§ 34A-1-309 — Add-on fees.

(1) As used in this section:

(1)(a) "Carrier" means:
(1)(a)(i) a workers' compensation insurance carrier;
(1)(a)(ii) the Uninsured Employers' Fund, an employer that does not carry workers' compensation insurance; or
(1)(a)(iii) a self-insured employer as defined in Section 34A-2-201.5.
(1)(b) "Indemnity compensation" means a workers' compensation claim for indemnity benefits that arises from or may arise from a denial of a medical claim.
(1)(c) "Medical claim" means a workers' compensation claim for medical expenses or recommended medical care.
(1)(d) "Unconditional denial" means a carrier's denial of a medical claim:
(1)(d)(i) after the carrier completes an investigation; or
(1)(d)(ii) 90 days after the day on which the claim was submitted to the carrier.
(2) (2)(a) The commission may award an add-on fee to a claimant to be paid by the carrier if:
(2)(a)(i) a medical claim is at issue;
(2)(a)(ii) the carrier issues an unconditional denial of the medical claim;
(2)(a)(iii) the claimant hires an attorney to represent the claimant during the formal adjudicative process before the commission;
(2)(a)(iv) after the carrier issues the unconditional denial, the commission orders the carrier or the carrier agrees to pay the medical claim; and
(2)(a)(v) any award of indemnity compensation in the case is less than $5,000.
(2)(b) An award of an add-on fee under this section is in addition to:
(2)(b)(i) the amount awarded for the medical claim or indemnity compensation; and
(2)(b)(ii) any amount for attorney fees agreed upon between the claimant and the claimant's attorney.
(2)(c) An award under this section is governed by the law in effect at the time the claimant files an application for hearing with the Division of Adjudication.
(2)(d) (2)(d)(i) Medical expenses awarded as part of a medical claim under this section shall be calculated in accordance with the amount the carrier is required to pay under the rules established by the commission under Subsection 34A-2-407(9).
(2)(d)(ii) If the medical expenses awarded under this section are not set forth in the rules described in Subsection 34A-2-407(9), the medical expenses shall be calculated based on the amount the carrier paid or is contractually required to pay to the medical provider, whichever is greater.
(3) If the commission awards an add-on fee under this section, the commission shall award the add-on fee in the following amount:

(3)(a) the lesser of 25% of the medical expenses the commission awards to the claimant or $25,000, for a case that is resolved at the commission level;
(3)(b) the lesser of 30% of the medical expenses the Utah Court of Appeals awards to the claimant or $30,000, for a case that is resolved on appeal before the Utah Court of Appeals; or
(3)(c) the lesser of 35% of the medical expenses that the Utah Supreme Court awards to the claimant or $35,000, for a case that is resolved on appeal before the Utah Supreme Court.
(4) If a court invalidates any portion of this section, the entire section is invalid.

Legislative History

Amended by Chapter 364, 2023 General Session