287.140. Employer to provide medical and other services, transportation, artificial devices, reactivation of claim--duties of health care providers--refusal of treatment, effect--medical evidence--div
Employer to provide medical and other services, transportation,artificial devices, reactivation of claim--duties of health careproviders--refusal of treatment, effect--medicalevidence--division, commission responsibilities--notice to healthcare provider of workers' compensation claim, contents,effect--use of employee leave time.
287.140. 1. In addition to all other compensation paid to theemployee under this section, the employee shall receive and the employershall provide such medical, surgical, chiropractic, and hospital treatment,including nursing, custodial, ambulance and medicines, as may reasonably berequired after the injury or disability, to cure and relieve from theeffects of the injury. If the employee desires, he shall have the right toselect his own physician, surgeon, or other such requirement at his ownexpense. Where the requirements are furnished by a public hospital orother institution, payment therefor shall be made to the properauthorities. Regardless of whether the health care provider is selected bythe employer or is selected by the employee at the employee's expense, thehealth care provider shall have the affirmative duty to communicate fullywith the employee regarding the nature of the employee's injury andrecommended treatment exclusive of any evaluation for a permanentdisability rating. Failure to perform such duty to communicate shallconstitute a disciplinary violation by the provider subject to theprovisions of chapter 620, RSMo. When an employee is required to submit tomedical examinations or necessary medical treatment at a place outside ofthe local or metropolitan area from the employee's principal place ofemployment, the employer or its insurer shall advance or reimburse theemployee for all necessary and reasonable expenses; except that an injuredemployee who resides outside the state of Missouri and who is employed byan employer located in Missouri shall have the option of selecting thelocation of services provided in this section either at a location withinone hundred miles of the injured employee's residence, place of injury orplace of hire by the employer. The choice of provider within the locationselected shall continue to be made by the employer. In case of a medicalexamination if a dispute arises as to what expenses shall be paid by theemployer, the matter shall be presented to the legal advisor, theadministrative law judge or the commission, who shall set the sum to bepaid and same shall be paid by the employer prior to the medicalexamination. In no event, however, shall the employer or its insurer berequired to pay transportation costs for a greater distance than twohundred fifty miles each way from place of treatment.
2. If it be shown to the division or the commission that therequirements are being furnished in such manner that there is reasonableground for believing that the life, health, or recovery of the employee isendangered thereby, the division or the commission may order a change inthe physician, surgeon, hospital or other requirement.
3. All fees and charges under this chapter shall be fair andreasonable, shall be subject to regulation by the division or thecommission, or the board of rehabilitation in rehabilitation cases. Ahealth care provider shall not charge a fee for treatment and care which isgoverned by the provisions of this chapter greater than the usual andcustomary fee the provider receives for the same treatment or service whenthe payor for such treatment or service is a private individual or aprivate health insurance carrier. The division or the commission, or theboard of rehabilitation in rehabilitation cases, shall also havejurisdiction to hear and determine all disputes as to such charges. Ahealth care provider is bound by the determination upon the reasonablenessof health care bills.
4. The division shall, by regulation, establish methods to resolvedisputes concerning the reasonableness of medical charges, services, oraids. This regulation shall govern resolution of disputes betweenemployers and medical providers over fees charged, whether or not paid, andshall be in lieu of any other administrative procedure under this chapter.The employee shall not be a party to a dispute over medical charges, norshall the employee's recovery in any way be jeopardized because of suchdispute.
5. No compensation shall be payable for the death or disability of anemployee, if and insofar as the death or disability may be caused,continued or aggravated by any unreasonable refusal to submit to anymedical or surgical treatment or operation, the risk of which is, in theopinion of the division or the commission, inconsiderable in view of theseriousness of the injury. If the employee dies as a result of anoperation made necessary by the injury, the death shall be deemed to becaused by the injury.
6. The testimony of any physician or chiropractic physician whotreated the employee shall be admissible in evidence in any proceedings forcompensation under this chapter, subject to all of the provisions ofsection 287.210.
7. Every hospital or other person furnishing the employee withmedical aid shall permit its record to be copied by and shall furnish fullinformation to the division or the commission, the employer, the employeeor his dependents and any other party to any proceedings for compensationunder this chapter, and certified copies of the records shall be admissiblein evidence in any such proceedings.
8. The employer may be required by the division or the commission tofurnish an injured employee with artificial legs, arms, hands, surgicalorthopedic joints, or eyes, or braces, as needed, for life whenever thedivision or the commission shall find that the injured employee may bepartially or wholly relieved of the effects of a permanent injury by theuse thereof. The director of the division shall establish a procedurewhereby a claim for compensation may be reactivated after settlement ofsuch claim is completed. The claim shall be reactivated only after theclaimant can show good cause for the reactivation of this claim and theclaim shall be made only for the payment of medical procedures involvinglife-threatening surgical procedures or if the claimant requires the use ofa new, or the modification, alteration or exchange of an existing,prosthetic device. For the purpose of this subsection, "life threatening"shall mean a situation or condition which, if not treated immediately, willlikely result in the death of the injured worker.
