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)  After suffering an industrial injury, a worker needs

• Page 3, Line 7to be educated regarding how to file a claim and how to seek

• Page 3, Line 8treatment through the workers' compensation system.

• Page 3, Line 9Employers, as the first line of communication with an injured

• Page 3, Line 10worker, are encouraged or obligated to provide that education and information to each worker.

• Page 3, Line 11(III)  Even after an employer and insurer direct a worker to seek

• Page 3, Line 12treatment with a specific physician or physicians, they can deny the

• Page 3, Line 13medical care that a physician recommends as unreasonable or

• Page 3, Line 14unnecessary. When such a dispute arises, it is the worker who bears the burden of proof in court.

• Page 3, Line 15(IV)  While employers and insurers are directed to follow the

• Page 3, Line 16state's utilization standards in making determinations regarding the

• Page 3, Line 17authorization or denial of medical care, they often fail to do so. When

• Page 3, Line 18they do fail, there is no expeditious recourse for workers. The division of

• Page 3, Line 19workers' compensation in the department of labor and employment does

• Page 3, Line 20not have clear authority to rule on issues surrounding an employer or their insurer's violation of the utilization standards.

• Page 3, Line 21(V)  Many Colorado employers use third-party

• Page 3, Line 22administrators and insurance providers to handle their

• Page 4, Line 1workers' compensation claims. The third-party administrators

• Page 4, Line 2are often located outside the state and are a step removed from

• Page 4, Line 3an injured worker. As a result of the separation, third-party

• Page 4, Line 4administrators delay and deny care with more frequency than

• Page 4, Line 5workers' compensation insurers. The workers' compensation

• Page 4, Line 6system should take action to ensure that third-party administrators are being held to the same standard as insurers.

• Page 4, Line 7(VI)  Workers whose injuries are severe enough to lead to wage

• Page 4, Line 8loss or permanent impairment, or both, are limited in recovering their

• Page 4, Line 9economic losses by arbitrary benefit caps. Those caps most significantly and wrongfully impact workers whose injuries are severe.

• Page 4, Line 10(VII)  Benefits payable to injured workers for permanent

• Page 4, Line 11impairment are paid unequally. While some permanent disabilities are

• Page 4, Line 12paid through a holistic lens based on the permanency of the workers'

• Page 4, Line 13symptoms, lost income, and an inability to work or complete activities of

• Page 4, Line 14daily living, others are paid according to an arbitrary schedule of benefits.

• Page 4, Line 15The schedule of benefits almost always results in less compensation for injured workers, even in instances of severe disability.

• Page 4, Line 16(VIII)  Injured workers who are entitled to permanent impairment

• Page 4, Line 17benefits must wait months or even years to fully collect their award. By

• Page 4, Line 18default, employers and their insurers are allowed to pay those benefits

• Page 4, Line 19over 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 20(IX)  Workers who are the most severely injured and therefore

• Page 4, Line 21unable to return to similar or "suitable" employment following an

• Page 4, Line 22industrial injury are not owed any additional monetary benefit under the

• Page 4, Line 23current scheme. Since the 1991 changes to the workers' act, to obtain

• Page 5, Line 1permanent total disability in Colorado, a worker must be "unable to earn

• Page 5, Line 2any wage". This standard has rendered permanent total disability benefits nearly obsolete.

• Page 5, Line 3(X)  Despite the fact that an injured worker is the first-party

• Page 5, Line 4insured of their employer's workers' compensation insurer, meaning that

• Page 5, Line 5the insurer is prohibited from the unreasonable delay or denial of benefits,

• Page 5, Line 6workers do not have access to the normal statutory remedies available for

• Page 5, Line 7the unfair claims handling practices of a workers' compensation insurer.

• Page 5, Line 8This emboldens Colorado workers' compensation insurers to engage in

• Page 5, Line 9deceptive, unfair, unreasonable, and frivolous practices in the handling of claims.

• Page 5, Line 10(XI)  All workers deserve the best care when injured. The state of

• Page 5, Line 11Colorado, as an employer, should make every effort to obtain workers'

• Page 5, Line 12compensation coverage with the worker experience in mind. Pinnacol is

• Page 5, Line 13the top-rated workers' compensation insurer by workers and is already a

• Page 5, Line 14quasi-state agency. The state should contract with Pinnacol for coverage,

• Page 5, Line 15rather than other third parties, many of which are out-of-state entities

• Page 5, Line 16without a connection to Colorado and are not subject to the same transparency and financial disclosure requirements as Pinnacol.

