House Bill 25-1300 Preamended

A Bill for an Act

• Page 1, Line 101Concerning claimants' access to medical care in workers'

• Page 1, Line 102compensation claims, and, in connection therewith,

• Page 1, Line 103requiring an employer or the employer's insurer to use

• Page 1, Line 104the division of workers' compensation's utilization

• Page 1, Line 105standards and changing the mechanism by which a

• Page 1, Line 106claimant can choose a treating physician.

Bill Summary

(Note: This summary applies to this bill as introduced and does not reflect any amendments that may be subsequently adopted. If this bill passes third reading in the house of introduction, a bill summary that applies to the reengrossed version of this bill will be available at http://leg.colorado.gov.)

In a dispute in a workers' compensation claim, current law requires a claimant to prove, by a preponderance of the evidence, the claimant's entitlement to medical benefits. When the dispute concerns whether the medical treatment recommended by an authorized treating physician is reasonable, necessary, and related to the claimant's injury, the bill shifts the burden of proof from the claimant to the claimant's employer or the employer's workers' compensation insurer.

The bill provides injured workers control over the selection of their primary treating physician in workers' compensation cases, allowing them to choose from any level I or level II accredited physician through the division of workers' compensation. The bill creates the mechanism by which an injured worker may select the treating physician and requires the employer or insurer to choose the physician when an injured worker is unable or unwilling to select the treating physician.

• This Unofficial Version Includes Committee

• Amendments Not Yet Adopted on Second Reading

• Page 2, Line 1Be it enacted by the General Assembly of the State of Colorado:

• Page 2, Line 2SECTION 1.  Legislative declaration. (1)  The general assembly finds that:

• Page 2, Line 3(a)  Without workers, no products are made, no meals are served,

• Page 2, Line 4no goods are transported, no ski areas operate, no medical care is

• Page 2, Line 5provided, no fires are fought, and no highways stay safe. Workers are the

• Page 2, Line 6backbone of Colorado. When a worker is hurt, Colorado's backbone is weakened.

• Page 2, Line 7(b)  Colorado's workers' compensation act, referred to in this

• Page 2, Line 8section as the "workers' act", was enacted in 1915, and it opens with an

• Page 2, Line 9unequivocal declaration of intent that can be summarized as assuring the

• Page 2, Line 10quick and efficient delivery of disability and medical benefits to injured workers at a reasonable cost, without the necessity of litigation;

• Page 2, Line 11(c)  In 1991, Colorado Senate Bill 91-218 drastically altered the

• Page 2, Line 12workers' compensation system, undermining the intent of the workers' act

• Page 2, Line 13set forth by the general assembly in 1915. Thirty-four years after those

• Page 2, Line 14amendments, we still have a workers' compensation system weighted

• Page 2, Line 15heavily against injured workers and in favor of insurance companies, as evidenced by:

• Page 3, Line 1(I)  Injured workers in Colorado lack basic agency to choose who

• Page 3, Line 2treats their injuries. When a worker is hurt on the job, the employer and

• Page 3, Line 3its insurer have control over the primary doctor assigned. Once a primary

• Page 3, Line 4physician is assigned, that physician's referrals to other medical

• Page 3, Line 5specialists and therapists are also subject to denial by employers and their insurers.

• Page 3, Line 6(II)  Even after an employer and insurer direct a worker to seek

• Page 3, Line 7treatment with a specific physician or physicians, they can deny the

• Page 3, Line 8medical care that a physician recommends as unreasonable or

• Page 3, Line 9unnecessary. When such a dispute arises, it is the worker who bears the burden of proof in court.

• Page 3, Line 10(III)  While employers and insurers are directed to follow the

• Page 3, Line 11state's utilization standards in making determinations regarding the

• Page 3, Line 12authorization or denial of medical care, they often fail to do so. When

• Page 3, Line 13they do fail, there is no expeditious recourse for workers. The division of

• Page 3, Line 14workers' compensation in the department of labor and employment does

• Page 3, Line 15not have clear authority to rule on issues surrounding an employer or their insurer's violation of the utilization standards.

