or
supplies to an employee under this chapter.
(l) As used in this chapter, "pecuniary liability" means the
responsibility of an employer or the employer's insurance carrier for the
payment of the charges for each specific service or product for human
medical treatment provided under this chapter in a defined community,
equal to or less than the charges made by medical service providers at
the eightieth percentile in the same community for like services or
products.
determination could not be made within thirty (30) days and states the
facts or circumstances that are necessary to determine liability within
the additional thirty (30) days. More than thirty (30) days of additional
time may be approved by the worker's compensation board upon the
filing of a petition by the employer or the employer's insurance carrier
that sets forth:
(1) the extraordinary circumstances that have precluded a
determination of liability within the initial sixty (60) days;
(2) the status of the investigation on the date the petition is filed;
(3) the facts or circumstances that are necessary to make a
determination; and
(4) a timetable for the completion of the remaining investigation.
An employer who fails to comply with this section is subject to a civil
penalty of fifty dollars ($50), to be assessed and collected by the board
upon notice and hearing. Civil penalties collected under this section
shall be deposited in the state general fund. under IC 22-3-4-15.
(b) Once begun, temporary total disability benefits may not be
terminated by the employer unless:
(1) the employee has returned to work;
(2) the employee has died;
(3) the employee has refused to undergo a medical examination
under section 20 of this chapter;
(4) the employee has received five hundred (500) weeks of
temporary total disability benefits or has been paid the maximum
compensation allowable under section 19 of this chapter; or
(5) the employee is unable or unavailable to work for reasons
unrelated to the compensable disease.
In all other cases the employer must notify the employee in writing of
the employer's intent to terminate the payment of temporary total
disability benefits, and of the availability of employment, if any, on a
form approved by the board. If the employee disagrees with the
proposed termination, the employee must give written notice of
disagreement to the board and the employer within seven (7) days after
receipt of the notice of intent to terminate benefits. If the board and
employer do not receive a notice of disagreement under this section,
the employee's temporary total disability benefits shall be terminated.
Upon receipt of the notice of disagreement, the board shall immediately
contact the parties, which may be by telephone or other means and
attempt to resolve the disagreement. If the board is unable to resolve
the disagreement within ten (10) days of receipt of the notice of
disagreement, the board shall immediately arrange for an evaluation of
the employee by an independent medical examiner. The independent
medical examiner shall be selected by mutual agreement of the parties
or, if the parties are unable to agree, appointed by the board under
IC 22-3-4-11. If the independent medical examiner determines that the
employee is no longer temporarily disabled or is still temporarily
disabled but can return to employment that the employer has made
available to the employee, or if the employee fails or refuses to appear
for examination by the independent medical examiner, temporary total
disability benefits may be terminated. If either party disagrees with the
opinion of the independent medical examiner, the party shall apply to
the board for a hearing under section 27 of this chapter.
(c) An employer is not required to continue the payment of
temporary total disability benefits for more than fourteen (14) days
after the employer's proposed termination date unless the independent
medical examiner determines that the employee is temporarily disabled
and unable to return to any employment that the employer has made
available to the employee.
(d) If it is determined that as a result of this section temporary total
disability benefits were overpaid, the overpayment shall be deducted
from any benefits due the employee under this section and, if there are
no benefits due the employee or the benefits due the employee do not
equal the amount of the overpayment, the employee shall be
responsible for paying any overpayment which cannot be deducted
from benefits due the employee.
(e) For disablements occurring on and after July 1, 1976, from
occupational disease resulting in temporary total disability for any work
there shall be paid to the disabled employee during the temporary total
disability weekly compensation equal to sixty-six and two-thirds
percent (66 2/3%) of the employee's average weekly wages, as defined
in section 19 of this chapter, for a period not to exceed five hundred
(500) weeks. Compensation shall be allowed for the first seven (7)
calendar days only if the disability continues for longer than twenty-one
(21) days.
(f) For disablements occurring on and after July 1, 1974, from
occupational disease resulting in temporary partial disability for work
there shall be paid to the disabled employee during such disability a
weekly compensation equal to sixty-six and two-thirds percent (66
2/3%) of the difference between the employee's average weekly wages,
as defined in section 19 of this chapter, and the weekly wages at which
the employee is actually employed after the disablement, for a period
not to exceed three hundred (300) weeks. Compensation shall be
allowed for the first seven (7) calendar days only if the disability
continues for longer than twenty-one (21) days. In case of partial
disability after the period of temporary total disability, the latter period
shall be included as a part of the maximum period allowed for partial
disability.