• Page 5, Line 17(d)  In contrast to the hardships faced by injured workers since

• Page 5, Line 181991, Colorado's workers' compensation insurers are enjoying

• Page 5, Line 19unprecedented economic success, posting profit margins higher than any other type of insurance in Colorado.

• Page 5, Line 20(2)  The general assembly declares that:

• Page 5, Line 21(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 22(b)  With this act, the state of Colorado hopes to alleviate a portion

• Page 6, Line 1of the inequities set forth in this section but acknowledges that additional change must be made in the coming years.

• Page 6, Line 2SECTION 2.  In Colorado Revised Statutes, 8-42-101, amend (3)(a)(I) and (5) as follows:

• Page 6, Line 38-42-101.  Employer must furnish medical aid - approval of

• Page 6, Line 4plan - fee schedule - contracting for treatment - no recovery from

• Page 6, Line 5employee - medical treatment guidelines - accreditation of physicians

• Page 6, Line 6and other medical providers - mental health provider qualifications

• Page 6, Line 7- mileage reimbursement - rules - definitions - repeal.

• Page 6, Line 8(3) (a) (I) (A)  The director shall establish a schedule fixing the fees for

• Page 6, Line 9which all surgical, hospital, dental, nursing, vocational rehabilitation, and

• Page 6, Line 10medical services, whether related to treatment or not, pertaining to injured

• Page 6, Line 11employees under this section shall be compensated. It is unlawful, void,

• Page 6, Line 12and unenforceable as a debt for any a physician, chiropractor, hospital,

• Page 6, Line 13person, expert witness, reviewer, evaluator, or institution to contract with,

• Page 6, Line 14bill, or charge any party for services, rendered in connection with injuries

• Page 6, Line 15coming within the purview of this article article 42 or an applicable fee

• Page 6, Line 16schedule, which that are or may be in excess of said the fee schedule

• Page 6, Line 17unless such charges are approved by the director. Fee schedules shall be

• Page 6, Line 18reviewed on or before July 1 of each year by the director, and appropriate

• Page 6, Line 19health-care practitioners shall be given a reasonable opportunity to be

• Page 6, Line 20heard as required pursuant to section 24-4-103 C.R.S., prior to fixing the

• Page 6, Line 21fees; impairment rating guidelines, which shall be based on the revised

• Page 6, Line 22third edition of the "American Medical Association Guides to the

• Page 6, Line 23Evaluation of Permanent Impairment", in effect as of July 1, 1991; and

• Page 6, Line 24medical treatment guidelines and utilization standards. Fee schedules

• Page 6, Line 25established pursuant to this subparagraph (I) subsection (3)(a)(I) shall

• Page 7, Line 1take effect on January 1. The director shall promulgate adopt rules

• Page 7, Line 2concerning reporting requirements, penalties for failure to report correctly

• Page 7, Line 3or in a timely manner, utilization control requirements for services

• Page 7, Line 4provided under this section, and the accreditation process described in

• Page 7, Line 5subsection (3.6) of this section. The fee schedule shall apply applies to

• Page 7, Line 6all surgical, hospital, dental, nursing, vocational rehabilitation, and

• Page 7, Line 7medical services and to expert witness, expert reviewer, or expert

• Page 7, Line 8evaluator services, whether related to treatment or not, provided after any final order, final admission, or full or partial settlement of the claim.

• Page 7, Line 9(B)  An employer or the employer's insurer shall use the

• Page 7, Line 10division's utilization standards when responding to a request

• Page 7, Line 11for authorization from a treating physician. If an employer or

• Page 7, Line 12the employer's insurer fails to act in accordance with the

• Page 7, Line 13division's utilization standards when reviewing a request for

• Page 7, Line 14authorization, the director may deem the services provided by

• Page 7, Line 15an authorized treating physician as authorized, reasonable, and

• Page 7, Line 16necessary and require payment for the services by the employer or the employer's insurer.

