House Bill 25-1300 Revised

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.

• 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)  It is an injured worker's duty to establish a workers'

• Page 3, Line 7compensation claim and entitlement to benefits following an industrial

• Page 3, Line 8injury, and to successfully do so, an injured worker must research and

• Page 3, Line 9follow a complicated set of rules established by our legal system. This

• Page 3, Line 10duty can be overwhelming, especially while also dealing with the pain

• Page 3, Line 11and suffering of a physical injury. This act is not intended to interfere

• Page 3, Line 12with a healthy working relationship between an employer and employee

• Page 3, Line 13and should not be interpreted to disallow or discourage an employer from assisting an injured worker that needs help in navigating a claim.

• Page 3, Line 14(III)  Even after an employer and insurer direct a worker to seek

• Page 3, Line 15treatment with a specific physician or physicians, they can deny the

• Page 3, Line 16medical care that a physician recommends as unreasonable or

• Page 3, Line 17unnecessary. When such a dispute arises, it is the worker who bears the burden of proof in court.

• Page 3, Line 18(IV)  While employers and insurers are directed to follow the

• Page 3, Line 19state's utilization standards in making determinations regarding the

• Page 3, Line 20authorization or denial of medical care, they often fail to do so. When

• Page 3, Line 21they do fail, there is no expeditious recourse for workers. The division of

• Page 3, Line 22workers' compensation in the department of labor and employment does

• Page 3, Line 23not have clear authority to rule on issues surrounding an employer or their insurer's violation of the utilization standards.

• Page 4, Line 1 (V)  Many Colorado employers use third-party administrators

• Page 4, Line 2and insurance providers to handle their workers' compensation claims.

• Page 4, Line 3The third-party administrators are often located outside the state and are

• Page 4, Line 4a step removed from an injured worker. As a result of the separation,

• Page 4, Line 5third-party administrators delay and deny care with more frequency than

• Page 4, Line 6workers' compensation insurers. The workers' compensation system

• Page 4, Line 7should take action to ensure that third-party administrators are being held to the same standard as insurers.

• Page 4, Line 8(VI)  Workers whose injuries are severe enough to lead to wage

• Page 4, Line 9loss or permanent impairment, or both, are limited in recovering their

• Page 4, Line 10economic losses by arbitrary benefit caps. Those caps most significantly and wrongfully impact workers whose injuries are severe.

• Page 4, Line 11(VII)  Benefits payable to injured workers for permanent

• Page 4, Line 12impairment are paid unequally. While some permanent disabilities are

• Page 4, Line 13paid through a holistic lens based on the permanency of the workers'

• Page 4, Line 14symptoms, lost income, and an inability to work or complete activities of

• Page 4, Line 15daily living, others are paid according to an arbitrary schedule of benefits.

• Page 4, Line 16The schedule of benefits almost always results in less compensation for injured workers, even in instances of severe disability.

• Page 4, Line 17(VIII)  Injured workers who are entitled to permanent impairment

• Page 4, Line 18benefits must wait months or even years to fully collect their award. By

• Page 4, Line 19default, employers and their insurers are allowed to pay those benefits

• Page 4, Line 20over 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 21(IX)  Workers who are the most severely injured and therefore

• Page 4, Line 22unable to return to similar or "suitable" employment following an

• Page 5, Line 1industrial injury are not owed any additional monetary benefit under the

• Page 5, Line 2current scheme. Since the 1991 changes to the workers' act, to obtain

• Page 5, Line 3permanent total disability in Colorado, a worker must be "unable to earn

• Page 5, Line 4any wage". This standard has rendered permanent total disability benefits nearly obsolete.

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

• Page 5, Line 6insured of their employer's workers' compensation insurer, meaning that

• Page 5, Line 7the insurer is prohibited from the unreasonable delay or denial of benefits,

• Page 5, Line 8workers do not have access to the normal statutory remedies available for

• Page 5, Line 9the unfair claims handling practices of a workers' compensation insurer.

• Page 5, Line 10This emboldens Colorado workers' compensation insurers to engage in

• Page 5, Line 11deceptive, unfair, unreasonable, and frivolous practices in the handling of claims.