(g) For disabilities occurring on and after July 1, 1979, and before
July 1, 1988, from occupational disease in the schedule set forth in
subsection (j), the employee shall receive in addition to disability
benefits, not exceeding fifty-two (52) weeks on account of the
occupational disease, a weekly compensation of sixty percent (60%) of
the employee's average weekly wages, not to exceed one hundred
twenty-five dollars ($125) average weekly wages, for the period stated
for the disabilities.
(h) For disabilities occurring on and after July 1, 1988, and before
July 1, 1989, from occupational disease in the schedule set forth in
subsection (j), the employee shall receive in addition to disability
benefits, not exceeding seventy-eight (78) weeks on account of the
occupational disease, a weekly compensation of sixty percent (60%) of
the employee's average weekly wages, not to exceed one hundred
sixty-six dollars ($166) average weekly wages, for the period stated for
the disabilities.
(i) For disabilities occurring on and after July 1, 1989, and before
July 1, 1990, from occupational disease in the schedule set forth in
subsection (j), the employee shall receive in addition to disability
benefits, not exceeding seventy-eight (78) weeks on account of the
occupational disease, a weekly compensation of sixty percent (60%) of
the employee's average weekly wages, not to exceed one hundred
eighty-three dollars ($183) average weekly wages, for the period stated
for the disabilities.
(j) For disabilities occurring on and after July 1, 1990, and before
July 1, 1991, from occupational disease in the following schedule, the
employee shall receive in addition to disability benefits, not exceeding
seventy-eight (78) weeks on account of the occupational disease, a
weekly compensation of sixty percent (60%) of the employee's average
weekly wages, not to exceed two hundred dollars ($200) average
weekly wages, for the period stated for the disabilities.
(1) Amputations: For the loss by separation, of the thumb, sixty
(60) weeks; of the index finger, forty (40) weeks; of the second
finger, thirty-five (35) weeks; of the third or ring finger, thirty
(30) weeks; of the fourth or little finger, twenty (20) weeks; of the
hand by separation below the elbow, two hundred (200) weeks; of
the arm above the elbow joint, two hundred fifty (250) weeks; of
the big toe, sixty (60) weeks; of the second toe, thirty (30) weeks;
of the third toe, twenty (20) weeks; of the fourth toe, fifteen (15)
weeks; of the fifth or little toe, ten (10) weeks; of the foot below
the knee joint, one hundred fifty (150) weeks; and of the leg
above the knee joint, two hundred (200) weeks. The loss of more
than one (1) phalange of a thumb or toe shall be considered as the
loss of the entire thumb or toe. The loss of more than two (2)
phalanges of a finger shall be considered as the loss of the entire
finger. The loss of not more than one (1) phalange of a thumb or
toe shall be considered as the loss of one-half (1/2) of the thumb
or toe and compensation shall be paid for one-half (1/2) of the
period for the loss of the entire thumb or toe. The loss of not more
than two (2) phalanges of a finger shall be considered as the loss
of one-half (1/2) the finger and compensation shall be paid for
one-half (1/2) of the period for the loss of the entire finger.
(2) Loss of Use: The total permanent loss of the use of an arm,
hand, thumb, finger, leg, foot, toe, or phalange shall be considered
as the equivalent of the loss by separation of the arm, hand,
thumb, finger, leg, foot, toe, or phalange and the compensation
shall be paid for the same period as for the loss thereof by
separation.
(3) Partial Loss of Use: For the permanent partial loss of the use
of an arm, hand, thumb, finger, leg, foot, toe, or phalange,
compensation shall be paid for the proportionate loss of the use of
such arm, hand, thumb, finger, leg, foot, toe, or phalange.
(4) For disablements for occupational disease resulting in total
permanent disability, five hundred (500) weeks.
(5) For the loss of both hands, or both feet, or the total sight of
both eyes, or any two (2) of such losses resulting from the same
disablement by occupational disease, five hundred (500) weeks.
