Rep. Norm Thurston — Voting Record

Bill

Number

S.B. 190 (2025GS)

Sponsor

Sen. Sandall, Scott D.

Final action

Governor Signed 3/26/2025

Outcome

Became law — signed by Gov. Spencer J. Cox

Summary

What it does

• This bill:
• defines terms;
• expands the Labor Commission's authority to disclosures by health care providers;
• expands the Labor Commission's authority over fees for health care providers;
• expands the prohibition of balance billing for workers' compensation claims to health care providers; and
• makes technical changes.

Every vote on this bill

Bill text

3
34A-2-407
34A-2-407
2
Workers' Compensation Modifications
2025 GENERAL SESSION
STATE OF UTAH
Chief Sponsor: Scott D. Sandall
House Sponsor: James A. Dunnigan
LONG TITLE
General Description:
This bill amends the Workers' Compensation Act.
Highlighted Provisions:
This bill:
defines terms; 
expands the Labor Commission's authority to disclosures by health care providers;
expands the Labor Commission's authority over fees for health care providers;
expands the prohibition of balance billing for workers' compensation claims to health care 
providers; and 
makes technical changes.
Money Appropriated in this Bill:
None
Other Special Clauses:
None
Utah Code Sections Affected:
AMENDS:
34A-2-407
, as last amended by Laws of Utah 2021, Chapter 64
Be it enacted by the Legislature of the state of Utah:
Section 1, Section 
34A-2-407
 is amended to read:
34A-2-407
. Reporting of industrial injuries -- Regulation of health care 
providers.
(1)
As used in this section
, "physician" is as defined in Section 
34A-2-111
.
:
(a)
"Balance billing" means charging an individual, on whose behalf a workers' 
compensation insurance carrier or self-insured employer is obligated to pay covered 
medical services under this chapter or Chapter 3, Utah Occupational Disease Act, the 
amount calculated by subtracting the amount the workers' compensation insurance 
carrier or self-insured employer reimburses the health care provider for covered 
medical services from the amount the health care provider charges for the covered 
medical services.
(b)
"Covered medical services" means medical services provided by a health care 
provider that are covered by workers' compensation medical benefits under this 
chapter or Chapter 3, Utah Occupational Disease Act.
(c)
"Health care provider" means the same as that term is defined in Section 
34A-2-111
.
(d)
"Hospital" means the same as that term is defined in Section 
26B-2-219
.
(e)
"Physician" means the same as that term is defined in Section 
34A-2-111
.
(f)
"Self-insured employer" means the same as that term is defined in Section 
34A-2-201.5
.
(2)
(a)
An employee sustaining an injury arising out of and in the course of employment 
shall provide notification to the employee's employer promptly of the injury.
(b)
If the employee is unable to provide the notification required by Subsection 
(2)(a)
, 
the following may provide notification of the injury to the employee's employer:
(i)
the employee's next of kin; or
(ii)
the employee's attorney.
(c)
An employee claiming benefits under this chapter or 
Chapter 3, Utah Occupational 
Disease Act
, shall comply with rules adopted by the commission regarding disclosure 
of medical records of the employee medically relevant to the industrial accident or 
occupational disease claim.
An employee claiming benefits under this chapter, or 
Chapter 3, Utah Occupational Disease Act, shall comply with the commission's 
requirements for disclosure of medical records for a work-related injury claim.
(3)
(a)
An employee is barred for any claim of benefits arising from an injury if the 
employee fails to notify within the time period described in Subsection 
(3)(b)
:
(i)
the employee's employer in accordance with Subsection 
(2)
; or
(ii)
the division.
(b)
The 
An employee shall provide the 
notice required by Subsection 
(3)(a)
shall be 
made 
within:
(i)
180 days 
of
after
 the day on which the injury occurs; or
(ii)
in the case of an occupational hearing loss, the time period specified in Section 
34A-2-506
.
(4)
The following 
constitute
constitutes
 notification of injury 
from the employee, the 
employee's next of kin, or the employee's attorney, as 
required by Subsection 
(2)
:
(a)
an employer's report 
once 
filed with:
(i)
the division; or
(ii)
the employer's workers' compensation insurance carrier;
(b)
a physician's injury report 
once 
filed with:
(i)
the division;
(ii)
the employer; or
(iii)
the employer's workers' compensation insurance carrier;
(c)
a workers' compensation insurance carrier's report filed with the division; or
(d)
