Utah Admin. Code R612-200-1 - Reporting and Investigating Injuries
A. Employers' Duty to Report Work Injuries.
1. An employer is not required to report an
injury that requires only first aid treatment, as defined by Subsection
R612-100-3.A.
2. Except for injuries treated only by first
aid, an employer shall report each employee work injury within 7 days after
receiving initial notice of the injury , a s f o l l o w s :
a. An employer that has obtained workers'
compensation insurance shall report the injury to its insurance
carrier.
b. An employer that has
received Division authorization to self-insure shall report the injury to its
claims administrator.
c. An
employer that has failed to obtain worker's compensation coverage shall report
the injury by contacting the Division directly.
3. An employer has notice of a work injury
upon the earliest of:
a. observation of the
injury;
b. verbal or written notice
of the injury from any source; or
c. receipt of any other information
sufficient to warrant further inquiry by the employer.
B. Submitting Reports of Injury to
the Division.
1. An insurance carrier or
self-inured employer shall submit Reports of Injury and Subsequent Reports of
Injury electronically in compliance with the requirements of the Industrial
Accidents Division Claims EDI Implementation Guide and Utah Claims R3 EDI
Tables, which are incorporated by reference.
2. Except for injuries treated only by first
aid as defined by Subsection
R612-100-2.J, an
insurance carrier, self-insured employer, or uninsured employer shall submit a
First Report of Injury or illness to the Division within fourteen days after
receiving initial notice of the injury.
a. An
insurance carrier or self-insured employer has notice of a work injury upon
receipt of verbal or written information that includes the name of the
employer, the name of the employee and the date of injury.
b. An uninsured employer shall report the
information required by this subsection as part of the employer's initial
contact with the Division required by Subsection A.2.c of this rule.
C. Investigation of
Claims; Notice to Division and Claimants; Commencement of Benefits.
1. An insurance carrier or self-insured
employer shall promptly investigate a reported work injury and either accept or
deny workers' compensation liability for the claim within 21 days after
receiving initial notice of the injury.
a. If,
with reasonable diligence, an insurance carrier or self-insured employer cannot
complete its investigation within 21 days after initial notice, the insurance
carrier or self-insured employer shall report the investigation of the claim
through current EDI processes. The insurance carrier, self-insured employer, or
uninsured employer is then allowed 24 days in addition to the initial 21-day
period to complete its investigation and accept or deny liability of the
claim.
b. An insurance carrier or
self-insured employer denying a claim for workers' compensation benefits shall
report such denial through current EDI processes.
c. If the insurance carrier or self-insured
employer accepts liability for the claim, payment of benefits shall commence
within 7 days from the date of acceptance. The insurance carrier or
self-insured employer shall report the initial benefits paid to a claimant
through current EDI processes. The statement of benefits paid must accompany
the first payment to the claimant .
d. An insurance carrier or self-insured
employer's payment of benefits during investigation of a claim does not prevent
subsequent denial of the claim after the investigation is completed.
D. Consequences of
Failure to Comply.
1. Pursuant to Subsection
34A-2-407(8)
of the Utah Workers' Compensation Act, the Division may impose a civil
assessment of up to $500 for an insurance carrier, insured employer,
self-insured employer, or uninsured employer's failure, without good cause, to
comply with the requirements of this rule.
a.
"Good cause" includes a claimant's unreasonable failure to sign requested
medical releases or otherwise cooperate in the investigation of a
claim.
b. For improperly filed
reports, the civil assessment shall be imposed for the report as a whole and
not for each data element within a report.
2. In addition to the civil assessment
authorized by Subsection
34A-2-407(8),
an insurance company or self-insured employer's failure, without good cause, to
comply with the requirements of this rule may result in:
a. referral of the insurance company to the
Insurance Department for appropriate disciplinary action; or
b. revocation of a self-insured employer's
authorization to remain self-insured.
3. The method of issuing the assessments
shall be set by the division's policies and procedures.
4. Assessments shall be issued in the form of
an order signed by the division's presiding officer and pursuant to the
requirements contained in Section
63G-4-203.
5. An aggrieved party may seek agency review
of any order pursuant to Section
63G-4-301.
Notes
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