(6) For the permanent and complete loss of vision by enucleation
of an eye or its reduction to one-tenth (1/10) of normal vision with
glasses, one hundred fifty (150) weeks, and for any other
permanent reduction of the sight of an eye, compensation shall be
paid for a period proportionate to the degree of such permanent
reduction without correction or glasses. However, when such
permanent reduction without correction or glasses would result in
one hundred percent (100%) loss of vision, but correction or
glasses would result in restoration of vision, then compensation
shall be paid for fifty percent (50%) of such total loss of vision
without glasses plus an additional amount equal to the
proportionate amount of such reduction with glasses, not to
exceed an additional fifty percent (50%).
(7) For the permanent and complete loss of hearing, two hundred
(200) weeks.
(8) In all other cases of permanent partial impairment,
compensation proportionate to the degree of such permanent
partial impairment, in the discretion of the worker's compensation
board, not exceeding five hundred (500) weeks.
(9) In all cases of permanent disfigurement, which may impair the
future usefulness or opportunities of the employee, compensation
in the discretion of the worker's compensation board, not
exceeding two hundred (200) weeks, except that no compensation
shall be payable under this paragraph where compensation shall
be payable under subdivisions (1) through (8). Where
compensation for temporary total disability has been paid, this
amount of compensation shall be deducted from any
compensation due for permanent disfigurement.
(k) With respect to disablements in the following schedule occurring
on and after July 1, 1991, the employee shall receive in addition to
temporary total disability benefits, not exceeding one hundred
twenty-five (125) weeks on account of the disablement, compensation
in an amount determined under the following schedule to be paid
weekly at a rate of sixty-six and two-thirds percent (66 2/3%) of the
employee's average weekly wages during the fifty-two (52) weeks
immediately preceding the week in which the disablement occurred:
(1) Amputation: For the loss by separation of the thumb, twelve
(12) degrees of permanent impairment; of the index finger, eight
(8) degrees of permanent impairment; of the second finger, seven
(7) degrees of permanent impairment; of the third or ring finger,
six (6) degrees of permanent impairment; of the fourth or little
finger, four (4) degrees of permanent impairment; of the hand by
separation below the elbow joint, forty (40) degrees of permanent
impairment; of the arm above the elbow, fifty (50) degrees of
permanent impairment; of the big toe, twelve (12) degrees of
permanent impairment; of the second toe, six (6) degrees of
permanent impairment; of the third toe, four (4) degrees of
permanent impairment; of the fourth toe, three (3) degrees of
permanent impairment; of the fifth or little toe, two (2) degrees of
permanent impairment; of separation of the foot below the knee
joint, thirty-five (35) degrees of permanent impairment; and of the
leg above the knee joint, forty-five (45) degrees of permanent
impairment.
(2) Amputations occurring on or after July 1, 1997: For the loss
by separation of any of the body parts described in subdivision (1)
on or after July 1, 1997, the dollar values per degree applying on
the date of the injury as described in subsection (l) shall be
multiplied by two (2). However, the doubling provision of this
subdivision does not apply to a loss of use that is not a loss by
separation.
(3) The loss of more than one (1) phalange of a thumb or toe shall
be considered as the loss of the entire thumb or toe. The loss of
more than two (2) phalanges of a finger shall be considered as the
loss of the entire finger. The loss of not more than one (1)
phalange of a thumb or toe shall be considered as the loss of
one-half (1/2) of the degrees of permanent impairment for the loss
of the entire thumb or toe. The loss of not more than one (1)
phalange of a finger shall be considered as the loss of one-third
(1/3) of the finger and compensation shall be paid for one-third
(1/3) of the degrees payable for the loss of the entire finger. The
loss of more than one (1) phalange of the finger but not more than
two (2) phalanges of the finger shall be considered as the loss of
one-half (1/2) of the finger and compensation shall be paid for
one-half (1/2) of the degrees payable for the loss of the entire
finger.
(4) For the loss by separation of both hands or both feet or the
total sight of both eyes or any two (2) such losses in the same
accident, one hundred (100) degrees of permanent impairment.
(5) For the permanent and complete loss of vision by enucleation
or its reduction to one-tenth (1/10) of normal vision with glasses,
thirty-five (35) degrees of permanent impairment.
(6) For the permanent and complete loss of hearing in one (1) ear,
fifteen (15) degrees of permanent impairment, and in both ears,
forty (40) degrees of permanent impairment.
