Subject: Workers’ compensation — medical benefits, provider choice, and payment requirements
HB 5182 amends section 315 of the Workers’ Disability Compensation Act (MCL 418.315) to modify employer obligations for furnishing medical care to injured employees, to clarify limits and licensing requirements for certain services, to strengthen an employee’s right to choose a treating provider, and to create timelines and penalties for employer/carrier responses to treatment requests and provider notices.
Employer duty to furnish medical care: Confirms employer obligation to furnish reasonable and timely medical, surgical, hospital services, medicines, and other treatment, plus dental services, crutches, artificial limbs/eyes/teeth, eyeglasses, hearing aids, and other appliances necessary to cure or ameliorate injury effects.
Limits on reimbursable services:
- Optometric and chiropractic services are reimbursable only if they met specified definitions in the Public Health Code as of certain historical dates (optometry as of May 20, 1992; chiropractic as of Jan 1, 2009).
- Services provided by professions that became licensed after Jan 1, 1998 are not required to be reimbursed if they were not licensed/registered by that earlier date.
- Physical therapy is reimbursable only if provided by a licensed physical therapist or a PTA under a licensed PT’s supervision and pursuant to a prescription from specified licensed health professionals (cites parts of the Public Health Code).
Family attendant care cap: When attendant or nursing care is provided by a spouse, sibling, child, parent, or combinations of these relatives, the weekly ordered care cap is raised from 56 hours to 84 hours per week.
Employee choice of provider and timelines:
- After notice/inception of medical care, an employee may treat with a physician or provider of their choice by providing the employer/carrier the provider’s name and a notice of intent. If the employer/carrier does not furnish reasonable and timely care within 10 days after the notice of injury, the employee may pursue care with their chosen provider and the employer/carrier must pay.
- Treatment by the employee’s chosen provider is presumed reasonable.
Administrative timelines and penalties:
- Employer/carrier must provide an “open claim” letter to the employee’s chosen provider within 7 days after receiving the employee’s notice. Failure to do so triggers a penalty of $100 per day payable to the employee, capped at $25,000.
- Employer/carrier must give the injured employee, within 10 days of the employee’s notice of injury, a director-prescribed form informing the employee of the right to choose a provider and the employer’s obligations.
Preauthorization and dispute process:
- Injured employees or their providers may request preauthorization for proposed treatment. The employer/carrier/TPA has 10 days to respond. If not authorized within 10 days, the employee may file for mediation or hearing; a magistrate may give such cases precedence.
- Employers/carriers may file petitions objecting to the employee’s chosen provider; a worker’s compensation magistrate may hear the objection and order discontinuance of treatment or payment limits as appropriate.
Enforcement: The bill directs worker’s compensation magistrates to order payment of reasonable unpaid expenses or proposed care when employers/carriers/TPAs fail to meet obligations (text truncated in source; bill appears to strengthen remedies and ordering authority).
Note: The provided bill text was partially truncated in places; this summary reflects the available language and highlights where portions were incomplete.