• Page 7, Line 17(5)  If any party files an application for hearing on whether the a

• Page 7, Line 18claimant is entitled to medical maintenance benefits recommended by an

• Page 7, Line 19authorized treating physician that are unpaid and contested, and any

• Page 7, Line 20requested medical maintenance benefit is admitted fewer than twenty

• Page 7, Line 21days before the hearing or ordered after application for hearing is filed,

• Page 7, Line 22the court shall award the claimant all reasonable costs incurred in pursuing the medical benefit. Such costs do not include attorney fees.

• Page 7, Line 24SECTION 3.  In Colorado Revised Statutes, 8-43-404, amend (5)(a) and (10)(b) as follows:

• Page 8, Line 18-43-404.  Examination - refusal - personal responsibility -

• Page 8, Line 2physicians to testify and furnish results - injured worker right to

• Page 8, Line 3select treating physician - injured worker right to third-party

• Page 8, Line 4communications - rules. (5) (a) (I) (A)  In all cases of injury, the

• Page 8, Line 5employer or insurer shall provide a list of at least four physicians or four

• Page 8, Line 6corporate medical providers or at least two physicians and two corporate

• Page 8, Line 7medical providers or a combination thereof where available, in the first

• Page 8, Line 8instance, from which list an injured employee may select the physician

• Page 8, Line 9who attends the injured employee. At least one of the four designated

• Page 8, Line 10physicians or corporate medical providers offered must be at a distinct

• Page 8, Line 11location from the other three designated physicians or corporate medical

• Page 8, Line 12providers without common ownership. If there are not at least two

• Page 8, Line 13physicians or corporate medical providers at distinct locations without

• Page 8, Line 14common ownership within thirty miles of the employer's place of

• Page 8, Line 15business, then an employer may designate physicians or corporate medical

• Page 8, Line 16providers at the same location or with shared ownership interests. Upon

• Page 8, Line 17request by an interested party to the workers' compensation claim, a

• Page 8, Line 18designated provider on the employer's list shall provide a list of

• Page 8, Line 19ownership interests and employment relationships, if any, to the

• Page 8, Line 20requesting party within five days of the receipt of the request. If the

• Page 8, Line 21services of a physician are not tendered at the time of injury, the

• Page 8, Line 22employee shall have the right to select a physician or chiropractor. For

• Page 8, Line 23purposes of this section, "corporate medical provider" means a medical

• Page 8, Line 24organization in business as a sole proprietorship, professional

• Page 8, Line 25corporation, or partnership Immediately upon receipt of notice of an

• Page 8, Line 26on-the-job injury from an employee who is a resident of

• Page 9, Line 1Colorado, but not more than seven business days after receipt

• Page 9, Line 2of notice of the on-the-job injury, an employer or insurer shall,

• Page 9, Line 3in written verified form, notify the injured employee of the

• Page 9, Line 4injured employee's right to designate a treating physician and

• Page 9, Line 5notify the injured employee where to access the division's list of

• Page 9, Line 6level I and level II accredited physicians. The director shall

• Page 9, Line 7create a form to implement the procedure to designate a

• Page 9, Line 8physician. The employee may designate only a level I or level II

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

• Page 9, Line 10Practice Act", article 240 of title 12, as the employee's

• Page 9, Line 11authorized treating physician. The authorized treating

• Page 9, Line 12physician designated by the employee must be within seventy

• Page 9, Line 13miles of the employee's work or home address, unless there are

• Page 9, Line 14three or fewer level I or level II accredited physicians within

• Page 9, Line 15seventy miles of the employee's work or home address who are

• Page 9, Line 16willing to treat the injured employee. If there are three or

• Page 9, Line 17fewer level I or level II accredited physicians within seventy

• Page 9, Line 18miles of the employee's work or home address who are willing to

• Page 9, Line 19treat the injured employee, then the authorized treating

• Page 9, Line 20physician designated by the employee must be within one hundred

• Page 9, Line 21miles of the employee's work or homeaddress; except that an

• Page 9, Line 22injured employee may, upon good cause shown, designate an

• Page 9, Line 23authorized treating physician who is not within one hundred

• Page 9, Line 24miles of the employee's work or home address. Good cause is

• Page 9, Line 25presumed to exist if there are three or fewer level I or level II