(7) For the loss of one (1) testicle, ten (10) degrees of permanent
impairment; for the loss of both testicles, thirty (30) degrees of
permanent impairment.
(8) Loss of use: The total permanent loss of the use of an arm, a
hand, a thumb, a finger, a leg, a foot, a toe, or a phalange shall be
considered as the equivalent of the loss by separation of the arm,
hand, thumb, finger, leg, foot, toe, or phalange, and compensation
shall be paid in the same amount as for the loss by separation.
However, the doubling provision of subdivision (2) does not
apply to a loss of use that is not a loss by separation.
(9) Partial loss of use: For the permanent partial loss of the use of
an arm, a hand, a thumb, a finger, a leg, a foot, a toe, or a
phalange, compensation shall be paid for the proportionate loss of
the use of the arm, hand, thumb, finger, leg, foot, toe, or phalange.
(10) For disablements resulting in total permanent disability, the
amount payable for impairment or five hundred (500) weeks of
compensation, whichever is greater.
(11) to twenty (20), seven hundred dollars ($700) per degree; for
each degree of permanent impairment from twenty-one (21) to
thirty-five (35), one thousand dollars ($1,000) per degree; for
each degree of permanent impairment from thirty-six (36) to fifty
(50), one thousand four hundred dollars ($1,400) per degree; for
each degree of permanent impairment above fifty (50), one
thousand seven hundred dollars ($1,700) per degree.
(4) With respect to disablements occurring on and after July 1,
1997, and before July 1, 1998, for each degree of permanent
impairment from one (1) to ten (10), seven hundred fifty dollars
($750) per degree; for each degree of permanent impairment from
eleven (11) to thirty-five (35), one thousand dollars ($1,000) per
degree; for each degree of permanent impairment from thirty-six
(36) to fifty (50), one thousand four hundred dollars ($1,400) per
degree; for each degree of permanent impairment above fifty (50),
one thousand seven hundred dollars ($1,700) per degree.
(5) With respect to disablements occurring on and after July 1,
1998, and before July 1, 1999, for each degree of permanent
impairment from one (1) to ten (10), seven hundred fifty dollars
($750) per degree; for each degree of permanent impairment from
eleven (11) to thirty-five (35), one thousand dollars ($1,000) per
degree; for each degree of permanent impairment from thirty-six
(36) to fifty (50), one thousand four hundred dollars ($1,400) per
degree; for each degree of permanent impairment above fifty (50),
one thousand seven hundred dollars ($1,700) per degree.
(6) With respect to disablements occurring on and after July 1,
1999, and before July 1, 2000, for each degree of permanent
impairment from one (1) to ten (10), nine hundred dollars ($900)
per degree; for each degree of permanent impairment from eleven
(11) to thirty-five (35), one thousand one hundred dollars
($1,100) per degree; for each degree of permanent impairment
from thirty-six (36) to fifty (50), one thousand six hundred dollars
($1,600) per degree; for each degree of permanent impairment
above fifty (50), two thousand dollars ($2,000) per degree.
(7) With respect to disablements occurring on and after July 1,
2000, and before July 1, 2001, for each degree of permanent
impairment from one (1) to ten (10), one thousand one hundred
dollars ($1,100) per degree; for each degree of permanent
impairment from eleven (11) to thirty-five (35), one thousand
three hundred dollars ($1,300) per degree; for each degree of
permanent impairment from thirty-six (36) to fifty (50), two
thousand dollars ($2,000) per degree; for each degree of
permanent impairment above fifty (50), two thousand five
hundred fifty dollars ($2,500) per degree.
(8) With respect to disablements occurring on and after July 1,
2001, and before July 1, 2007, for each degree of permanent
impairment from one (1) to ten (10), one thousand three hundred
dollars ($1,300) per degree; for each degree of permanent
impairment from eleven (11) to thirty-five (35), one thousand five
hundred dollars ($1,500) per degree; for each degree of
permanent impairment from thirty-six (36) to fifty (50), two
thousand four hundred dollars ($2,400) per degree; for each
degree of permanent impairment above fifty (50), three thousand
dollars ($3,000) per degree.
