Haw. Code R. § 12-15-40 - Concurrent medical treatment

(a) One attending physician shall be in charge of the care of the injured employee. However, treatment by more than one qualified health care provider may be allowed if the attending physician determines the employee's injury involves more than one body system and requires multidiscipline care or is so severe or complex that services of more than one qualified health care provider are required.

(b) When requesting consideration for concurrent treatment, the attending physician shall obtain permission from the employer prior to initiating such referral. The name, business address, discipline, and specialty of the assisting qualified health care provider and the reasons for concurrent treatment shall be submitted in writing to the employer at least seven calendar days prior to referral.

(c) In the event of concurrent treatment, the director and the employer shall continue to recognize the attending physician who shall be responsible for directing the overall treatment program and assuring that copies of all required reports are submitted. The concurrent health care provider shall comply with the treatment requirements pursuant to section 12-15-32.

(d) Whenever a request for concurrent treatment is received, the employer shall respond within seven calendar days after postmark of such request, giving authorization, or stating in writing the reason for refusal to the attending physician, the injured employee, and the director. The employer's denial of concurrent treatment shall be supported by health care recommendations and shall explicitly state that failure to request a review by the director of the employer's denial within fourteen calendar days after postmark of the employer's denial shall be construed as acceptance of the employer's denial. If a request for concurrent medical treatment has been denied, the attending physician may not resubmit the same request for concurrent care with the same medical specialty for forty-five calendar days after postmark of the employer's denial. Failure by the employer to respond within seven calendar days shall constitute approval of the request.

(e) The attending physician or the injured employee may request in writing that the director review the employer's denial of authorization for concurrent treatment. The request for review shall be filed with the director, copying the employer, within fourteen calendar days after postmark of the employer's denial. A copy of the denied concurrent treatment request shall be submitted with the request for review. For cases not under the jurisdiction of the director at the time of request, the injured employee shall be responsible to have the case remanded to the director's jurisdiction. Failure to file a request for review of the employer's denial to the director within fourteen calendar days after postmark of the employer's denial shall be deemed acceptance of the employer's denial, and the attending physician may not resubmit the same request for concurrent care with the same medical specialty for forty-five calendar days after postmark of the employer's denial.

(f) The director shall issue a decision after hearing, approving or denying the request for concurrent treatment based on the evidence presented (inclusive of records on file).

(g) The decision shall be final unless appealed pursuant to section 386-87, HRS. The appeal shall not stay the director's decision.

(h) If the nature of the injury requires the concurrent services of two or more specialists for treatment, then each physician shall be entitled to the listed fee for services rendered.

Notes

Haw. Code R. § 12-15-40

[Eff 1/1/96; am 1/1/97; am 12/17/01] (Auth: HRS §§ 386-21, 386-26, 386-72) (Imp: HRS §§ 386-21, 386-26)