• Page 3, Line 16(IV)  Workers whose injuries are severe enough to lead to wage

• Page 3, Line 17loss or permanent impairment, or both, are limited in recovering their

• Page 3, Line 18economic losses by arbitrary benefit caps. Those caps most significantly and wrongfully impact workers whose injuries are severe.

• Page 3, Line 19(V)  Benefits payable to injured workers for permanent impairment

• Page 3, Line 20are paid unequally. While some permanent disabilities are paid through

• Page 3, Line 21a holistic lens based on the permanency of the workers' symptoms, lost

• Page 3, Line 22income, and an inability to work or complete activities of daily living,

• Page 4, Line 1others are paid according to an arbitrary schedule of benefits. The

• Page 4, Line 2schedule of benefits almost always results in less compensation for injured workers, even in instances of severe disability.

• Page 4, Line 3(VI)  Injured workers who are entitled to permanent impairment

• Page 4, Line 4benefits must wait months or even years to fully collect their award. By

• Page 4, Line 5default, employers and their insurers are allowed to pay those benefits

• Page 4, Line 6over time, and if a worker wants the benefit paid in full without delay, they must pay a discount charge to the insurer.

• Page 4, Line 7(VII)  Workers who are the most severely injured and therefore

• Page 4, Line 8unable to return to similar or "suitable" employment following an

• Page 4, Line 9industrial injury are not owed any additional monetary benefit under the

• Page 4, Line 10current scheme. Since the 1991 changes to the workers' act, to obtain

• Page 4, Line 11permanent total disability in Colorado, a worker must be "unable to earn

• Page 4, Line 12any wage". This standard has rendered permanent total disability benefits nearly obsolete.

• Page 4, Line 13(VIII)  Despite the fact that an injured worker is the first-party

• Page 4, Line 14insured of their employer's workers' compensation insurer, meaning that

• Page 4, Line 15the insurer is prohibited from the unreasonable delay or denial of benefits,

• Page 4, Line 16workers do not have access to the normal statutory remedies available for

• Page 4, Line 17the unfair claims handling practices of a workers' compensation insurer.

• Page 4, Line 18This emboldens Colorado workers' compensation insurers to engage in

• Page 4, Line 19deceptive, unfair, unreasonable, and frivolous practices in the handling of claims.

• Page 4, Line 20(IX)  All workers deserve the best care when injured. The state of

• Page 4, Line 21Colorado, as an employer, should make every effort to obtain workers'

• Page 4, Line 22compensation coverage with the worker experience in mind. Pinnacol is

• Page 4, Line 23the top-rated workers' compensation insurer by workers and is already a

• Page 5, Line 1quasi-state agency. The state should contract with Pinnacol for coverage,

• Page 5, Line 2rather than other third parties, many of which are out-of-state entities

• Page 5, Line 3without a connection to Colorado and are not subject to the same transparency and financial disclosure requirements as Pinnacol.

• Page 5, Line 4(d)  In contrast to the hardships faced by injured workers since

• Page 5, Line 51991, Colorado's workers' compensation insurers are enjoying

• Page 5, Line 6unprecedented economic success, posting profit margins higher than any other type of insurance in Colorado.

• Page 5, Line 7(2)  The general assembly declares that:

• Page 5, Line 8(a)  The playing field must be leveled and the workers' act must be returned to a mechanism with the functionality of its original intent; and

• Page 5, Line 9(b)  With this act, the state of Colorado hopes to alleviate a portion

• Page 5, Line 10of the inequities set forth in this section but acknowledges that additional change must be made in the coming years.

• Page 5, Line 11SECTION 2.  In Colorado Revised Statutes, 8-42-101, amend (3)(a)(I) and (5) as follows:

• Page 5, Line 128-42-101.  Employer must furnish medical aid - approval of

• Page 5, Line 13plan - fee schedule - contracting for treatment - no recovery from

• Page 5, Line 14employee - medical treatment guidelines - accreditation of physicians

• Page 5, Line 15and other medical providers - mental health provider qualifications

• Page 5, Line 16- mileage reimbursement - rules - definitions - repeal.