• Page 5, Line 12(XI)  All workers deserve the best care when injured. The state of

• Page 5, Line 13Colorado, as an employer, should make every effort to obtain workers'

• Page 5, Line 14compensation coverage with the worker experience in mind. Pinnacol is

• Page 5, Line 15the top-rated workers' compensation insurer by workers and is already a

• Page 5, Line 16quasi-state agency. The state should contract with Pinnacol for coverage,

• Page 5, Line 17rather than other third parties, many of which are out-of-state entities

• Page 5, Line 18without a connection to Colorado and are not subject to the same transparency and financial disclosure requirements as Pinnacol.

• Page 5, Line 19(d)  In contrast to the hardships faced by injured workers since

• Page 5, Line 201991, Colorado's workers' compensation insurers are enjoying

• Page 5, Line 21unprecedented economic success, posting profit margins higher than any other type of insurance in Colorado.

• Page 5, Line 22(2)  The general assembly declares that:

• Page 5, Line 23(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 6, Line 1(b)  With this act, the state of Colorado hopes to alleviate a portion

• Page 6, Line 2of the inequities set forth in this section but acknowledges that additional change must be made in the coming years.

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

• Page 6, Line 48-42-101.  Employer must furnish medical aid - approval of

• Page 6, Line 5plan - fee schedule - contracting for treatment - no recovery from

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

• Page 6, Line 7and other medical providers - mental health provider qualifications

• Page 6, Line 8- mileage reimbursement - rules - definitions - repeal.

• Page 6, Line 9(3) (a) (I) (A)  The director shall establish a schedule fixing the fees for

• Page 6, Line 10which all surgical, hospital, dental, nursing, vocational rehabilitation, and

• Page 6, Line 11medical services, whether related to treatment or not, pertaining to injured

• Page 6, Line 12employees under this section shall be compensated. It is unlawful, void,

• Page 6, Line 13and unenforceable as a debt for any a physician, chiropractor, hospital,

• Page 6, Line 14person, expert witness, reviewer, evaluator, or institution to contract with,

• Page 6, Line 15bill, or charge any party for services, rendered in connection with injuries

• Page 6, Line 16coming within the purview of this article article 42 or an applicable fee

• Page 6, Line 17schedule, which that are or may be in excess of said the fee schedule

• Page 6, Line 18unless such charges are approved by the director. Fee schedules shall be

• Page 6, Line 19reviewed on or before July 1 of each year by the director, and appropriate

• Page 6, Line 20health-care practitioners shall be given a reasonable opportunity to be

• Page 6, Line 21heard as required pursuant to section 24-4-103 C.R.S., prior to fixing the

• Page 6, Line 22fees; impairment rating guidelines, which shall be based on the revised

• Page 6, Line 23third edition of the "American Medical Association Guides to the

• Page 6, Line 24Evaluation of Permanent Impairment", in effect as of July 1, 1991; and

• Page 7, Line 1medical treatment guidelines and utilization standards. Fee schedules

• Page 7, Line 2established pursuant to this subparagraph (I) subsection (3)(a)(I) shall

• Page 7, Line 3take effect on January 1. The director shall promulgate adopt rules

• Page 7, Line 4concerning reporting requirements, penalties for failure to report correctly

• Page 7, Line 5or in a timely manner, utilization control requirements for services

• Page 7, Line 6provided under this section, and the accreditation process described in

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

• Page 7, Line 8all surgical, hospital, dental, nursing, vocational rehabilitation, and

• Page 7, Line 9medical services and to expert witness, expert reviewer, or expert

• Page 7, Line 10evaluator 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 11(B)  An employer or the employer's insurer shall use the

• Page 7, Line 12division's utilization standards when responding to a request

• Page 7, Line 13for authorization from a treating physician. If an employer or

• Page 7, Line 14the employer's insurer fails to act in accordance with the

• Page 7, Line 15division's utilization standards when reviewing a request for

• Page 7, Line 16authorization, the director may deem the services provided by

• Page 7, Line 17an authorized treating physician as authorized, reasonable, and

• Page 7, Line 18necessary and require payment for the services by the employer or the employer's insurer.

