Bill > S1011

This bill aims to ensure fairness in the disability adjudication process by making several changes to Chapter 152 of the General Laws, which governs workers' compensation. Specifically, it establishes that an insurer contesting an employee's total permanent disability after it has been definitively decided in the employee's favor, without new evidence of improvement, changed behavior, or significant medical advancements, will be considered to have acted without reasonable grounds if they do so more than once in a five-year period. Additionally, the bill mandates that all bills submitted after an adjudication must be paid within 30 days, with interest applied to any late payments unless good cause for delay is shown within that timeframe. Hearings will now be recorded, with copies or transcriptions available for a reasonable fee, and proceedings involving sensitive personal information can be closed to the public upon request. The bill also removes a provision that presumed an employee's termination within a year of returning to work was due to their inability to perform the job, shifting the burden of proof to the insurer to demonstrate otherwise. Finally, insurers will be prohibited from participating in the medical judgments of utilization review processes, only being allowed to provide necessary information when requested by the review agent.