• Page 5, Line 17(3) (a) (I) (A)  The director shall establish a schedule fixing the fees for

• Page 5, Line 18which all surgical, hospital, dental, nursing, vocational rehabilitation, and

• Page 5, Line 19medical services, whether related to treatment or not, pertaining to injured

• Page 5, Line 20employees under this section shall be compensated. It is unlawful, void,

• Page 5, Line 21and unenforceable as a debt for any a physician, chiropractor, hospital,

• Page 5, Line 22person, expert witness, reviewer, evaluator, or institution to contract with,

• Page 6, Line 1bill, or charge any party for services, rendered in connection with injuries

• Page 6, Line 2coming within the purview of this article article 42 or an applicable fee

• Page 6, Line 3schedule, which that are or may be in excess of said the fee schedule

• Page 6, Line 4unless such charges are approved by the director. Fee schedules shall be

• Page 6, Line 5reviewed on or before July 1 of each year by the director, and appropriate

• Page 6, Line 6health-care practitioners shall be given a reasonable opportunity to be

• Page 6, Line 7heard as required pursuant to section 24-4-103 C.R.S., prior to fixing the

• Page 6, Line 8fees; impairment rating guidelines, which shall be based on the revised

• Page 6, Line 9third edition of the "American Medical Association Guides to the

• Page 6, Line 10Evaluation of Permanent Impairment", in effect as of July 1, 1991; and

• Page 6, Line 11medical treatment guidelines and utilization standards. Fee schedules

• Page 6, Line 12established pursuant to this subparagraph (I) subsection (3)(a)(I) shall

• Page 6, Line 13take effect on January 1. The director shall promulgate adopt rules

• Page 6, Line 14concerning reporting requirements, penalties for failure to report correctly

• Page 6, Line 15or in a timely manner, utilization control requirements for services

• Page 6, Line 16provided under this section, and the accreditation process described in

• Page 6, Line 17subsection (3.6) of this section. The fee schedule shall apply applies to

• Page 6, Line 18all surgical, hospital, dental, nursing, vocational rehabilitation, and

• Page 6, Line 19medical services and to expert witness, expert reviewer, or expert

• Page 6, Line 20evaluator services, whether related to treatment or not, provided after any final order, final admission, or full or partial settlement of the claim.

• Page 6, Line 21(B)  An employer or the employer's insurer shall use the

• Page 6, Line 22division's utilization standards when responding to a request

• Page 6, Line 23for authorization from a treating physician. If an employer or

• Page 6, Line 24the employer's insurer fails to act in accordance with the

• Page 6, Line 25division's utilization standards when reviewing a request for

• Page 6, Line 26authorization, the director may deem the services provided by

• Page 7, Line 1an authorized treating physician as authorized, reasonable, and

• Page 7, Line 2necessary and require payment for the services by the employer or the employer's insurer.

• Page 7, Line 3(5)  If any party files an application for hearing on whether the a

• Page 7, Line 4claimant is entitled to medical maintenance benefits recommended by an

• Page 7, Line 5authorized treating physician that are unpaid and contested, and any

• Page 7, Line 6requested medical maintenance benefit is admitted fewer than twenty

• Page 7, Line 7days before the hearing or ordered after application for hearing is filed,

• Page 7, Line 8the court shall award the claimant all reasonable costs incurred in pursuing the medical benefit. Such costs do not include attorney fees.

