Edward Stone
Attorney at Law
435.640.5810

UTAH WORKER'S COMPENSATION

Please select from below for applicable Utah statutes and explanations:

* This page is not intended to describe all facets of workers' compensation law in the Utah. It simply seeks to answer common questions of potential litigants with workers compensation cases. This page does not establish an attorney/client relationship, nor does it dispense legal advice..

Please contact Edward Stone for more information.

Utah Workers' Compensation- Employer Responsibilities

Utah Code, Section 34A-2-30

(1) An employer may not:

(a) construct, occupy, or maintain any place of employment that is not safe;

(b) require or knowingly permit any employee to be in any employment or place of employment that is not safe;

(c) fail to provide and use safety devices and safeguards;

(d) remove, disable, or bypass safety devices and safeguards;

(e) fail to obey orders of the commission

(f) fail to obey the rules of the commission;

(g) fail to adopt and use methods and processes reasonably adequate to render the employment and place of employment safe; or;

(h) fail or neglect to do every other thing reasonably necessary to protect the life, health, and safety of the employer's employees;
(2) Compensation as provided in this Chapter 3, shall be increased by 15%, except in the case of injury resulting in death, when injury is caused by the willful failure of an employer to comply with:
(a) the law;
(b) a rule of the commission;
(c) any lawful order of the commission;
(d) the employer's own written workplace safety program.


Temporary Disability Compensation

Utah Code Section 34A-2-410: Temporary Disability- Amount of Payments-State average weekly wage defined

(1)(a) In case of temporary disability, so long as the disability is total, the employee shall receive 66 and 2/3rds percent of that employee's weekly salary wages at the time of the injury, but:

(i) not more than a maximum of 100% of the state average weekly wage at the time of the injury per week, and;

(ii) not less than a minimum of $45 per week plus $5 for a dependent spouse and $5 for each dependent child under the age of 18 years, up to a maximum of four dependent children, not to exceed the average weekly wage of the employee at the time of the injury, but not to exceed 100% of the state average weekly wage at the time of the injury per week.

(b) In no case shall the compensation exceed 312 weeks at the rate of 100% of the state average weekly wage at the time of the injury over a period of 12 years from the date of the injury.

(2) In the event a light duty medical release is obtained prior to the employee reaching a fixed state of recovery, and when no light duty employment is available to the employee from the employer, temporary disability benefits shall continue to be paid.

(3) the "State average weekly wage", as referred to in this chapter and Chapter 3, Utah Occupational Disease Act, shall be determined by the commission as follows:

(a) On or before June 1 of each year, the total wages reported on contribution reports to the Division of Workforce Information and Payment Services for the preceding calendar year shall be divided by the average monthly number of insured workers determined by dividing the total number of insured workers reported for the preceding year by 12.

(b) the average annual wage obtained under Subsection (3)

(a) shall be divided by 52.

(4) The state average weekly wage determined by under Subsection (3) shall be used as the basis for computing the maximum compensation rate for:

(a) injuries or disabilities arising from occupational disease that occurred during the twelve-month period commencing July 1 following the June 1 determination; and

(b) any death resulting from the injuries or disabilities arising from occupational disease.

34A-2-411. Temporary partial disability -- Amount of payments.

(1) If the injury causes temporary partial disability for work, the employee shall receive weekly compensation equal to:

(a) 66-2/3% of the difference between the employee's average weekly wages before the accident and the weekly wages the employee is able to earn after the accident, but not more than 100% of the state average weekly wage at the time of injury; plus

(b) $5 for a dependent spouse and $5 for each dependent child under the age of 18 years, up to a maximum of four such dependent children, but only up to a total weekly compensation that does not exceed 100% of the state average weekly wage at the time of injury.

(2) The commission may order an award for temporary partial disability for work at any time prior to 12 years after the date of the injury to an employee: (a) whose physical condition resulting from the injury is not finally healed and fixed 12 years after the date of injury; and
(b) who files an application for hearing under Section 34A-2-417.

(3) The duration of weekly payments may not exceed 312 weeks nor continue more than 12 years after the date of the injury. Payments shall terminate when the disability ends or the injured employee dies.


Temporary Partial Disability Compensation

34A-2-412. Permanent partial disability -- Scale of payments.

(1) An employee who sustained a permanent impairment as a result of an industrial accident and who files an application for hearing under Section 34A-2-417 may receive a permanent partial disability award from the commission.
(2) Weekly payments may not in any case continue after the disability ends, or the death of the injured person.
(3) (a) In the case of the injuries described in Subsections (4) through (6), the compensation shall be 66-2/3% of that employee's average weekly wages at the time of the injury, but not more than a maximum of 66-2/3% of the state average weekly wage at the time of the injury per week and not less than a minimum of $45 per week plus $5 for a dependent spouse and $5 for each dependent child under the age of 18 years, up to a maximum of four dependent children, but not to exceed 66-2/3% of the state average weekly wage at the time of the injury per week. (b) The compensation determined under Subsection


(3)(a) shall be:

(i) paid in routine pay periods not to exceed four weeks for the number of weeks provided for in this section; and

(ii) in addition to the compensation provided for temporary total disability and temporary partial disability.
(4) For the loss of: Number of Weeks
(a) Upper extremity (i) Arm (A) Arm and shoulder (forequarter amputation) 218

(B) Arm at shoulder joint, or above deltoid insertion 187

(C) Arm between deltoid insertion and elbow joint, at elbow joint, or below elbow joint proximal to insertion of biceps tendon 178