• Page 7, Line 19(c)  The department shall update the general assembly on

• Page 7, Line 20the changes made to the utilization standards for physician

• Page 7, Line 21authorization requests as part of the department's presentation

• Page 7, Line 22to the legislative committees of reference at the committees'

• Page 7, Line 23hearings held pursuant to the "State Measurement for

• Page 7, Line 24Accountable, Responsive, and Transparent (SMART)

• Page 7, Line 25Government Act" pursuant to part 2 of article 7 of title 2.

• Page 8, Line 1(5)  If any party files an application for hearing on whether the a

• Page 8, Line 2claimant is entitled to medical maintenance benefits recommended by an

• Page 8, Line 3authorized treating physician that are unpaid and contested, and any

• Page 8, Line 4requested medical maintenance benefit is admitted fewer than twenty

• Page 8, Line 5days before the hearing or ordered after application for hearing is filed,

• Page 8, Line 6the court shall award the claimant all reasonable costs incurred in pursuing the medical benefit. Such costs do not include attorney fees.

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

• Page 8, Line 98-43-404.  Examination - refusal - personal responsibility -

• Page 8, Line 10physicians to testify and furnish results - injured worker right to

• Page 8, Line 11select treating physician - injured worker right to third-party

• Page 8, Line 12communications - rules. (5) (a) (I) (A)  In all cases of injury, the

• Page 8, Line 13employer or insurer shall provide a list of at least four physicians or four

• Page 8, Line 14corporate medical providers or at least two physicians and two corporate

• Page 8, Line 15medical providers or a combination thereof where available, in the first

• Page 8, Line 16instance, from which list an injured employee may select the physician

• Page 8, Line 17who attends the injured employee. At least one of the four designated

• Page 8, Line 18physicians or corporate medical providers offered must be at a distinct

• Page 8, Line 19location from the other three designated physicians or corporate medical

• Page 8, Line 20providers without common ownership. If there are not at least two

• Page 8, Line 21physicians or corporate medical providers at distinct locations without

• Page 8, Line 22common ownership within thirty miles of the employer's place of

• Page 8, Line 23business, then an employer may designate physicians or corporate medical

• Page 8, Line 24providers at the same location or with shared ownership interests. Upon

• Page 8, Line 25request by an interested party to the workers' compensation claim, a

• Page 9, Line 1designated provider on the employer's list shall provide a list of

• Page 9, Line 2ownership interests and employment relationships, if any, to the

• Page 9, Line 3requesting party within five days of the receipt of the request. If the

• Page 9, Line 4services of a physician are not tendered at the time of injury, the

• Page 9, Line 5employee shall have the right to select a physician or chiropractor. For

• Page 9, Line 6purposes of this section, "corporate medical provider" means a medical

• Page 9, Line 7organization in business as a sole proprietorship, professional

• Page 9, Line 8corporation, or partnership Immediately upon receipt of notice of an

• Page 9, Line 9on-the-job injury from an employee who is a resident of

• Page 9, Line 10Colorado, but not more than seven calendar days after receipt

• Page 9, Line 11of notice of the on-the-job injury, an employer or insurer shall,

• Page 9, Line 12in written verified form, notify the injured employee of the

• Page 9, Line 13injured employee's right to designate a treating physician and

• Page 9, Line 14notify the injured employee where to access the division's list of

• Page 9, Line 15level I and level II accredited physicians. The director shall

• Page 9, Line 16create a form to implement the procedure to designate a

• Page 9, Line 17physician. The employee may designate only a level I or level II

• Page 9, Line 18accredited physician licensed under the "Colorado Medical

• Page 9, Line 19Practice Act", article 240 of title 12, as the employee's

• Page 9, Line 20authorized treating physician. The authorized treating

• Page 9, Line 21physician designated by the employee must be within seventy

• Page 9, Line 22miles of the employee's work or home address, unless there are

• Page 9, Line 23three or fewer level I or level II accredited physicians within

• Page 9, Line 24seventy miles of the employee's work or home address who are

• Page 9, Line 25willing to treat the injured employee. If there are three or

• Page 9, Line 26fewer level I or level II accredited physicians within seventy

• Page 9, Line 27miles of the employee's work or home address who are willing to

• Page 10, Line 1treat the injured employee, then the authorized treating

• Page 10, Line 2physician designated by the employee must be within one hundred

• Page 10, Line 3miles of the employee's work or homeaddress; except that an

• Page 10, Line 4injured employee may, upon good cause shown, designate an

• Page 10, Line 5authorized treating physician who is not within one hundred

• Page 10, Line 6miles of the employee's work or home address. Good cause is

• Page 10, Line 7presumed to exist if there are three or fewer level I or level II

