This bill amends existing workers' compensation laws to improve the payment and dispute resolution processes for medical claims. Key changes include extending the timeframe for insurance carriers, self-insurers, or payors to pay uncontested claims and introducing an optional mediation process for contested claims. The standard for resolving disputes is modified from a "reasonable effort" to a "good faith effort," requiring both parties to sincerely attempt resolution before escalating issues to the commissioner. The bill also grants the commissioner exclusive jurisdiction to determine the reasonable value of medical services in disputes and mandates the Department of Labor to establish rules for the mediation process.

Additionally, the bill increases civil penalties for non-compliance, raising the maximum penalty for insurance carriers and self-insurers from $2,500 to $5,000 for improper handling of medical records related to workers' compensation claims. It imposes the same increased penalty on healthcare providers who bill injured employees or their employers for services that should be covered under the workers' compensation system. Other amendments include requiring healthcare facilities to report to employers or insurance companies within 10 days of the first treatment, changing the payment timeline for employers or insurers to 45 days, and mandating that any medical report received must be filed with the commissioner within 15 days, with penalties for non-compliance. The act is set to take effect 60 days after its passage.

Statutes affected:
Introduced: 281-A:24, 281-A:23
HB1352 text: 281-A:24, 281-A:23