Claim for compensation: Duty of treating physician or chiropractor to file or delegate duty to medical facility; electronic filing; form and contents; maintenance of forms; penalty.
1. Except as otherwise provided in this section, a treating physician or chiropractor shall, within 3 working days after first providing treatment to an injured employee for a particular injury, complete and file a claim for compensation with the employer of the injured employee and the employer’s insurer. If the employer is a self-insured employer, the treating physician or chiropractor shall file the claim for compensation with the employer’s third-party administrator. If the physician or chiropractor files the claim for compensation by electronic transmission, the physician or chiropractor shall, upon request, mail to the insurer or third-party administrator the form that contains the original signatures of the injured employee and the physician or chiropractor. The form must be mailed within 7 days after receiving such a request.
2. A physician or chiropractor who has a duty to file a claim for compensation pursuant to subsection 1 may delegate the duty to a medical facility. If the physician or chiropractor delegates the duty to a medical facility:
(a) The medical facility must comply with the filing requirements set forth in this section; and
(b) The delegation must be in writing and signed by:
(1) The physician or chiropractor; and
(2) An authorized representative of the medical facility.
3. A claim for compensation required by subsection 1 must be filed on a form prescribed by the Administrator.
4. If a claim for compensation is accompanied by a certificate of disability, the certificate must include a description of any limitation or restrictions on the injured employee’s ability to work.
5. Each physician, chiropractor and medical facility that treats injured employees, each insurer, third-party administrator and employer, and the Division shall maintain at their offices a sufficient supply of the forms prescribed by the Administrator for filing a claim for compensation.
6. The Administrator may impose an administrative fine of not more than $1,000 for each violation of subsection 1 on:
(a) A physician or chiropractor; or
(b) A medical facility if the duty to file the claim for compensation has been delegated to the medical facility pursuant to this section.
Last modified: February 25, 2006