• Page 10, Line 8accredited physicians within one hundred miles of the employee's

• Page 10, Line 9work or home address who are willing to treat the injured

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

• Page 10, Line 11an injured worker unless the physician indicates the contrary

• Page 10, Line 12to a party. The employee must designate the treating physician

• Page 10, Line 13in writing on the form prescribed by the director. The employee

• Page 10, Line 14may make one treating physician designation on the form

• Page 10, Line 15prescribed by the director any time after the on-the-job injury

• Page 10, Line 16but before being placed at maximum medical improvement. If the

• Page 10, Line 17employee declines to designate a physician within seven

• Page 10, Line 18calendar days after receipt of notice of the right to designate

• Page 10, Line 19in written verified form, an employer or insurer may designate

• Page 10, Line 20only a level I or level II accredited physician licensed under the

• Page 10, Line 21"Colorado Medical Practice Act", article 240 of title 12, as the

• Page 10, Line 22employee's authorized treating physician. The employee may

• Page 10, Line 23subsequently designate a physician consistent with this

• Page 10, Line 24subsection (5)(a)(I)(A). The physician designated by the employer

• Page 10, Line 25or insurer and the physician designated by the employee shall

• Page 10, Line 26comply with subsection (5)(a)(IV)(A) of this section.For an

• Page 10, Line 27injured employee who is not a resident of Colorado, as soon as

• Page 11, Line 1possible, but no later than tencalendardays after the receipt

• Page 11, Line 2of a notice of an on-the-job injury, an employer or insurer shall

• Page 11, Line 3designate a treating physician and notify the employee of the

• Page 11, Line 4designation in writing. The treating physician must be within one

• Page 11, Line 5hundred miles of the employee's home address. If the employer or

• Page 11, Line 6insurer declines to designate a physician within the

• Page 11, Line 7ten-calendar-daytime period, the employee may designate a

• Page 11, Line 8treating physician within one hundred miles of the employee's

• Page 11, Line 9home address in writing to the employer or through attendance at an appointment with the employee's designated physician.

• Page 11, Line 10(B)  If there are fewer than four physicians or corporate medical

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

• Page 11, Line 12willing to treat an injured employee, the employer or insurer may instead

• Page 11, Line 13designate one physician or one corporate medical provider, and

• Page 11, Line 14subparagraphs (III) and (IV) of this paragraph (a) shall not apply. A

• Page 11, Line 15physician is presumed willing to treat injured workers unless he or she

• Page 11, Line 16indicates to the employer or insurer to the contrary In an emergency

• Page 11, Line 17situation, an injured employee shall be taken to any physician or

• Page 11, Line 18health-care facility that is able to provide the necessary care.

• Page 11, Line 19When emergency care is no longer required, subsection

• Page 11, Line 20(5)(a)(I)(A) of this section applies. Immediately upon receipt of

• Page 11, Line 21notice that emergency care is no longer required, but not more

• Page 11, Line 22than seven calendar days after receipt of notice that

• Page 11, Line 23emergency care is no longer required, an employer or insurer

• Page 11, Line 24shall, in written verified form, notify the injured employee of

• Page 11, Line 25the injured employee's right to designate a treating physician

• Page 11, Line 26and notify the injured employee where to access the division's list of level I and level II accredited physicians.

• Page 12, Line 1(C)  If there are more than three physicians or corporate medical

• Page 12, Line 2providers, but fewer than nine physicians or corporate medical providers

• Page 12, Line 3within thirty miles of the employer's place of business who are willing to

• Page 12, Line 4treat an injured employee, the employer or insurer may instead designate

• Page 12, Line 5two physicians or two corporate medical providers or any combination

• Page 12, Line 6thereof. The two designated providers shall be at two distinct locations

• Page 12, Line 7without common ownership. If there are not two providers at two distinct

• Page 12, Line 8locations without common ownership within thirty miles of the

• Page 12, Line 9employer's place of business, then an employer may designate two

• Page 12, Line 10providers at the same location or with shared ownership interests. Upon

• Page 12, Line 11request by an interested party to the workers' compensation claim, a

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

• Page 12, Line 13ownership interests and employment relationships, if any, to the requesting party within five days of the receipt of the request.