• Page 7, Line 10SECTION 3.  In Colorado Revised Statutes, 8-43-404, amend (5)(a) and (10)(b) as follows:

• Page 7, Line 118-43-404.  Examination - refusal - personal responsibility -

• Page 7, Line 12physicians to testify and furnish results - injured worker right to

• Page 7, Line 13select treating physician - injured worker right to third-party

• Page 7, Line 14communications - rules. (5) (a) (I) (A)  In all cases of injury, the

• Page 7, Line 15employer or insurer shall provide a list of at least four physicians or four

• Page 7, Line 16corporate medical providers or at least two physicians and two corporate

• Page 7, Line 17medical providers or a combination thereof where available, in the first

• Page 7, Line 18instance, from which list an injured employee may select the physician

• Page 7, Line 19who attends the injured employee. At least one of the four designated

• Page 7, Line 20physicians or corporate medical providers offered must be at a distinct

• Page 7, Line 21location from the other three designated physicians or corporate medical

• Page 7, Line 22providers without common ownership. If there are not at least two

• Page 7, Line 23physicians or corporate medical providers at distinct locations without

• Page 7, Line 24common ownership within thirty miles of the employer's place of

• Page 8, Line 1business, then an employer may designate physicians or corporate medical

• Page 8, Line 2providers at the same location or with shared ownership interests. Upon

• Page 8, Line 3request by an interested party to the workers' compensation claim, a

• Page 8, Line 4designated provider on the employer's list shall provide a list of

• Page 8, Line 5ownership interests and employment relationships, if any, to the

• Page 8, Line 6requesting party within five days of the receipt of the request. If the

• Page 8, Line 7services of a physician are not tendered at the time of injury, the

• Page 8, Line 8employee shall have the right to select a physician or chiropractor. For

• Page 8, Line 9purposes of this section, "corporate medical provider" means a medical

• Page 8, Line 10organization in business as a sole proprietorship, professional

• Page 8, Line 11corporation, or partnership Immediately upon receipt of notice of an

• Page 8, Line 12on-the-job injury from an employee who is a resident of

• Page 8, Line 13Colorado, but not more than seven business days after receipt

• Page 8, Line 14of notice of the on-the-job injury, an employer or insurer shall,

• Page 8, Line 15in written verified form, notify the injured employee of the

• Page 8, Line 16injured employee's right to designate a treating physician and

• Page 8, Line 17notify the injured employee where to access the division's list of

• Page 8, Line 18level I and level II accredited physicians. The director shall

• Page 8, Line 19create a form to implement the procedure to designate a

• Page 8, Line 20physician. The employee may designate only a level I or level II

• Page 8, Line 21accredited physician licensed under the "Colorado Medical

• Page 8, Line 22Practice Act", article 240 of title 12, as the employee's

• Page 8, Line 23authorized treating physician. The authorized treating

• Page 8, Line 24physician designated by the employee must be within seventy

• Page 8, Line 25miles of the employee's work or home address, unless there are

• Page 8, Line 26three or fewer level I or level II accredited physicians within

• Page 8, Line 27seventy miles of the employee's work or home address who are

• Page 9, Line 1willing to treat the injured employee. If there are three or

• Page 9, Line 2fewer level I or level II accredited physicians within seventy

• Page 9, Line 3miles of the employee's work or home address who are willing to

• Page 9, Line 4treat the injured employee, then the authorized treating

• Page 9, Line 5physician designated by the employee must be within one hundred

• Page 9, Line 6miles of the employee's work or home address. An accredited

• Page 9, Line 7physician is presumed willing to treat an injured worker unless

• Page 9, Line 8the physician indicates the contrary to a party. The employee

• Page 9, Line 9must designate the treating physician in writing on the form

• Page 9, Line 10prescribed by the director. The employee may make one treating

• Page 9, Line 11physician designation on the form prescribed by the director any

• Page 9, Line 12time after the on-the-job injury but before being placed at

• Page 9, Line 13maximum medical improvement. If the employee declines to

• Page 9, Line 14designate a physician within seven business days after receipt of

• Page 9, Line 15notice of the right to designate in written verified form, an

• Page 9, Line 16employer or insurer may designate only a level I or level II

• Page 9, Line 17accredited physician licensed under the "Colorado Medical

• Page 9, Line 18Practice Act", article 240 of title 12, as the employee's

• Page 9, Line 19authorized treating physician. The employee may subsequently

• Page 9, Line 20designate a physician consistent with this subsection (5)(a)(I)(A).

