§ 65-05-07 — Injured employee given medical and hospital service required - Furnished artificial limbs and appliances for rehabilitation - Fee approval

artificial limbs and appliances for rehabilitation - Fee approval.
The fund shall furnish to an injured employee reasonable and appropriate medical, surgical,
and hospital service and supplies necessary to treat a compensable injury. The fund may furnish
artificial members and replacements the organization determines necessary to rehabilitate an
injured employee.
1. The allied health care professional must be acting within the scope of the allied health
care professional's license or fees will be denied.
2. Fees may not be approved for more than one allied health care professional in a case
in which treatment is provided over the same period of time except for the services of
a consulting doctor, assistant surgeon, or anesthetist or in an emergency.
3. The organization, in cooperation with professional organizations of allied health care
professionals, shall establish a system of peer review to determine reasonableness of
fees and payment denials for unjustified treatments, hospitalization, or visits. The allied
health care professional may appeal adverse decisions of the organization in
accordance with the medical aid rules adopted by the organization.
4. An allied health care professional may not bill an injured employee for a service
rendered as a result of the compensable work injury.
5. Under this section, the organization may modify real estate and may provide for
adaptations and modifications to motor vehicles as follows:
a. Except as provided in subdivision c, in the case of an injured employee who
sustained a catastrophic injury, as defined in chapter 65-05.1, the organization
may pay an amount not to exceed one hundred fifty thousand dollars to provide
permanent additions, remodeling, or adaptations to real estate it determines
necessary. The dollar limit is for the life of the injured employee, regardless of any
subsequent claim. This subdivision does not allow the organization to purchase
any real estate.
b. Except as provided in subdivision c, in the case of an injured employee who
sustained a catastrophic injury, as defined in chapter 65-05.1, the organization
may pay an amount not to exceed two hundred thousand dollars to provide the
most cost-effective, specially equipped motor vehicle or vehicle adaptations the
organization determines medically necessary. The organization may establish
factors to be used in determining whether a specially equipped motor vehicle or
adaptation is necessary. Under this subdivision, the organization may not pay for
insurance of or maintenance of the motor vehicle. Within the dollar limit and
under this subdivision, the organization may pay for vehicle or adaptation
replacement purchases. The dollar limit is for the life of the injured employee,
regardless of any subsequent claim.
c. In the case of an injured employee who has not sustained a catastrophic injury,
as defined in chapter 65-05.1, the organization may provide the benefits under
subdivisions a and b if the organization determines the benefits would be cost-
effective and appropriate because of exceptional circumstances as determined by
the organization.
6. If an allied health care professional who has treated or provided services to an injured
employee fails or refuses without just cause to file with the organization a report
required by section 65-05-02, 65-05-08, or 65-05-08.1, within thirty days of
examination, treatment, or provision of other services rendered in connection with a
compensable work injury, or within thirty days of a request for the report made by the
claimant, the claimant's representative, or the organization, the organization shall
assess as a penalty a sum of one hundred dollars. Health care providers and allied
health care professionals may not bill an injured worker for a penalty assessed by the
organization under this subsection.
7. The filing of an accident report or the rendering of treatment to an injured worker who
comes under the organization's jurisdiction constitutes acceptance of the
organization's medical aid rules and compliance with the organization's rules and fees.
8. The organization may not pay for:

a. Personal items for the injured employee's personal use or hygiene, including
toothbrushes, slippers, shampoo, and soap.
b. A product or item including clothing or footwear unless the items are considered
orthopedic devices and are prescribed by the treating allied health care
professional.
c. Furniture except hospital beds, shower stools, wheelchairs, or whirlpools if
prescribed by the treating allied health care professional.
d. Vitamins and food supplements except in those cases in which the injury causes
severe dietary problems, the injury results in the employee's paraplegia or
quadriplegia, or the employee becomes wheelchair-bound due to the injury.
e. Eye examinations unless there is a reasonable potential for injury to the
employee's eyes as a result of the injury.
f. Private hospital or nursing home rooms except in cases of extreme medical
necessity and only when directed by the attending doctor. If the employee desires
better accommodations than those ordered by the attending doctor, the employee
will pay the difference in cost.
g. Serological tests, including VDRL and RPR, or other tests for venereal disease or
pregnancy, or any other routine tests unless clearly necessitated by the injury.
h. Aids or programs primarily intended to help the employee lose weight or stop
smoking unless ordered by the organization.
i. Home gymnasium or exercise equipment unless ordered by the organization.
j. Memberships or monthly dues to health clubs, unless ordered by the
organization.
k. Massage, unless ordered by the organization.
l. Medical marijuana.