(9) With respect to disablements occurring on and after July 1,
2007, and before July 1, 2008, for each degree of permanent
impairment from one (1) to ten (10), one thousand three hundred
forty dollars ($1,340) per degree; for each degree of permanent
impairment from eleven (11) to thirty-five (35), one thousand five
hundred forty-five dollars ($1,545) per degree; for each degree of
permanent impairment from thirty-six (36) to fifty (50), two
thousand four hundred seventy-five dollars ($2,475) per degree;
for each degree of permanent impairment above fifty (50), three
thousand one hundred fifty dollars ($3,150) per degree.
(10) With respect to disablements occurring on and after July 1,
2008, and before July 1, 2009, for each degree of permanent
impairment from one (1) to ten (10), one thousand three hundred
sixty-five dollars ($1,365) per degree; for each degree of
permanent impairment from eleven (11) to thirty-five (35), one
thousand five hundred seventy dollars ($1,570) per degree; for
each degree of permanent impairment from thirty-six (36) to fifty
(50), two thousand five hundred twenty-five dollars ($2,525) per
degree; for each degree of permanent impairment above fifty (50),
three thousand two hundred dollars ($3,200) per degree.
(11) With respect to disablements occurring on and after July 1,
2009, and before July 1, 2010, for each degree of permanent
impairment from one (1) to ten (10), one thousand three hundred
eighty dollars ($1,380) per degree; for each degree of permanent
impairment from eleven (11) to thirty-five (35), one thousand five
hundred eighty-five dollars ($1,585) per degree; for each degree
of permanent impairment from thirty-six (36) to fifty (50), two
thousand six hundred dollars ($2,600) per degree; for each degree
of permanent impairment above fifty (50), three thousand three
hundred dollars ($3,300) per degree.
(12) With respect to disablements occurring on and after July 1,
2010, for each degree of permanent impairment from one (1) to
ten (10), one thousand four hundred dollars ($1,400) per degree;
for each degree of permanent impairment from eleven (11) to
thirty-five (35), one thousand six hundred dollars ($1,600) per
degree; for each degree of permanent impairment from thirty-six
(36) to fifty (50), two thousand seven hundred dollars ($2,700)
per degree; for each degree of permanent impairment above fifty
(50), three thousand five hundred dollars ($3,500) per degree.
(m) The average weekly wages used in the determination of
compensation for permanent partial impairment under subsections (k)
and (l) shall not exceed the following:
(1) With respect to disablements occurring on or after July 1,
1991, and before July 1, 1992, four hundred ninety-two dollars
($492).
(2) With respect to disablements occurring on or after July 1,
1992, and before July 1, 1993, five hundred forty dollars ($540).
(3) With respect to disablements occurring on or after July 1,
1993, and before July 1, 1994, five hundred ninety-one dollars
($591).
(4) With respect to disablements occurring on or after July 1,
1994, and before July 1, 1997, six hundred forty-two dollars
($642).
(5) With respect to disablements occurring on or after July 1,
1997, and before July 1, 1998, six hundred seventy-two dollars
($672).
(6) With respect to disablements occurring on or after July 1,
1998, and before July 1, 1999, seven hundred two dollars ($702).
(7) With respect to disablements occurring on or after July 1,
1999, and before July 1, 2000, seven hundred thirty-two dollars
($732).
(8) With respect to disablements occurring on or after July 1,
2000, and before July 1, 2001, seven hundred sixty-two dollars
($762).
(9) With respect to injuries occurring on or after July 1, 2001, and
before July 1, 2002, eight hundred twenty-two dollars ($822).
(10) With respect to injuries occurring on or after July 1, 2002,
and before July 1, 2006, eight hundred eighty-two dollars ($882).
(11) With respect to injuries occurring on or after July 1, 2006,
and before July 1, 2007, nine hundred dollars ($900).
(12) With respect to injuries occurring on or after July 1, 2007,
and before July 1, 2008, nine hundred thirty dollars ($930).
(13) With respect to injuries occurring on or after July 1, 2008,
and before July 1, 2009, nine hundred fifty-four dollars ($954).
(14) With respect to injuries occurring on or after July 1, 2009,
nine hundred seventy-five dollars ($975).
(n) If any employee, only partially disabled, refuses employment
suitable to the employee's capacity procured for the employee, the
employee shall not be entitled to any compensation at any time during
the continuance of such refusal unless, in the opinion of the worker's
compensation board, such refusal was justifiable. The employee must
be served with a notice setting forth the consequences of the refusal
under this subsection. The notice must be in a form prescribed by the
worker's compensation board.