• Page 9, Line 26accredited physicians within one hundred miles of the employee's

• Page 9, Line 27work or home address who are willing to treat the injured

• Page 10, Line 1employee.An accredited physician is presumed willing to treat

• Page 10, Line 2an injured worker unless the physician indicates the contrary

• Page 10, Line 3to a party. The employee must designate the treating physician

• Page 10, Line 4in writing on the form prescribed by the director. The employee

• Page 10, Line 5may make one treating physician designation on the form

• Page 10, Line 6prescribed by the director any time after the on-the-job injury

• Page 10, Line 7but before being placed at maximum medical improvement. If the

• Page 10, Line 8employee declines to designate a physician within seven business

• Page 10, Line 9days after receipt of notice of the right to designate in written

• Page 10, Line 10verified form, an employer or insurer may designate only a level

• Page 10, Line 11I or level II accredited physician licensed under the "Colorado

• Page 10, Line 12Medical Practice Act", article 240 of title 12, as the employee's

• Page 10, Line 13authorized treating physician. The employee may subsequently

• Page 10, Line 14designate a physician consistent with this subsection (5)(a)(I)(A).

• Page 10, Line 15The physician designated by the employer or insurer and the

• Page 10, Line 16physician designated by the employee shall comply with

• Page 10, Line 17subsection (5)(a)(IV)(A) of this section.For an injured employee

• Page 10, Line 18who is not a resident of Colorado, as soon as possible, but no

• Page 10, Line 19later than ten business days after the receipt of a notice of an

• Page 10, Line 20on-the-job injury, an employer or insurer shall designate a

• Page 10, Line 21treating physician and notify the employee of the designation in

• Page 10, Line 22writing. The treating physician must be within one hundred miles

• Page 10, Line 23of the employee's home address. If the employer or insurer

• Page 10, Line 24declines to designate a physician within the ten-business-day

• Page 10, Line 25time period, the employee may designate a treating physician

• Page 10, Line 26within one hundred miles of the employee's home address in

• Page 10, Line 27writing to the employer or through attendance at an appointment with the employee's designated physician.

• Page 11, Line 1(B)  If there are fewer than four physicians or corporate medical

• Page 11, Line 2providers within thirty miles of the employer's place of business who are

• Page 11, Line 3willing to treat an injured employee, the employer or insurer may instead

• Page 11, Line 4designate one physician or one corporate medical provider, and

• Page 11, Line 5subparagraphs (III) and (IV) of this paragraph (a) shall not apply. A

• Page 11, Line 6physician is presumed willing to treat injured workers unless he or she

• Page 11, Line 7indicates to the employer or insurer to the contrary In an emergency

• Page 11, Line 8situation, an injured employee shall be taken to any physician or

• Page 11, Line 9health-care facility that is able to provide the necessary care.

• Page 11, Line 10When emergency care is no longer required, subsection

• Page 11, Line 11(5)(a)(I)(A) of this section applies. Immediately upon receipt of

• Page 11, Line 12notice that emergency care is no longer required, but not more

• Page 11, Line 13than seven business days after receipt of notice that emergency

• Page 11, Line 14care is no longer required, an employer or insurer shall, in

• Page 11, Line 15written verified form, notify the injured employee of the injured

• Page 11, Line 16employee's right to designate a treating physician and notify the

• Page 11, Line 17injured employee where to access the division's list of level I and level II accredited physicians.

• Page 11, Line 18(C)  If there are more than three physicians or corporate medical

• Page 11, Line 19providers, but fewer than nine physicians or corporate medical providers

• Page 11, Line 20within thirty miles of the employer's place of business who are willing to

• Page 11, Line 21treat an injured employee, the employer or insurer may instead designate

• Page 11, Line 22two physicians or two corporate medical providers or any combination

• Page 11, Line 23thereof. The two designated providers shall be at two distinct locations

• Page 11, Line 24without common ownership. If there are not two providers at two distinct

• Page 11, Line 25locations without common ownership within thirty miles of the

• Page 12, Line 1employer's place of business, then an employer may designate two

• Page 12, Line 2providers at the same location or with shared ownership interests. Upon

• Page 12, Line 3request by an interested party to the workers' compensation claim, a

• Page 12, Line 4designated provider on the employer's list shall provide a list of

• Page 12, Line 5ownership interests and employment relationships, if any, to the requesting party within five days of the receipt of the request.