• Page 12, Line 14(D)  Except as otherwise provided by sub-subparagraph (E) of this

• Page 12, Line 15subparagraph (I), any party may request an expedited hearing on the issue

• Page 12, Line 16of whether the employer or insurer provided a list in compliance with this

• Page 12, Line 17subsection (5) if the application for expedited hearing is filed within

• Page 12, Line 18forty-five days after the claimant provides notice of the injury to the employer.

• Page 12, Line 19(E)  If the insurer or self-insured employer admits liability for the

• Page 12, Line 20claim, any party may request an expedited hearing on the issue of whether

• Page 12, Line 21the employer or insurer provided a list in compliance with this subsection

• Page 12, Line 22(5) if the application for expedited hearing is filed within forty-five days

• Page 12, Line 23after the initial admission of liability for the claim. The director shall set

• Page 12, Line 24any expedited matter for hearing within sixty days after the date of the

• Page 13, Line 1application. The time schedule for an expedited hearing is subject to the

• Page 13, Line 2extensions set forth in section 8-43-209. If the party elects not to request

• Page 13, Line 3an expedited hearing under this subsection (5), the time schedule for hearing the matter is as set forth in section 8-43-209.

• Page 13, Line 4(II) (A)  If the employer is a health-care provider or a

• Page 13, Line 5governmental entity that currently has its own occupational health-care

• Page 13, Line 6provider system, the employer may designate health-care providers from

• Page 13, Line 7within its own system and is not required to provide an alternative physician or corporate medical provider from outside its own system.

• Page 13, Line 8(B)  If the employer has its own on-site health-care facility, the

• Page 13, Line 9employer may designate such on-site health-care facility as the authorized

• Page 13, Line 10treating physician, but the employer shall comply with subparagraph (III)

• Page 13, Line 11of this paragraph (a). For purposes of this sub-subparagraph (B), "on-site

• Page 13, Line 12health-care facility" means an entity that meets all applicable state requirements to provide health-care services on the employer's premises.

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

• Page 13, Line 14designated authorized treating physician under this section by providing notice that meets the following requirements:

• Page 13, Line 15(A)  The notice is provided within ninety one hundred twenty

• Page 13, Line 16days after the date of the injury first physician designation, but

• Page 13, Line 17before the injured worker employee reaches maximum medical improvement;

• Page 13, Line 18(B)  The notice is in writing and submitted on a form designated

• Page 13, Line 19by the director. The notice provided in this subparagraph (III) shall

• Page 13, Line 20subsection (5)(a)(II) must also simultaneously serve as a request and

• Page 13, Line 21authorization to the initially authorized treating physician to release all

• Page 13, Line 22relevant medical records to the newly authorized treating physician.

• Page 14, Line 1(C)  The notice is directed to the insurance carrier insurer or to

• Page 14, Line 2the employer's authorized representative, if self-insured, and to the

• Page 14, Line 3initially authorized treating physician and is deposited in the United States

• Page 14, Line 4mail or hand-delivered to the employer, who shall notify the insurance

• Page 14, Line 5carrier insurer, if necessary, and the initially authorized treating physician;

• Page 14, Line 6(D)  The new physician is on the employer's designated list or

• Page 14, Line 7provides medical services for a designated corporate medical provider on

• Page 14, Line 8the list a level I or level II accredited physician licensed under

• Page 14, Line 9the "Colorado Medical Practice Act", article 240 of title 12; and

• Page 14, Line 10(E)  The transfer of medical care does not pose a threat to the health or safety of the injured employee.

• Page 14, Line 11(F)  (III)  An insurance carrier insurer, or an employer's

• Page 14, Line 12authorized representative if the employer is self-insured, shall track how

• Page 14, Line 13often injured employees change their authorized treating physician

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

• Page 14, Line 15(IV) (A)  When an injured employee changes his or her their

• Page 14, Line 16designated authorized treating physician, the newly authorized treating

• Page 14, Line 17physician shall make a reasonable effort to avoid any unnecessary duplication of medical services.