• Page 9, Line 21The physician designated by the employer or insurer and the

• Page 9, Line 22physician designated by the employee shall comply with

• Page 9, Line 23subsection (5)(a)(IV)(A) of this section.For an injured employee

• Page 9, Line 24who is not a resident of Colorado, as soon as possible, but no

• Page 9, Line 25later than ten business days after the receipt of a notice of an

• Page 9, Line 26on-the-job injury, an employer or insurer shall designate a

• Page 9, Line 27treating physician and notify the employee of the designation in

• Page 10, Line 1writing. The treating physician must be within one hundred miles

• Page 10, Line 2of the employee's home address. If the employer or insurer

• Page 10, Line 3declines to designate a physician within the ten-business-day

• Page 10, Line 4time period, the employee may designate a treating physician

• Page 10, Line 5within one hundred miles of the employee's home address in

• Page 10, Line 6writing to the employer or through attendance at an appointment with the employee's designated physician.

• Page 10, Line 7(B)  If there are fewer than four physicians or corporate medical

• Page 10, Line 8providers within thirty miles of the employer's place of business who are

• Page 10, Line 9willing to treat an injured employee, the employer or insurer may instead

• Page 10, Line 10designate one physician or one corporate medical provider, and

• Page 10, Line 11subparagraphs (III) and (IV) of this paragraph (a) shall not apply. A

• Page 10, Line 12physician is presumed willing to treat injured workers unless he or she

• Page 10, Line 13indicates to the employer or insurer to the contrary In an emergency

• Page 10, Line 14situation, an injured employee shall be taken to any physician or

• Page 10, Line 15health-care facility that is able to provide the necessary care.

• Page 10, Line 16When emergency care is no longer required, subsection

• Page 10, Line 17(5)(a)(I)(A) of this section applies. Immediately upon receipt of

• Page 10, Line 18notice that emergency care is no longer required, but not more

• Page 10, Line 19than seven business days after receipt of notice that emergency

• Page 10, Line 20care is no longer required, an employer or insurer shall, in

• Page 10, Line 21written verified form, notify the injured employee of the injured

• Page 10, Line 22employee's right to designate a treating physician and notify the

• Page 10, Line 23injured employee where to access the division's list of level I and level II accredited physicians.

• Page 10, Line 24(C)  If there are more than three physicians or corporate medical

• Page 10, Line 25providers, but fewer than nine physicians or corporate medical providers

• Page 11, Line 1within thirty miles of the employer's place of business who are willing to

• Page 11, Line 2treat an injured employee, the employer or insurer may instead designate

• Page 11, Line 3two physicians or two corporate medical providers or any combination

• Page 11, Line 4thereof. The two designated providers shall be at two distinct locations

• Page 11, Line 5without common ownership. If there are not two providers at two distinct

• Page 11, Line 6locations without common ownership within thirty miles of the

• Page 11, Line 7employer's place of business, then an employer may designate two

• Page 11, Line 8providers at the same location or with shared ownership interests. Upon

• Page 11, Line 9request by an interested party to the workers' compensation claim, a

• Page 11, Line 10designated provider on the employer's list shall provide a list of

• Page 11, Line 11ownership interests and employment relationships, if any, to the requesting party within five days of the receipt of the request.

• Page 11, Line 12(D)  Except as otherwise provided by sub-subparagraph (E) of this

• Page 11, Line 13subparagraph (I), any party may request an expedited hearing on the issue

• Page 11, Line 14of whether the employer or insurer provided a list in compliance with this

• Page 11, Line 15subsection (5) if the application for expedited hearing is filed within

• Page 11, Line 16forty-five days after the claimant provides notice of the injury to the employer.