the payment of any medical or disability benefits by:
(i)
the employer; or
(ii)
the employer's workers' compensation insurance carrier.
(5)
(a)
An employer and the employer's workers' compensation insurance carrier, if any, 
shall file a report in accordance with the rules made under Subsection 
(5)(b)
 of a:
(i)
work-related fatality; or
(ii)
work-related injury resulting in:
(A)
medical treatment;
(B)
loss of consciousness;
(C)
loss of work;
(D)
restriction of work; or
(E)
transfer to another job.
(b)
(i)
(A)
An employer or the employer's workers' compensation insurance 
carrier, if any, shall file a report required by Subsection 
(5)(a)
, and any 
subsequent reports of a previously reported injury
 as may be required by the 
commission, within the time limits and in the manner established by rule by the 
commission made after consultation with the workers' compensation advisory 
council and in accordance with 
Title 63G, Chapter 3, Utah Administrative 
Rulemaking Act
. 
The commission may require additional reports for a 
previously reported injury by rule made after consulting with the workers' 
compensation advisory council and in accordance with Title 63G, Chapter 3, 
Utah Administrative Rulemaking Act.
(B)
An employer or the employer's workers' compensation insurance carrier, if 
any, shall file the report required by Subsection (5)(a) and any other report of a 
previously reported injury within the time limits and in the manner the 
commission establishes.
(ii)
A rule made under this Subsection 
(5)(b)
 shall:
(i)
(A)
be reasonable; and
(ii)
(B)
take into consideration the practicality and cost of complying with the 
rule.
(c)
A
An employer is not required to file a
 report 
is not required to be filed under this 
Subsection 
(5)
for a minor injury, such as a cut or scratch that requires first aid 
treatment only, unless:
(i)
a treating physician files a report with the division in accordance with Subsection 
(9)
; or
(ii)
a treating physician is required to file a report with the division in accordance 
with Subsection 
(9)
.
(6)
An employer and 
its
the employer's
 workers' compensation insurance carrier, if any, 
required to file a report under Subsection 
(5)
 shall provide the employee with:
(a)
a copy of the report submitted to the division; and
(b)
a statement, as prepared by the division, of the employee's rights and responsibilities 
related to the industrial injury.
(7)
An employer shall maintain a record in a manner 
prescribed by 
the commission
provides
 by rule of all:
(a)
work-related fatalities; or
(b)
work-related injuries resulting in:
(i)
medical treatment;
(ii)
loss of consciousness;
(iii)
loss of work;
(iv)
restriction of work; or
(v)
transfer to another job.
(8)
(a)
Except as provided in Subsection 
(8)(b)
, an employer or a workers' compensation 
insurance carrier 
who
that
 refuses or neglects to make a report, maintain a record, or 
file a report as required by this section is subject to a civil assessment:
(i)
imposed by the division, subject to the requirements of 
Title 63G, Chapter 4, 
Administrative Procedures Act
; and
(ii)
that may not exceed $500.
(b)
An employer or workers' compensation insurance carrier is not subject to the civil 
assessment under this Subsection 
(8)
 if:
(i)
the employer or workers' compensation insurance carrier submits a report later 
than required by this section; and
(ii)
the division finds that the employer or workers' compensation insurance carrier 
has shown good cause for submitting a report later than required by this section.
(c)
(i)
A 
The division shall deposit a 
civil assessment collected under this 
Subsection 
(8)
shall be deposited 
into the Uninsured Employers' Fund created in 
Section 
34A-2-704
 to be used for a purpose specified in Section 
34A-2-704
.
(ii)
The administrator of the Uninsured Employers' Fund shall 
collect
receive and 
distribute the
 money 
required to be deposited into the Uninsured Employers' 
Fund under this Subsection 
(8)(c)
 in accordance with Section 
34A-2-704
.
in 
accordance with Section 
34A-2-704
.
(9)
(a)
A 
physician attending
health care provider treating
 an injured employee shall 
comply with rules 
established by 
the commission 
establishes in accordance with 
Title 63G, Chapter 3, Utah Administrative Rulemaking Act, 
regarding:
(i)
fees for 
physician's
covered medical
 services
, other than a hospital's covered 
medical services
;
(ii)
fees for a hospital's covered medical services, which, if the commission 
establishes, shall be based on Medicare reimbursement rates;
(ii)
(iii)
disclosure of medical records of the employee medically relevant to the 
employee's 
industrial accident or occupational disease