(o) If an employee has sustained a permanent impairment or
disability from an accidental injury other than an occupational disease
in another employment than that in which the employee suffered a
subsequent disability from an occupational disease, such as herein
specified, the employee shall be entitled to compensation for the
subsequent disability in the same amount as if the previous impairment
or disability had not occurred. However, if the permanent impairment
or disability resulting from an occupational disease for which
compensation is claimed results only in the aggravation or increase of
a previously sustained permanent impairment from an occupational
disease or physical condition regardless of the source or cause of such
previously sustained impairment from an occupational disease or
physical condition, the board shall determine the extent of the
previously sustained permanent impairment from an occupational
disease or physical condition as well as the extent of the aggravation or
increase resulting from the subsequent permanent impairment or
disability, and shall award compensation only for that part of said
occupational disease or physical condition resulting from the
subsequent permanent impairment. An amputation of any part of the
body or loss of any or all of the vision of one (1) or both eyes caused by
an occupational disease shall be considered as a permanent impairment
or physical condition.
(p) If an employee suffers a disablement from an occupational
disease for which compensation is payable while the employee is still
receiving or entitled to compensation for a previous injury by accident
or disability by occupational disease in the same employment, the
employee shall not at the same time be entitled to compensation for
both, unless it be for a permanent injury, such as specified in
subsection (k)(1), (k)(4), (k)(5), (k)(8), or (k)(9), but the employee shall
be entitled to compensation for that disability and from the time of that
disability which will cover the longest period and the largest amount
payable under this chapter.
(q) If an employee receives a permanent disability from an
occupational disease such as specified in subsection (k)(1), (k)(4),
(k)(5), (k)(8), or (k)(9) after having sustained another such permanent
disability in the same employment the employee shall be entitled to
compensation for both such disabilities, but the total compensation
shall be paid by extending the period and not by increasing the amount
of weekly compensation and, when such previous and subsequent
permanent disabilities, in combination result in total permanent
disability or permanent total impairment, compensation shall be
payable for such permanent total disability or impairment, but
payments made for the previous disability or impairment shall be
deducted from the total payment of compensation due.
(r) When an employee has been awarded or is entitled to an award
of compensation for a definite period from an occupational disease
wherein disablement occurs on and after April 1, 1963, and such
employee dies from other causes than such occupational disease,
payment of the unpaid balance of such compensation not exceeding
three hundred fifty (350) weeks shall be paid to the employee's
dependents of the second and third class as defined in sections 11
through 14 of this chapter and compensation, not exceeding five
hundred (500) weeks shall be made to the employee's dependents of the
first class as defined in sections 11 through 14 of this chapter.
(s) Any payment made by the employer to the employee during the
period of the employee's disability, or to the employee's dependents,
which, by the terms of this chapter, was not due and payable when
made, may, subject to the approval of the worker's compensation board,
be deducted from the amount to be paid as compensation, but such
deduction shall be made from the distal end of the period during which
compensation must be paid, except in cases of temporary disability.
(t) When so provided in the compensation agreement or in the
award of the worker's compensation board, compensation may be paid
semimonthly, or monthly, instead of weekly.
(u) When the aggregate payments of compensation awarded by
agreement or upon hearing to an employee or dependent under eighteen
(18) years of age do not exceed one hundred dollars ($100), the
payment thereof may be made directly to such employee or dependent,
except when the worker's compensation board shall order otherwise.
(v) Whenever the aggregate payments of compensation, due to any
person under eighteen (18) years of age, exceed one hundred dollars
($100), the payment thereof shall be made to a trustee, appointed by the
circuit or superior court, or to a duly qualified guardian, or, upon the
order of the worker's compensation board, to a parent or to such minor
person. The payment of compensation, due to any person eighteen (18)
years of age or over, may be made directly to such person.
(w) If an employee, or a dependent, is mentally incompetent, or a
minor at the time when any right or privilege accrues to the employee
under this chapter, the employee's guardian or trustee may, in the
employee's behalf, claim and exercise such right and privilege.
(x) All compensation payments named and provided for in this
section, shall mean and be defined to be for only such occupational
diseases and disabilities therefrom as are proved by competent
evidence, of which there are or have been objective conditions or
symptoms proven, not within the physical or mental control of the
employee.
necessary to limit or reduce the amount and extent of such impairment.