• Page 11, Line 17(E)  If the insurer or self-insured employer admits liability for the

• Page 11, Line 18claim, any party may request an expedited hearing on the issue of whether

• Page 11, Line 19the employer or insurer provided a list in compliance with this subsection

• Page 11, Line 20(5) if the application for expedited hearing is filed within forty-five days

• Page 11, Line 21after the initial admission of liability for the claim. The director shall set

• Page 11, Line 22any expedited matter for hearing within sixty days after the date of the

• Page 11, Line 23application. The time schedule for an expedited hearing is subject to the

• Page 11, Line 24extensions set forth in section 8-43-209. If the party elects not to request

• Page 11, Line 25an expedited hearing under this subsection (5), the time schedule for hearing the matter is as set forth in section 8-43-209.

• Page 12, Line 1(II) (A)  If the employer is a health-care provider or a

• Page 12, Line 2governmental entity that currently has its own occupational health-care

• Page 12, Line 3provider system, the employer may designate health-care providers from

• Page 12, Line 4within its own system and is not required to provide an alternative physician or corporate medical provider from outside its own system.

• Page 12, Line 5(B)  If the employer has its own on-site health-care facility, the

• Page 12, Line 6employer may designate such on-site health-care facility as the authorized

• Page 12, Line 7treating physician, but the employer shall comply with subparagraph (III)

• Page 12, Line 8of this paragraph (a). For purposes of this sub-subparagraph (B), "on-site

• Page 12, Line 9health-care facility" means an entity that meets all applicable state requirements to provide health-care services on the employer's premises.

• Page 12, Line 10(III)  (II)  An employee may obtain a one-time change in the

• Page 12, Line 11designated authorized treating physician under this section by providing notice that meets the following requirements:

• Page 12, Line 12(A)  The notice is provided within ninety one hundred twenty

• Page 12, Line 13days after the date of the injury employee's first physician

• Page 12, Line 14designation, but before the injured worker employee reaches maximum medical improvement;

• Page 12, Line 15(B)  The notice is in writing and submitted on a form designated

• Page 12, Line 16by the director. The notice provided in this subparagraph (III) shall

• Page 12, Line 17subsection (5)(a)(II) must also simultaneously serve as a request and

• Page 12, Line 18authorization to the initially authorized treating physician to release all relevant medical records to the newly authorized treating physician.

• Page 12, Line 19(C)  The notice is directed to the insurance carrier insurer or to

• Page 12, Line 20the employer's authorized representative, if self-insured, and to the

• Page 12, Line 21initially authorized treating physician and is deposited in the United States

• Page 13, Line 1mail or hand-delivered to the employer, who shall notify the insurance

• Page 13, Line 2carrier insurer, if necessary, and the initially authorized treating physician;

• Page 13, Line 3(D)  The new physician is on the employer's designated list or

• Page 13, Line 4provides medical services for a designated corporate medical provider on

• Page 13, Line 5the list a level I or level II accredited physician licensed under

• Page 13, Line 6the "Colorado Medical Practice Act", article 240 of title 12; and

• Page 13, Line 7(E)  The transfer of medical care does not pose a threat to the health or safety of the injured employee.

• Page 13, Line 8(F)  (III)  An insurance carrier insurer, or an employer's

• Page 13, Line 9authorized representative if the employer is self-insured, shall track how

• Page 13, Line 10often injured employees change their authorized treating physician

• Page 13, Line 11pursuant to this subparagraph (III) subsection (5)(a)(II) of this section and shall report such information to the division upon request.

• Page 13, Line 12(IV) (A)  When an injured employee changes his or her their

• Page 13, Line 13designated authorized treating physician, the newly authorized treating

• Page 13, Line 14physician shall make a reasonable effort to avoid any unnecessary duplication of medical services.

• Page 13, Line 15(B)  The originally authorized treating physician shall send all

• Page 13, Line 16medical records in his or her their possession pertaining to the injured

• Page 13, Line 17employee to the newly authorized treating physician within seven

• Page 13, Line 18calendar days after receiving a request for medical records from the newly authorized treating physician.