• Page 12, Line 6(D)  Except as otherwise provided by sub-subparagraph (E) of this

• Page 12, Line 7subparagraph (I), any party may request an expedited hearing on the issue

• Page 12, Line 8of whether the employer or insurer provided a list in compliance with this

• Page 12, Line 9subsection (5) if the application for expedited hearing is filed within

• Page 12, Line 10forty-five days after the claimant provides notice of the injury to the employer.

• Page 12, Line 11(E)  If the insurer or self-insured employer admits liability for the

• Page 12, Line 12claim, any party may request an expedited hearing on the issue of whether

• Page 12, Line 13the employer or insurer provided a list in compliance with this subsection

• Page 12, Line 14(5) if the application for expedited hearing is filed within forty-five days

• Page 12, Line 15after the initial admission of liability for the claim. The director shall set

• Page 12, Line 16any expedited matter for hearing within sixty days after the date of the

• Page 12, Line 17application. The time schedule for an expedited hearing is subject to the

• Page 12, Line 18extensions set forth in section 8-43-209. If the party elects not to request

• Page 12, Line 19an 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 20(II) (A)  If the employer is a health-care provider or a

• Page 12, Line 21governmental entity that currently has its own occupational health-care

• Page 12, Line 22provider system, the employer may designate health-care providers from

• Page 12, Line 23within its own system and is not required to provide an alternative

• Page 12, Line 24physician or corporate medical provider from outside its own system.

• Page 13, Line 1(B)  If the employer has its own on-site health-care facility, the

• Page 13, Line 2employer may designate such on-site health-care facility as the authorized

• Page 13, Line 3treating physician, but the employer shall comply with subparagraph (III)

• Page 13, Line 4of this paragraph (a). For purposes of this sub-subparagraph (B), "on-site

• Page 13, Line 5health-care facility" means an entity that meets all applicable state requirements to provide health-care services on the employer's premises.

• Page 13, Line 6(III)  (II)  An employee may obtain a one-time change in the

• Page 13, Line 7designated authorized treating physician under this section by providing notice that meets the following requirements:

• Page 13, Line 8(A)  The notice is provided within ninety one hundred twenty

• Page 13, Line 9days after the date of the injury first physician designation, but

• Page 13, Line 10before the injured worker employee reaches maximum medical improvement;

• Page 13, Line 11(B)  The notice is in writing and submitted on a form designated

• Page 13, Line 12by the director. The notice provided in this subparagraph (III) shall

• Page 13, Line 13subsection (5)(a)(II) must also simultaneously serve as a request and

• Page 13, Line 14authorization to the initially authorized treating physician to release all relevant medical records to the newly authorized treating physician.

• Page 13, Line 15(C)  The notice is directed to the insurance carrier insurer or to

• Page 13, Line 16the employer's authorized representative, if self-insured, and to the

• Page 13, Line 17initially authorized treating physician and is deposited in the United States

• Page 13, Line 18mail or hand-delivered to the employer, who shall notify the insurance

• Page 13, Line 19carrier insurer, if necessary, and the initially authorized treating physician;

• Page 13, Line 20(D)  The new physician is on the employer's designated list or

• Page 13, Line 21provides medical services for a designated corporate medical provider on

• Page 13, Line 22the list a level I or level II accredited physician licensed under

• Page 14, Line 1the "Colorado Medical Practice Act", article 240 of title 12; and

• Page 14, Line 2(E)  The transfer of medical care does not pose a threat to the health or safety of the injured employee.

• Page 14, Line 3(F)  (III)  An insurance carrier insurer, or an employer's

• Page 14, Line 4authorized representative if the employer is self-insured, shall track how

• Page 14, Line 5often injured employees change their authorized treating physician

• Page 14, Line 6pursuant to this subparagraph (III) subsection (5)(a)(II) of this section and shall report such information to the division upon request.

• Page 14, Line 7(IV) (A)  When an injured employee changes his or her their

• Page 14, Line 8designated authorized treating physician, the newly authorized treating

• Page 14, Line 9physician shall make a reasonable effort to avoid any unnecessary duplication of medical services.