work-related injury
 claim;
(iii)
(iv)
reports to the division regarding:
(A)
the condition and treatment of an injured employee; or
(B)
any other matter concerning 
employees with 
industrial cases that the 
physician 
health care provider 
is treating; and
(iv)
(v)
rules made under Section 
34A-2-407.5
.
(b)
A physician who is associated with, employed by, or bills through a hospital is 
subject to Subsection 
(9)(a)
.
(c)
A hospital providing services for an injured employee is not subject to the 
requirements of Subsection 
(9)(a)
 except for rules made by the commission that are 
described in Subsection 
(9)(a)(ii)
 or 
(iii)
 or Section 
34A-2-407.5
.
(d)
(b)
The commission's schedule of fees may reasonably differentiate 
remuneration 
to be 
compensation 
paid to 
health care 
providers 
of health services
for covered 
medical services
 based on:
(i)
the severity of the employee's condition;
(ii)
the nature of the treatment necessary; and
(iii)
the facilities or equipment specially required to deliver that treatment.
(e)
(c)
This Subsection 
(9)
 does not prohibit a contract with a 
health care 
provider of 
health services
covered medical services
 relating to the pricing of goods and
 covered 
medical
 services.
(d)
A health care provider may not engage in balance billing.
(10)
A
 health care provider treating an injured employee shall provide a
 copy of the initial 
report filed under Subsection 
(9)(a)(iii)
 shall be furnished 
(9)(a)(iv) 
to:
(a)
the division;
(b)
the employee; and
(c)
(i)
the employer; or
(ii)
the employer's workers' compensation insurance carrier.
(11)
(a)
As used in this Subsection 
(11)
:
(i)
"Balance billing" means charging a person, on whose behalf a workers' 
compensation insurance carrier or self-insured employer is obligated to pay 
medical benefits under this chapter or 
Chapter 3, Utah Occupational Disease Act
, 
for the difference between what the workers' compensation insurance carrier or 
self-insured employer reimburses the hospital for covered medical services and 
what the hospital charges for those covered medical services.
(ii)
"Covered medical services" means medical services provided by a hospital that 
are covered by workers' compensation medical benefits under this chapter or 
Chapter 3, Utah Occupational Disease Act
.
(iii)
"Self-insured employer" means the same as that term is defined in Section 
34A-2-201.5
.
(b)
Subject to Subsection 
(11)(d)
, a workers' compensation insurance carrier or 
self-insured employer may contract, either in writing or by mutual oral agreement, 
with a hospital to establish reimbursement rates.
(c)
Subject to Subsection 
(11)(d)
, for the time period beginning on May 8, 2018, and 
ending on July 1, 2021, a workers' compensation insurance carrier or self-insured 
employer that is reimbursing a hospital for covered medical services shall reimburse 
the hospital:
(i)
in accordance with a contract described in Subsection 
(11)(b)
; or
(ii)
(A)
if the hospital is located in a county of the first, second, or third class, as 
classified in Section 
17-50-501
, at 75% of the billed hospital fees for the 
covered medical services; or
(B)
if the hospital is located in a county of the fourth, fifth, or sixth class, as 
classified in Section 
17-50-501
, at 85% of the billed hospital fees for the 
covered medical services.
(d)
A hospital may not engage in balance billing. 
(12)
(11)
(a)
Subject to appellate review under Section 
34A-1-303
, the commission has 
exclusive jurisdiction to hear and determine:
(i)
whether goods 
provided to 
or services 
rendered 
provided 
to an employee are 
compensable 
pursuant to
under
 this chapter or 
Chapter 3, Utah Occupational 
Disease Act
, including:
(A)
medical, nurse, or hospital 
covered medical 
services;
(B)
medicines; and
(C)
artificial means, appliances, or prosthesis;
(ii)
except for amounts charged or paid under Subsection 
(11)
(9)(c)
, the 
reasonableness of the amounts charged or paid for a good or service described in 
Subsection 
(12)(a)(i)
(11)(a)(i)
; and
(iii)
collection issues related to a good or service described in Subsection 
(12)(a)(i)
(11)(a)(i)
.
(b)
Except as provided in Subsection 
(12)(a)
(11)(a)
, Subsection 
34A-2-211(6)
, or 
Section 
34A-2-212
, a person may not maintain a cause of action in any forum within 
this state other than the commission for collection or payment for goods or
 covered 
medical
 services described in Subsection 
(12)(a)
(11)(a)
 that are compensable under 
this chapter or 
Chapter 3, Utah Occupational Disease Act
.
Section 2. 
Effective Date.
This bill takes effect on 
May 7, 2025
.
3-6-25 12:54 PM