RULE 099.00.97-002 - WCC Form N - Notice to Employer/Notice Employee

RULE 099.00.97-002. WCC Form N - Notice to Employer/Notice Employee

NOTICE OF INJURY, NOTICE TO EMPLOYE

A.C.A. § 11-9-701. Notice of injury or death.

(a)

(1) Unless an injury either renders the employee physically or menially unable 10 do so. or is made known to the employer immediately after it occurs, the employee shall report the injury to the employer on a form prescribed or approved by the Workers' Compensation Commission and to a person or at a place specified by the employer, and the employer shall not be responsible for disability, medical, or other benefits prior to receipt of the employee's report of injury.

(2) All reporting procedures specified by the employer must be reasonable and shall afford each employee reasonable notice of the reporting requirements.

(3) The foregoing shall not apply when an employee requires emergency medical treatment outside the employers normal business hours; however, in that event, the employee shall cause a report of the injury to be made to the employer on the employer's next regular business day.

(b)

(1) Failure to give the notice shall not bar any claim:

(A) If the employer had knowledge of the injury or death:

(B) If the employee had no knowledge that the condition or disease arose out of and in the course of the employment or

(C) If the commission excuses the failure on the grounds that for some satisfactory reason the notice could not be given

(2) Objection to failure to give notice must be made at or before the first hearing on the claim.

CHOICE\CHANGE OF PHYSICIAN

A.C. A, § 11-9-508. Medical services and supplies.

(e) ... the injured employee shall have direct access to any optometric or ophthalmologic medical service provider Who agree under the rules, terms, and conditions regarding services performed by the managed care entity initially chosen by the employer for the; treatment and management of eye injuries or conditions.

A.C.A. § 11-9-514. Change of physician.

EXCEPT FOR EMERGENCY TREATMENT. if your employer or its insurance company has contracted with a certified Managed Care Organization (MCO) or is certified as an Internal Managed Care System (IMCS) you must follow these rules:

1. Your employer has the right to select your initial primary care physician. The employer may select the initial primary care physician from among those associated with certified managed care entities.

2. You may request a change of physician. You should initially request a change of physician from the insurance carrier, employer, or self-insured employer. Within five business days of your initial request for a change of physician, the insurance carrier, employer, or self-insured employer should notify you of its decision to grant or deny the change of physician.

3. You may petition the Commission one (1) time only for a change of physician who must also either be associated with £ certified MCO or IMCS or who is your regular treating physician. (Your "Regular Treating Physician'' is one who maintains your medical records and with whom you have a history of regular treatment before the onset of your compensable injury.) The health care provider to whom you change must agree to refer you to a certified managed care entity for any specialized treatment, including physical therapy, and to comply with all the rules, terms, and conditions regarding services performed by the managed care entity initially chosen by your employer.

4. Treatment or services by any physician other than ones selected according to the foregoing, except emergency treatment, shall be a the employee's expense.

If the employer or insurance carrier is NOT in an MCO or IMCS arrangement, change-of-physician laws are different. Except for emergency treatment, after you receive this Notice, any unauthorized medical expense incurred shall not be the responsibility of your employer unless you have followed these rules:

1. If your employer chooses the Initial Treating Physician, you have the right to ask. onetime only, the WCC to approve a change. If the WCC approves a change, the WCC shall determine the second physician and not be bound by recommendations of you. the employer, or the insurance company.

2. However, if the desired change is to a chiropractic physician, optometrist or podiatrist, you may make the change after giving written advance notification to your employer or the employer's insurance company.

3. If you selected the first physician, the WCC will not approve a change unless there is a compelling reason or circumstance justifying the change.

A.C.A. § 11-9-106(a)(1). Penalties for misrepresentation. Any person or entity who willfully and knowingly makes any material false statement or representation for the purpose of obtaining any benefit or payment or for the purpose of defeating or wrongfully increasing or wrongfully decreasing any claim for benefit or payment or obtaining or avoiding workers' compensation coverage or avoiding payment of the proper insurance premium, or who aids and abets for either of said purposes, under this chapter shall be guilty of a Class D felony.

(1/9/1997)

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