• Page 14, Line 10(B)  The originally authorized treating physician shall send all

• Page 14, Line 11medical records in his or her their possession pertaining to the injured

• Page 14, Line 12employee to the newly authorized treating physician within seven

• Page 14, Line 13calendar days after receiving a request for medical records from the newly authorized treating physician.

• Page 14, Line 14(C)  The originally authorized treating physician shall continue as

• Page 14, Line 15the authorized treating physician for the injured employee until the

• Page 14, Line 16injured employee's initial visit with the newly authorized treating

• Page 14, Line 17physician, at which time the treatment relationship with the initially authorized treating physician shall terminate terminates.

• Page 14, Line 18(D)  The opinion of the originally authorized treating physician

• Page 14, Line 19regarding work restrictions and return to work shall control controls

• Page 14, Line 20unless and until such opinion is expressly modified by the newly

• Page 14, Line 21authorized treating physician.

• Page 15, Line 1(E)  The newly authorized treating physician shall be presumed to

• Page 15, Line 2have consented to treat the injured employee unless the newly authorized

• Page 15, Line 3treating physician expressly refuses in writing within five days after the

• Page 15, Line 4date of the notice to change authorized treating physicians. If the newly

• Page 15, Line 5authorized treating physician refuses to treat the injured employee, the

• Page 15, Line 6employee may return to the employer to request an alternative authorized

• Page 15, Line 7treating physician If the employer does not provide an alternative

• Page 15, Line 8authorized treating physician within five days after the employee's

• Page 15, Line 9request, rules established by the division shall control who is a level I

• Page 15, Line 10or level II accredited physician licensed under the "Colorado Medical Practice Act", article 240 of title 12.

• Page 15, Line 11(V)  If the an authorized treating physician moves from one

• Page 15, Line 12facility to another, or from one corporate medical provider to another, an

• Page 15, Line 13injured employee may continue care with the authorized treating

• Page 15, Line 14physician, and the original facility or corporate medical provider shall

• Page 15, Line 15provide the injured employee's medical records to the authorized treating

• Page 15, Line 16physician within seven days after receipt of a request for medical records from the authorized treating physician.

• Page 15, Line 17(VI) (A)  In addition to the one-time change of physician allowed

• Page 15, Line 18in subparagraph (III) of this paragraph (a) subsection (5)(a)(II) of this

• Page 15, Line 19section, upon written request to the insurance carrier insurer or to the

• Page 15, Line 20employer's authorized representative if the employer is self-insured, an

• Page 15, Line 21injured employee may procure written permission to have a personal

• Page 15, Line 22physician or chiropractor treat the employee. The employee must

• Page 15, Line 23complete the written request must be completed on a form that is

• Page 15, Line 24prescribed by the director. If permission is neither granted nor refused

• Page 15, Line 25the employer or insurer neither grants nor refuses the

• Page 16, Line 1permission request within twenty days after the date of the certificate

• Page 16, Line 2of service of the request form, the employer or insurance carrier shall be

• Page 16, Line 3insurer is deemed to have waived any objection to the employee's

• Page 16, Line 4request. If the employer or insurer objects to the request, the

• Page 16, Line 5employer or insurer shall make the objection shall be in writing on

• Page 16, Line 6a form prescribed by the director and shall be served serve the written

• Page 16, Line 7objection on the employee or, if represented, the employee's authorized

• Page 16, Line 8representative within twenty days after the date of the certificate of

• Page 16, Line 9service of the request form. An insurance carrier insurer, or an

• Page 16, Line 10employer's authorized representative if the employer is self-insured,

• Page 16, Line 11shall track how often an injured employee requests to change his or her

• Page 16, Line 12the employee's physician and how often such change is granted or

• Page 16, Line 13denied and shall report such information to the division upon request.

• Page 16, Line 14Upon the proper showing to the division, the employee may procure the

• Page 16, Line 15division's permission at any time to have a physician of the employee's

• Page 16, Line 16selection treat the employee, and in any nonsurgical case the employee,

• Page 16, Line 17with such permission, in lieu of medical aid, may procure any nonmedical

• Page 16, Line 18treatment recognized by the laws of this state as legal. The practitioner

• Page 16, Line 19administering the treatment shall receive fees under the medical

• Page 16, Line 20provisions of articles 40 to 47 of this title title 8 as specified by the division.

