§ 22-3-3-5 — Medical treatment; liability of estate; right to order payment; medical service provider claims; attending physician fees

Indiana § 22-3-3-5

• Jurisdiction: Indiana
• Art. 3: WORKER'S COMPENSATION SYSTEM
• Ch. 3: Worker's Compensation: Notice of Injury; Treatment

Text

(a) The pecuniary liability of the employer for
a service or product herein required shall be limited to the following:
(1) This subdivision applies before July 1, 2014, to all medical
service providers, and after June 30, 2014, to a medical service
provider that is not a medical service facility. Such charges as
prevail as provided under IC 22-3-6-1(k)(1), in the same
community (as defined in IC 22-3-6-1(h)) for a like service or
product to injured persons.
(2) This subdivision applies after June 30, 2014, to a medical
service facility. The amount provided under IC 22-3-6-1(k)(2).
(b) The employee and the employee's estate do not have liability to
a health care provider for payment for services obtained under IC 22-3-3-4.
(c) The right to order payment for all services or products provided
under IC 22-3-2 through IC 22-3-6 is solely with the board.
(d) All claims by a medical service provider for payment for
services or products are against the employer and the employer's
insurance carrier, if any, and must be made with the board under IC 22-3-2 through IC 22-3-6. After June 30, 2011, a medical service
provider must file an application for adjustment of a claim for a
medical service provider's fee with the board not later than two (2)
years after the receipt of an initial written communication from the
employer, the employer's insurance carrier, if any, or an agent acting on
behalf of the employer after the medical service provider submits a bill
for services or products. To offset a part of the board's expenses related
to the administration of medical service provider reimbursement
disputes, a medical service facility shall pay a filing fee of sixty dollars
($60) in a balance billing case. The filing fee must accompany each
application filed with the board. If an employer, an employer's
insurance carrier, or an agent acting on behalf of the employer denies
or fails to pay any amount on a claim submitted by a medical service
facility, a filing fee is not required to accompany an application that is
filed for the denied or unpaid claim. A medical service provider may
combine up to ten (10) individual claims into one (1) application
whenever:
(1) all individual claims involve the same employer, insurance
carrier, or billing review service; and
(2) the amount of each individual claim does not exceed two
hundred dollars ($200).
(e) The worker's compensation board may withhold the approval of
the fees of the attending physician in a case until the attending
physician files a report with the worker's compensation board on the
form prescribed by the board.
Formerly: Acts 1929, c.172, s.26. As amended by P.L.170-1991,
SEC.4; P.L.216-1995, SEC.1; P.L.258-1997(ss), SEC.4; P.L.168-2011,
SEC.3; P.L.275-2013, SEC.4.