9. Nothing in this chapter shall prevent an employee being providedtreatment for his injuries by prayer or spiritual means if the employerdoes not object to the treatment.
10. The employer shall have the right to select the licensed treatingphysician, surgeon, chiropractic physician, or other health care provider;provided, however, that such physicians, surgeons or other health careproviders shall offer only those services authorized within the scope oftheir licenses. For the purpose of this subsection, subsection 2 ofsection 287.030 shall not apply.
11. Any physician or other health care provider who orders, directsor refers a patient for treatment, testing, therapy or rehabilitation atany institution or facility shall, at or prior to the time of the referral,disclose in writing if such health care provider, any of his partners orhis employer has a financial interest in the institution or facility towhich the patient is being referred, to the following:
(1) The patient;
(2) The employer of the patient with workers' compensation liabilityfor the injury or disease being treated;
(3) The workers' compensation insurer of such employer; and
(4) The workers' compensation adjusting company for such insurer.
12. Violation of subsection 11 of this section is a class Amisdemeanor.
13. (1) No hospital, physician or other health care provider, otherthan a hospital, physician or health care provider selected by the employeeat his own expense pursuant to subsection 1 of this section, shall bill orattempt to collect any fee or any portion of a fee for services rendered toan employee due to a work-related injury or report to any credit reportingagency any failure of the employee to make such payment, when an injurycovered by this chapter has occurred and such hospital, physician or healthcare provider has received actual notice given in writing by the employee,the employer or the employer's insurer. Actual notice shall be deemedreceived by the hospital, physician or health care provider five days aftermailing by certified mail by the employer or insurer to the hospital,physician or health care provider.
(2) The notice shall include:
(a) The name of the employer;
(b) The name of the insurer, if known;
(c) The name of the employee receiving the services;
(d) The general nature of the injury, if known; and
(e) Where a claim has been filed, the claim number, if known.
(3) When an injury is found to be noncompensable under this chapter,the hospital, physician or other health care provider shall be entitled topursue the employee for any unpaid portion of the fee or other charges forauthorized services provided to the employee. Any applicable statute oflimitations for an action for such fees or other charges shall be tolledfrom the time notice is given to the division by a hospital, physician orother health care provider pursuant to subdivision (6) of this subsection,until a determination of noncompensability in regard to the injury which isthe basis of such services is made, or in the event there is an appeal tothe labor and industrial relations commission, until a decision is renderedby that commission.
(4) If a hospital, physician or other health care provider or a debtcollector on behalf of such hospital, physician or other health careprovider pursues any action to collect from an employee after such noticeis properly given, the employee shall have a cause of action against thehospital, physician or other health care provider for actual damagessustained plus up to one thousand dollars in additional damages, costs andreasonable attorney's fees.
(5) If an employer or insurer fails to make payment for authorizedservices provided to the employee by a hospital, physician or other healthcare provider pursuant to this chapter, the hospital, physician or otherhealth care provider may proceed pursuant to subsection 4 of this sectionwith a dispute against the employer or insurer for any fees or othercharges for services provided.
(6) A hospital, physician or other health care provider whoseservices have been authorized in advance by the employer or insurer maygive notice to the division of any claim for fees or other charges forservices provided for a work-related injury that is covered by thischapter, with copies of the notice to the employee, employer and theemployer's insurer. Where such notice has been filed, the administrativelaw judge may order direct payment from the proceeds of any settlement oraward to the hospital, physician or other health care provider for suchfees as are determined by the division. The notice shall be on a formprescribed by the division.
14. The employer may allow or require an employee to use any of theemployee's accumulated paid leave, personal leave, or medical or sick leaveto attend to medical treatment, physical rehabilitation, or medicalevaluations during work time. The intent of this subsection is tospecifically supercede and abrogate any case law that contradicts theexpress language of this section.
(RSMo 1939 § 3701, A.L. 1951 p. 613, A.L. 1957 p. 560, A.L. 1959 S.B. 167, A.L. 1965 pp. 397, 413, A.L. 1977 S.B. 49, S.B. 399, A.L. 1980 H.B. 1396, A.L. 1983 H.B. 243 & 260, A.L. 1988 H.B. 1277, A.L. 1990 S.B. 751, A.L. 1992 H.B. 975, A.L. 1993 S.B. 251, A.L. 1998 H.B. 1237, et al., A.L. 2005 S.B. 1 & 130)Prior revision: 1929 § 3311
(1987) Employer is liable for medical expenses incurred by claimant even though claimant selected her own medical providers and employer was not notified of need for medical treatment until expenses had been incurred where claimant did not know she had suffered a compensable injury until after physician advised by letter that employment was suspected of causing medical condition. Sheehan v. Springfield Seed and Floral, 733 S.W.2d 795 (Mo.App.).