The refusal of the employee to accept such services and supplies when
so provided by or on behalf of the employer, shall bar the employee
from all compensation otherwise payable during the period of such
refusal and the employee's right to prosecute any proceeding under this
chapter shall be suspended and abated until such refusal ceases. The
employee must be served with a notice setting forth the consequences
of the refusal under this section. The notice must be in a form
prescribed by the worker's compensation board. No compensation for
permanent total impairment, permanent partial impairment, permanent
disfigurement, or death shall be paid or payable for that part or portion
of such impairment, disfigurement, or death which is the result of the
failure of such employee to accept such treatment, services, and
supplies, provided that an employer may at any time permit an
employee to have treatment for the employee's disease or injury by
spiritual means or prayer in lieu of such physician, services, and
supplies.
(c) Regardless of when it occurs, where a compensable occupational
disease results in the amputation of a body part, the enucleation of an
eye, or the loss of natural teeth, the employer shall furnish an
appropriate artificial member, braces, and prosthodontics. The cost of
repairs to or replacements for the artificial members, braces, or
prosthodontics that result from a compensable occupational disease
pursuant to a prior award and are required due to either medical
necessity or normal wear and tear, determined according to the
employee's individual use, but not abuse, of the artificial member,
braces, or prosthodontics, shall be paid from the second injury fund
upon order or award of the worker's compensation board. The
employee is not required to meet any other requirement for admission
to the second injury fund.
(d) If an emergency or because of the employer's failure to provide
such attending physician or such surgical, hospital, or nurse's services
and supplies or such treatment by spiritual means or prayer as specified
in this section, or for other good reason, a physician other than that
provided by the employer treats the diseased employee within the
period of disability, or necessary and proper surgical, hospital, or
nurse's services and supplies are procured within the period, the
reasonable cost of such services and supplies shall, subject to approval
of the worker's compensation board, be paid by the employer.
(e) An employer or employer's insurance carrier may not delay the
provision of emergency medical care whenever emergency medical
care is considered necessary in the professional judgment of the
attending health care facility physician.
(f) This section may not be construed to prohibit an agreement
between an employer and employees that has the approval of the board
and that:
(1) binds the parties to medical care furnished by providers
selected by agreement before or after disablement; or
(2) makes the findings of a provider chosen in this manner
binding upon the parties.
(g) The employee and the employee's estate do not have liability to
a health care provider for payment for services obtained under this
section. The right to order payment for all services provided under this
chapter is solely with the board. All claims by a health care provider for
payment for services are against the employer and the employer's
insurance carrier, if any, and must be made with the board under this
chapter. After June 30, 2011, a health care provider must file an
application for adjustment of a claim for a health care provider's
fee with the board not later than two (2) years after the receipt of
an initial written communication from the employer, the
employer's insurance carrier, if any, or an agent acting on behalf
of the employer after the health care provider submits a bill for
services. To offset a part of the board's expenses related to the
administration of health care provider reimbursement disputes, a
hospital or facility that is a medical service provider (as defined in
IC 22-3-6-1) shall pay a filing fee of sixty dollars ($60) in a balance
billing case. The filing fee must accompany each application filed
with the board. If an employer, employer's insurance carrier, or an
agent acting on behalf of the employer denies or fails to pay any
amount on a claim submitted by a hospital or facility that is a
medical service provider, a filing fee is not required to accompany
an application that is filed for the denied or unpaid claim. A health
care provider may combine up to ten (10) individual claims into
one (1) application whenever:
(1) all individual claims involve the same employer, insurance
carrier, or billing review service; and
(2) the amount of each individual claim does not exceed two
hundred dollars ($200).
SECTION, "commission" refers to the pension management
oversight commission established by IC 2-5-12-1.
(b) The general assembly urges the legislative council to assign
the commission the task of studying the issue of increases in the
benefit schedules for worker's compensation and occupational
disease compensation.
(c) If the commission is assigned the topic described in
subsection (b), the commission shall issue a final report to the
legislative council containing the commission's findings and
recommendations, including any recommended legislation
concerning the topic, not later than November 1, 2011.
(d) This SECTION expires June 30, 2012.
____________________________ ____________________________
Senator BootsRepresentative Lehman
Chairperson
____________________________ ____________________________
Senator TallianRepresentative Niezgodski
Senate Conferees House Conferees