• Page 14, Line 18(B)  The originally authorized treating physician shall send all

• Page 14, Line 19medical records in his or her their possession pertaining to the injured

• Page 14, Line 20employee to the newly authorized treating physician within seven

• Page 14, Line 21calendar days after receiving a request for medical records from the newly

• Page 14, Line 22authorized treating physician.

• Page 15, Line 1(C)  The originally authorized treating physician shall continue as

• Page 15, Line 2the authorized treating physician for the injured employee until the

• Page 15, Line 3injured employee's initial visit with the newly authorized treating

• Page 15, Line 4physician, at which time the treatment relationship with the initially authorized treating physician shall terminate terminates.

• Page 15, Line 5(D)  The opinion of the originally authorized treating physician

• Page 15, Line 6regarding work restrictions and return to work shall control controls

• Page 15, Line 7unless and until such opinion is expressly modified by the newly authorized treating physician.

• Page 15, Line 8(E)  The newly authorized treating physician shall be presumed to

• Page 15, Line 9have consented to treat the injured employee unless the newly authorized

• Page 15, Line 10treating physician expressly refuses in writing within five days after the

• Page 15, Line 11date of the notice to change authorized treating physicians. If the newly

• Page 15, Line 12authorized treating physician refuses to treat the injured employee, the

• Page 15, Line 13employee may return to the employer to request an alternative authorized

• Page 15, Line 14treating physician If the employer does not provide an alternative

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

• Page 15, Line 16request, rules established by the division shall control who is a level I

• Page 15, Line 17or level II accredited physician licensed under the "Colorado Medical Practice Act", article 240 of title 12.

• Page 15, Line 18(V)  If the an authorized treating physician moves from one

• Page 15, Line 19facility to another, or from one corporate medical provider to another, an

• Page 15, Line 20injured employee may continue care with the authorized treating

• Page 15, Line 21physician, and the original facility or corporate medical provider shall

• Page 15, Line 22provide the injured employee's medical records to the authorized treating

• Page 15, Line 23physician within seven days after receipt of a request for medical records

• Page 15, Line 24from the authorized treating physician.

• Page 16, Line 1(VI) (A)  In addition to the one-time change of physician allowed

• Page 16, Line 2in subparagraph (III) of this paragraph (a) subsection (5)(a)(II) of this

• Page 16, Line 3section, upon written request to the insurance carrier insurer or to the

• Page 16, Line 4employer's authorized representative if the employer is self-insured, an

• Page 16, Line 5injured employee may procure written permission to have a personal

• Page 16, Line 6physician or chiropractor treat the employee. The employee must

• Page 16, Line 7complete the written request must be completed on a form that is

• Page 16, Line 8prescribed by the director. If permission is neither granted nor refused

• Page 16, Line 9the employer or insurer neither grants nor refuses the

• Page 16, Line 10permission request within twenty days after the date of the certificate

• Page 16, Line 11of service of the request form, the employer or insurance carrier shall be

• Page 16, Line 12insurer is deemed to have waived any objection to the employee's

• Page 16, Line 13request. If the employer or insurer objects to the request, the

• Page 16, Line 14employer or insurer shall make the objection shall be in writing on

• Page 16, Line 15a form prescribed by the director and shall be served serve the written

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

• Page 16, Line 17representative within twenty days after the date of the certificate of

• Page 16, Line 18service of the request form. An insurance carrier insurer, or an

• Page 16, Line 19employer's authorized representative if the employer is self-insured,

• Page 16, Line 20shall track how often an injured employee requests to change his or her

• Page 16, Line 21the employee's physician and how often such change is granted or

• Page 16, Line 22denied and shall report such information to the division upon request.