• Page 13, Line 19(C)  The originally authorized treating physician shall continue as

• Page 13, Line 20the authorized treating physician for the injured employee until the

• Page 13, Line 21injured employee's initial visit with the newly authorized treating

• Page 14, Line 1physician, at which time the treatment relationship with the initially authorized treating physician shall terminate terminates.

• Page 14, Line 2(D)  The opinion of the originally authorized treating physician

• Page 14, Line 3regarding work restrictions and return to work shall control controls

• Page 14, Line 4unless and until such opinion is expressly modified by the newly authorized treating physician.

• Page 14, Line 5(E)  The newly authorized treating physician shall be presumed to

• Page 14, Line 6have consented to treat the injured employee unless the newly authorized

• Page 14, Line 7treating physician expressly refuses in writing within five days after the

• Page 14, Line 8date of the notice to change authorized treating physicians. If the newly

• Page 14, Line 9authorized treating physician refuses to treat the injured employee, the

• Page 14, Line 10employee may return to the employer to request an alternative authorized

• Page 14, Line 11treating physician If the employer does not provide an alternative

• Page 14, Line 12authorized treating physician within five days after the employee's

• Page 14, Line 13request, rules established by the division shall control who is a level I

• Page 14, Line 14or level II accredited physician licensed under the "Colorado Medical Practice Act", article 240 of title 12.

• Page 14, Line 15(V)  If the an authorized treating physician moves from one

• Page 14, Line 16facility to another, or from one corporate medical provider to another, an

• Page 14, Line 17injured employee may continue care with the authorized treating

• Page 14, Line 18physician, and the original facility or corporate medical provider shall

• Page 14, Line 19provide the injured employee's medical records to the authorized treating

• Page 14, Line 20physician within seven days after receipt of a request for medical records from the authorized treating physician.

• Page 14, Line 21(VI) (A)  In addition to the one-time change of physician allowed

• Page 14, Line 22in subparagraph (III) of this paragraph (a) subsection (5)(a)(II) of this

• Page 14, Line 23section, upon written request to the insurance carrier insurer or to the

• Page 15, Line 1employer's authorized representative if the employer is self-insured, an

• Page 15, Line 2injured employee may procure written permission to have a personal

• Page 15, Line 3physician or chiropractor treat the employee. The employee must

• Page 15, Line 4complete the written request must be completed on a form that is

• Page 15, Line 5prescribed by the director. If permission is neither granted nor refused

• Page 15, Line 6the employer or insurer neither grants nor refuses the

• Page 15, Line 7permission request within twenty days after the date of the certificate

• Page 15, Line 8of service of the request form, the employer or insurance carrier shall be

• Page 15, Line 9insurer is deemed to have waived any objection to the employee's

• Page 15, Line 10request. If the employer or insurer objects to the request, the

• Page 15, Line 11employer or insurer shall make the objection shall be in writing on

• Page 15, Line 12a form prescribed by the director and shall be served serve the written

• Page 15, Line 13objection on the employee or, if represented, the employee's authorized

• Page 15, Line 14representative within twenty days after the date of the certificate of

• Page 15, Line 15service of the request form. An insurance carrier insurer, or an

• Page 15, Line 16employer's authorized representative if the employer is self-insured,

• Page 15, Line 17shall track how often an injured employee requests to change his or her

• Page 15, Line 18the employee's physician and how often such change is granted or

• Page 15, Line 19denied and shall report such information to the division upon request.

• Page 15, Line 20Upon the proper showing to the division, the employee may procure the

• Page 15, Line 21division's permission at any time to have a physician of the employee's

• Page 15, Line 22selection treat the employee, and in any nonsurgical case the employee,

• Page 15, Line 23with such permission, in lieu of medical aid, may procure any nonmedical

• Page 15, Line 24treatment recognized by the laws of this state as legal. The practitioner

• Page 15, Line 25administering the treatment shall receive fees under the medical

• Page 15, Line 26provisions of articles 40 to 47 of this title title 8 as specified by the

• Page 15, Line 27division.

