§ 65-05-28.2 — Preferred provider - Use required - Exceptions - Notice

North Dakota § 65-05-28.2

• Jurisdiction: North Dakota
• Title 65: Workforce Safety and Insurance
• Ch. 65-05: Claims and Compensation

Text

1. During the first thirty days after a work injury, an employee of an employer that has
selected a preferred provider under this section may seek medical treatment only from

the preferred provider for the injury. Treatment by a provider other than the preferred
provider is not compensable and the organization may not pay for treatment by a
provider who is not a preferred provider, unless a referral was made by the preferred
provider. A provider who is not a preferred provider may not certify disability or render
an opinion about any matter pertaining to the injury, including causation,
compensability, impairment, or disability. This section does not apply to emergency
care nor to any care the employee reasonably did not know was related to a work
injury.
2. An employee of an employer that has selected a preferred provider may elect to be
treated by a different provider provided the employee makes the election and notifies
the employer in writing before the occurrence of an injury.
3. After thirty days have passed following the injury, the employee may make a written
request to the organization to change providers. The employee shall make the request
and serve it on the employer and the organization at least thirty days before treatment
by the provider. The employee shall state the reasons for the request and the
employee's choice of provider.
4. If the employer objects to the provider selected by the employee under subsection 2 or
3, the employer may file an objection to the change of provider. The employer shall
detail in the objection the grounds for the objection and shall serve the objection on the
employee and the organization within five days of service of the request. The
employee may serve, within five days of service of the employer's objection, a written
response on the employer and the organization in support of the request for change of
provider. Within fifteen days after receipt of the response or of the expiration of the
time for filing the response, the organization shall rule on the request. Failure of the
organization to rule constitutes approval of the request. Treatment by the employee's
chosen provider is not compensable until the organization approves the request. The
preferred provider remains the treating provider until the organization approves the
employee's request to change providers.
5. An employer that selects a preferred provider shall give notice and post notice as
required under this subsection.
a. An employer shall give written notice of the identity and the terms of the preferred
provider program:
(1) To the employer's employees when the employer makes an initial selection
of a preferred provider.
(2) To the employer's employees when the employer changes the selection of
the preferred provider.
(3) To an employee at the time of hire.
(4) To the employer's employees at least annually after the initial notice.
b. An employer that has selected a preferred provider shall display notice of the
identity of the preferred provider and the terms of the preferred provider program
in a conspicuous manner at fixed worksites, and wherever feasible at mobile
worksites, and in a sufficient number of places to reasonably inform employees of
the identity of the preferred provider and of the terms of the preferred provider
program.
c. Failure to give written notice, to properly post notice, or to reasonably inform
employees of the terms of the preferred provider program as required under this
subsection invalidates the selection for the employee's claim.