• Page 16, Line 23Upon the proper showing to the division, the employee may procure the

• Page 16, Line 24division's permission at any time to have a physician of the employee's

• Page 16, Line 25selection treat the employee, and in any nonsurgical case the employee,

• Page 16, Line 26with such permission, in lieu of medical aid, may procure any nonmedical

• Page 16, Line 27treatment recognized by the laws of this state as legal. The practitioner

• Page 17, Line 1administering the treatment shall receive fees under the medical

• Page 17, Line 2provisions of articles 40 to 47 of this title title 8 as specified by the division.

• Page 17, Line 3(B)  If an injured employee is permitted to change physicians

• Page 17, Line 4under sub-subparagraph (A) of this subparagraph (VI) subsection

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

• Page 17, Line 6physician who will provide primary care for the injury, then the

• Page 17, Line 7previously authorized treating physician providing primary care shall

• Page 17, Line 8continue as the authorized treating physician providing primary care for

• Page 17, Line 9the injured employee until the injured employee's initial visit with the

• Page 17, Line 10newly authorized treating physician, at which time the treatment

• Page 17, Line 11relationship with the previously authorized treating physician providing primary care is terminated.

• Page 17, Line 12(C)  Nothing in this subparagraph (VI) subsection (5)(a)(VI)

• Page 17, Line 13precludes any former authorized treating physician from performing an examination under subsection (1) of this section.

• Page 17, Line 14(D)  If an injured employee is permitted to change physicians

• Page 17, Line 15pursuant to sub-subparagraph (A) of this subparagraph (VI) subsection

• Page 17, Line 16(5)(a)(VI)(A) of this section resulting in a new authorized treating

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

• Page 17, Line 18of the previously authorized treating physician providing primary care

• Page 17, Line 19regarding work restrictions and return to work controls unless that opinion is expressly modified by the newly authorized treating physician.

• Page 17, Line 20(VII)  An attorney representing an injured employee shall

• Page 17, Line 21not refer the injured employee to an authorized treating

• Page 17, Line 22physician or physician practice in which the attorney has an

• Page 17, Line 23ownership interest or other financial interest.

• Page 18, Line 1(10) (b)  If the an insurer or self-insured employer receives written

• Page 18, Line 2notice pursuant to paragraph (a) of this subsection (10) subsection

• Page 18, Line 3(10)(a) of this section, or if the insurer or self-insured employer and the

• Page 18, Line 4authorized treating physician receive written notice by certified mail,

• Page 18, Line 5return receipt requested, from the an injured employee or the injured

• Page 18, Line 6employee's legal representative that an authorized physician refused to

• Page 18, Line 7provide medical treatment to the injured employee or discharged the

• Page 18, Line 8injured employee from medical care for nonmedical reasons when such

• Page 18, Line 9the injured employee requires medical treatment to cure or relieve the

• Page 18, Line 10effects of the work injury, and there is no other authorized physician

• Page 18, Line 11willing to provide medical treatment, then the insurer or self-insured

• Page 18, Line 12employer shall, within fifteen calendar days from after receiving the

• Page 18, Line 13written notice, designate a new authorized physician willing to provide

• Page 18, Line 14medical treatment. If the insurer or self-insured employer fails to

• Page 18, Line 15designate a new physician pursuant to this paragraph (b), then the injured

• Page 18, Line 16employee may select the physician who attends to the injured employee

• Page 18, Line 17advise the injured employee in writing that the injured employee

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

• Page 18, Line 19licensed under the "Colorado Medical Practice Act", article 240

• Page 18, Line 20of title 12, as the employee's new authorized treating physician.

• Page 18, Line 21The employee must designate the new treating physician in writing on the form prescribed by the director.

• Page 18, Line 22SECTION 4.  Act subject to petition - effective date -

• Page 18, Line 23applicability. (1)  This act takes effect January 1, 2026; except that, if a

• Page 18, Line 24referendum petition is filed pursuant to section 1 (3) of article V of the

• Page 18, Line 25state constitution against this act or an item, section, or part of this act

• Page 18, Line 26within the ninety-day period after final adjournment of the general

• Page 19, Line 1assembly, then the act, item, section, or part will not take effect unless

• Page 19, Line 2approved by the people at the general election to be held in November

• Page 19, Line 32026 and, in such case, will take effect on the date of the official declaration of the vote thereon by the governor.

• Page 19, Line 4(2)  This act applies to workers' compensation claims filed on or after the applicable effective date of this act.