• Page 16, Line 1(B)  If an injured employee is permitted to change physicians

• Page 16, Line 2under sub-subparagraph (A) of this subparagraph (VI) subsection

• Page 16, Line 3(5)(a)(VI)(A) of this section resulting in a new authorized treating

• Page 16, Line 4physician who will provide primary care for the injury, then the

• Page 16, Line 5previously authorized treating physician providing primary care shall

• Page 16, Line 6continue as the authorized treating physician providing primary care for

• Page 16, Line 7the injured employee until the injured employee's initial visit with the

• Page 16, Line 8newly authorized treating physician, at which time the treatment

• Page 16, Line 9relationship with the previously authorized treating physician providing primary care is terminated.

• Page 16, Line 10(C)  Nothing in this subparagraph (VI) subsection (5)(a)(VI)

• Page 16, Line 11precludes any former authorized treating physician from performing an examination under subsection (1) of this section.

• Page 16, Line 12(D)  If an injured employee is permitted to change physicians

• Page 16, Line 13pursuant to sub-subparagraph (A) of this subparagraph (VI) subsection

• Page 16, Line 14(5)(a)(VI)(A) of this section resulting in a new authorized treating

• Page 16, Line 15physician who will provide primary care for the injury, then the opinion

• Page 16, Line 16of the previously authorized treating physician providing primary care

• Page 16, Line 17regarding work restrictions and return to work controls unless that opinion is expressly modified by the newly authorized treating physician.

• Page 16, Line 18(10) (b)  If the an insurer or self-insured employer receives written

• Page 16, Line 19notice pursuant to paragraph (a) of this subsection (10) subsection

• Page 16, Line 20(10)(a) of this section, or if the insurer or self-insured employer and the

• Page 16, Line 21authorized treating physician receive written notice by certified mail,

• Page 16, Line 22return receipt requested, from the an injured employee or the injured

• Page 16, Line 23employee's legal representative that an authorized physician refused to

• Page 16, Line 24provide medical treatment to the injured employee or discharged the

• Page 17, Line 1injured employee from medical care for nonmedical reasons when such

• Page 17, Line 2the injured employee requires medical treatment to cure or relieve the

• Page 17, Line 3effects of the work injury, and there is no other authorized physician

• Page 17, Line 4willing to provide medical treatment, then the insurer or self-insured

• Page 17, Line 5employer shall, within fifteen calendar days from after receiving the

• Page 17, Line 6written notice, designate a new authorized physician willing to provide

• Page 17, Line 7medical treatment. If the insurer or self-insured employer fails to

• Page 17, Line 8designate a new physician pursuant to this paragraph (b), then the injured

• Page 17, Line 9employee may select the physician who attends to the injured employee

• Page 17, Line 10advise the injured employee in writing that the injured employee

• Page 17, Line 11may designate a new level I or level II accredited physician

• Page 17, Line 12licensed under the "Colorado Medical Practice Act", article 240

• Page 17, Line 13of title 12, as the employee's new authorized treating physician.

• Page 17, Line 14The employee must designate the new treating physician in writing on the form prescribed by the director.

• Page 17, Line 15SECTION 4.  Act subject to petition - effective date -

• Page 17, Line 16applicability. (1)  This act takes effect January 1, 2026; except that, if a

• Page 17, Line 17referendum petition is filed pursuant to section 1 (3) of article V of the

• Page 17, Line 18state constitution against this act or an item, section, or part of this act

• Page 17, Line 19within the ninety-day period after final adjournment of the general

• Page 17, Line 20assembly, then the act, item, section, or part will not take effect unless

• Page 17, Line 21approved by the people at the general election to be held in November

• Page 17, Line 222026 and, in such case, will take effect on the date of the official declaration of the vote thereon by the governor.

• Page 17, Line 23(2)  This act applies to workers' compensation claims filed on or after the applicable effective date of this act.