• Page 16, Line 21(B)  If an injured employee is permitted to change physicians

• Page 16, Line 22under sub-subparagraph (A) of this subparagraph (VI) subsection

• Page 16, Line 23(5)(a)(VI)(A) of this section resulting in a new authorized treating

• Page 16, Line 24physician who will provide primary care for the injury, then the

• Page 16, Line 25previously authorized treating physician providing primary care shall

• Page 16, Line 26continue as the authorized treating physician providing primary care for

• Page 17, Line 1the injured employee until the injured employee's initial visit with the

• Page 17, Line 2newly authorized treating physician, at which time the treatment

• Page 17, Line 3relationship with the previously authorized treating physician providing primary care is terminated.

• Page 17, Line 4(C)  Nothing in this subparagraph (VI) subsection (5)(a)(VI)

• Page 17, Line 5precludes any former authorized treating physician from performing an examination under subsection (1) of this section.

• Page 17, Line 6(D)  If an injured employee is permitted to change physicians

• Page 17, Line 7pursuant to sub-subparagraph (A) of this subparagraph (VI) subsection

• Page 17, Line 8(5)(a)(VI)(A) of this section resulting in a new authorized treating

• Page 17, Line 9physician who will provide primary care for the injury, then the opinion

• Page 17, Line 10of the previously authorized treating physician providing primary care

• Page 17, Line 11regarding work restrictions and return to work controls unless that opinion is expressly modified by the newly authorized treating physician.

• Page 17, Line 12(VII)  An attorney representing an injured employee shall

• Page 17, Line 13not refer the injured employee to an authorized treating

• Page 17, Line 14physician or physician practice in which the attorney has an ownership interest or other financial interest.

• Page 17, Line 15(10) (b)  If the an insurer or self-insured employer receives written

• Page 17, Line 16notice pursuant to paragraph (a) of this subsection (10) subsection

• Page 17, Line 17(10)(a) of this section, or if the insurer or self-insured employer and the

• Page 17, Line 18authorized treating physician receive written notice by certified mail,

• Page 17, Line 19return receipt requested, from the an injured employee or the injured

• Page 17, Line 20employee's legal representative that an authorized physician refused to

• Page 17, Line 21provide medical treatment to the injured employee or discharged the

• Page 17, Line 22injured employee from medical care for nonmedical reasons when such

• Page 17, Line 23the injured employee requires medical treatment to cure or relieve the

• Page 18, Line 1effects of the work injury, and there is no other authorized physician

• Page 18, Line 2willing to provide medical treatment, then the insurer or self-insured

• Page 18, Line 3employer shall, within fifteen calendar days from after receiving the

• Page 18, Line 4written notice, designate a new authorized physician willing to provide

• Page 18, Line 5medical treatment. If the insurer or self-insured employer fails to

• Page 18, Line 6designate a new physician pursuant to this paragraph (b), then the injured

• Page 18, Line 7employee may select the physician who attends to the injured employee

• Page 18, Line 8advise the injured employee in writing that the injured employee

• Page 18, Line 9may designate a new level I or level II accredited physician

• Page 18, Line 10licensed under the "Colorado Medical Practice Act", article 240

• Page 18, Line 11of title 12, as the employee's new authorized treating physician.

• Page 18, Line 12The employee must designate the new treating physician in writing on the form prescribed by the director.

• Page 18, Line 13SECTION 4.  Act subject to petition - effective date -

• Page 18, Line 14applicability. (1)  This act takes effect January 1, 2026; except that, if a

• Page 18, Line 15referendum petition is filed pursuant to section 1 (3) of article V of the

• Page 18, Line 16state constitution against this act or an item, section, or part of this act

• Page 18, Line 17within the ninety-day period after final adjournment of the general

• Page 18, Line 18assembly, then the act, item, section, or part will not take effect unless

• Page 18, Line 19approved by the people at the general election to be held in November

• Page 18, Line 202026 and, in such case, will take effect on the date of the official declaration of the vote thereon by the governor.

• Page 18, Line 21(2)  This act applies to workers' compensation claims filed on or after the applicable effective date of this act.