Prohibits an employer from suspending workers' compensation benefits to an injured employee without an order from the director of labor and industrial relations. Provides compensation to permanently or temporarily disabled employees within 30 days of injury. Requires that an employer receive prior authorization from the director of labor and industrial relations prior to requesting an employee to submit to a medical examination by an employer's physician.

A BILL FOR AN ACT

SECTION 1. Section 386-31, Hawaii Revised Statutes, is amended to read as follows:

"§386-31 Total disability. (a) Permanent total disability. Where a work injury causes permanent total disability the employer shall pay the injured employee a weekly benefit equal to sixty-six and two-thirds per cent of the employee's average weekly wages, subject to the following limitation:

Beginning January 1, 1975, and during each succeeding twelve-month period thereafter, not more than the state average weekly wage last determined by the director, rounded to the nearest dollar, nor less than $38 or twenty-five per cent of the foregoing maximum amount, rounded to the nearest dollar, whichever is higher.

In the case of the following injuries, the disability caused thereby shall be deemed permanent and total:

In all other cases the permanency and totality of the disability shall be determined on the facts. No adjudication of permanent total disability shall be made until after two weeks from the date of the injury.

(b) Temporary total disability. Where a work injury causes total disability not determined to be permanent in character, the employer, for the duration of the disability, but not including the first three calendar days thereof, shall pay the injured employee a weekly benefit at the rate of sixty-six and two-thirds per cent of the employee's average weekly wages, subject to the limitations on weekly benefit rates prescribed in subsection (a), or if the employee's average weekly wages are less than the minimum weekly benefit rate prescribed in subsection (a), at the rate of one hundred per cent of the employee's average weekly wages.

The employer shall pay [temporary] total disability benefits promptly as they accrue to the person entitled thereto without waiting for a decision from the director, unless such right is controverted by the employer in the employer's initial report of industrial injury. The first payment of benefits shall become due and shall be paid no later than on the tenth day after the employer has been notified of the occurrence of the total disability, and thereafter the benefits due shall be paid weekly except as otherwise authorized pursuant to section 386-53.

The payment of such benefits shall only be terminated upon order of the director or if the employee is able to resume work. When the employer is of the opinion that temporary total disability benefits should be terminated because the injured employee is able to resume work, the employer shall notify the employee and the director in writing of an intent to terminate such benefits at least two weeks prior to the date when the last payment is to be made. The notice shall give the reason for stopping payment and shall inform the employee that the employee may make a written request to the director for a hearing if the employee disagrees with the employer. Upon receipt of the request from the employee, the director shall conduct a hearing as expeditiously as possible and render a prompt decision as specified in section 386-86.

In no case shall an employer suspend or discontinue benefits to an injured employee without an order from the director. No order shall be issued until after the conclusion of a full and fair hearing, at which the injured employee was given ample opportunity to review the employer's evidence and present rebuttal.

An employer or insurance carrier who fails to comply with this section shall pay not more than $2,500 into the special compensation fund upon the order of the director, in addition to attorneys' fees and cost to the employee for enforcing this section and other penalties prescribed in section 386-92.

(c) Where a work injury causes permanent or temporary disability, and payment of compensation due under this chapter was not begun within thirty days or within the same year as the date of injury, the employee shall be entitled to receive a weekly benefit equal to seventy per cent of the employee's average weekly wages, or a maximum weekly income benefit based on the state average weekly wage applicable on the date compensation was first received."

SECTION 2. Section 386-79, Hawaii Revised Statutes, is amended to read as follows:

"§386-79 Medical examination by employer's physician. (a) After an injury and during the period of disability, the employee, whenever ordered by the director of labor and industrial relations, shall submit to examination, at reasonable times and places, by a duly qualified physician or surgeon designated and paid by the employer. The employee shall have the right to have a physician or surgeon designated and paid by the employee present at the examination, which right, however, shall not be construed to deny to the employer's physician the right to visit the injured employee at all reasonable times and under all reasonable conditions during total disability.

(b) An order to attend an examination under subsection (a) shall only be issued by the director of labor and industrial relations. The employee so ordered shall be contacted in advance of the order to arrange a reasonable time and place for the examination. The employer shall reimburse the employee for any lost wages or expenses incurred in attending such an examination.

(c) If an employee unreasonably refuses to submit to, or in any way obstructs such examination, the employee's right to claim compensation for the work injury [shall], upon an order of the director of labor and industrial relations, may be suspended until the refusal or obstruction ceases and no compensation shall be payable for the period during which the refusal or obstruction continues.

(d) In cases where the employer is dissatisfied with the progress of the case or where major and elective surgery, or either, is contemplated, the employer may appoint a physician or surgeon of the employer's choice who shall examine the injured employee and make a report to the employer. If the employer remains dissatisfied, this report may be forwarded to the director. In no case shall an employer suspend or discontinue benefits to an injured employee without an order from the director. No order shall be issued until after the conclusion of a full and fair hearing, at which the injured employee was given ample opportunity to review the employer's evidence and present rebuttal.

(e) Employer requested examinations under this section shall not exceed more than one per case unless good and valid reasons [exist] with regard to the medical progress of the employee's treatment[.] are found to exist, as determined by the director at a hearing, and unless the selection of an examining physician or physicians is acceptable to the injured worker. The cost of conducting the ordered medical examination shall be limited to the complex consultation charges governed by the medical fee schedule established pursuant to section 386-21(c).

(f) Any employer or insurer found in violation of this section shall pay a fine of $500 per violation to the injured employee, plus attorneys' fees and costs to the employee for enforcing this section, in addition to the other penalties prescribed in section 386-92."

SECTION 3. Section 431:14-110.5, Hawaii Revised Statutes, is amended to read as follows:

"[[]§431:14-110.5[]] Disclosure of workers' compensation premium information. (a) All policies issued to employers for workers' compensation insurance shall disclose clearly to employers as separate figures the portion of the premium charged for:

In addition, a disclosure statement shall indicate to the employer the portion of the premium and monetary cost attributable to loss control and administrative costs, attorney's fees of the insurer, the cost of employer requested medical examinations, and private investigation costs.

(b) When a policy is issued to employers for workers' compensation insurance, it shall be accompanied by a statement disclosing the percentages of premiums expended during the previous year by the insurer for claims paid in the categories specified in subsection (a), including loss control and administrative costs, attorney's fees of the insurer, the cost of employer requested medical examinations, and private investigation costs.

(c) All denials of claims shall be reported to the employer on an annual basis, along with the dates of injury or alleged injury, the dates the employer's report was filed, the date of denial or the date compensability was accepted, and the dates of subsequent appeals and the status of the appeals.

[(c)] (d) The information provided to employers by insurers pursuant to this section shall be provided on an annual basis to the director of labor and industrial relations and to the commissioner.

[(d)] (e) Any insurer found in violation of this section shall pay a fine of $5,000 per violation to the insured, plus attorney's fees and costs to the insured for enforcing this section."

SECTION 4. This Act does not affect rights and duties that matured, penalties that were incurred, and proceedings that were begun, before its effective date.

SECTION 5. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 6. This Act shall take effect upon its approval.