(D) Forearm below elbow joint distal to insertion of biceps tendon 168
(ii) Hand (A) At wrist or midcarpal or midmetacarpal amputation 168 (B) All fingers except thumb at metacarpophalangeal joints 101
(iii) Thumb (A) At metacarpophalangeal joint or with resection of carpometacarpal bone 67 (B) At interphalangeal joint 50
(iv) Index finger
(A) At metacarpophalangeal joint or with resection of metacarpal bone 42
(B) At proximal interphalangeal joint 34
(C) At distal interphalangeal joint 18
(v) Middle finger
(A) At metacarpophalangeal joint or with resection of metacarpal bone 34
(B) At proximal interphalangeal joint 27
(C) At distal interphalangeal joint 15
(vi) Ring finger
(A) At metacarpophalangeal joint or with resection of metacarpal bone 17

(B) At proximal interphalangeal joint 13

(C) At distal interphalangeal joint 8
(vii) Little finger

(A) At metacarpophalangeal joint or with resection of metacarpal bone 8

(B) At proximal interphalangeal joint 6
(C) At distal interphalangeal joint 4
(b) Lower extremity
(i) Leg

(A) Hemipelvectomy (leg, hip and pelvis) 156

(B) Leg at hip joint or three inches or less below tuberosity of ischium 125

(C) Leg above knee with functional stump, at knee joint or Gritti-Stokes amputation or below knee with short stump (three inches or less below intercondylar notch) 112

(D) Leg below knee with functional stump 88
(ii) Foot

(A) Foot at ankle 88

(B) Foot partial amputation (Chopart's) 66

(C) Foot midmetatarsal amputation 44
(iii) Toes

(A) Great toe
(I) With resection of metatarsal bone 26
(II) At metatarsophalangeal joint 16
(III) At interphalangeal joint 12

(B) Lesser toe (2nd -- 5th)
(I) With resection of metatarsal bone 4
(II) At metatarsophalangeal joint 3
(III) At proximal interphalangeal joint 2
(IV) At distal interphalangeal joint 1

(C) All toes at metatarsophalangeal joints 26 (iv) Miscellaneous (A) One eye by enucleation 120 (B) Total blindness of one eye 100 (C) Total loss of binaural hearing 109
(5) Permanent and complete loss of use shall be deemed equivalent to loss of the member. Partial loss or partial loss of use shall be a percentage of the complete loss or loss of use of the member. This Subsection (5) does not apply to the items listed in Subsection (4)(b)(iv).

(6) (a) For any permanent impairment caused by an industrial accident that is not otherwise provided for in the schedule of losses in this section, permanent partial disability compensation shall be awarded by the commission based on the medical evidence. (b) Compensation for any impairment described in Subsection (6)(a) shall, as closely as possible, be proportionate to the specific losses in the schedule set forth in this section. (c) Permanent partial disability compensation may not: (i) exceed 312 weeks, which shall be considered the period of compensation for permanent total loss of bodily function; and (ii) be paid for any permanent impairment that existed prior to an industrial accident.

(7) The amounts specified in this section are all subject to the limitations as to the maximum weekly amount payable as specified in this section, and in no event shall more than a maximum of 66-2/3% of the state average weekly wage at the time of the injury for a total of 312 weeks in compensation be required to be paid.


Permanent Total Disability

34A-2-413. Permanent total disability -- Amount of payments -- Rehabilitation.

(1) (a) In cases of permanent total disability resulting from an industrial accident or occupational disease, the employee shall receive compensation as outlined in this section.

(b) To establish entitlement to permanent total disability compensation, the employee has the burden of proof to show by a preponderance of evidence that: (i) the employee sustained a significant impairment or combination of impairments as a result of the industrial accident or occupational disease that gives rise to the permanent total disability entitlement; (ii) the employee is permanently totally disabled; and (iii) the industrial accident or occupational disease was the direct cause of the employee's permanent total disability.

(c) To find an employee permanently totally disabled, the commission shall conclude that: (i) the employee is not gainfully employed; (ii) the employee has an impairment or combination of impairments that limit the employee's ability to do basic work activities; (iii) the industrial or occupationally caused impairment or combination of impairments prevent the employee from performing the essential functions of the work activities for which the employee has been qualified until the time of the industrial accident or occupational disease that is the basis for the employee's permanent total disability claim; and (iv) the employee cannot perform other work reasonably available, taking into consideration the employee's age, education, past work experience, medical capacity, and residual functional capacity.

(d) Evidence of an employee's entitlement to disability benefits other than those provided under this chapter and Chapter 3, Utah Occupational Disease Act, if relevant, may be presented to the commission, but is not binding and creates no presumption of an entitlement under this chapter and Chapter 3, Utah Occupational Disease Act.

(2) For permanent total disability compensation during the initial 312-week entitlement, compensation shall be 66-2/3% of the employee's average weekly wage at the time of the injury, limited as follows:

(a) compensation per week may not be more than 85% of the state average weekly wage at the time of the injury;

(b) compensation per week may not be less than the sum of $45 per week, plus $5 for a dependent spouse, plus $5 for each dependent child under the age of 18 years, up to a maximum of four dependent minor children, but not exceeding the maximum established in Subsection (2)(a) nor exceeding the average weekly wage of the employee at the time of the injury; and

(c) after the initial 312 weeks, the minimum weekly compensation rate under Subsection (2)(b) shall be 36% of the current state average weekly wage, rounded to the nearest dollar.

(3) For claims resulting from an accident or disease arising out of and in the course of the employee's employment on or before June 30, 1994:

(a) The employer or its insurance carrier is liable for the initial 312 weeks of permanent total disability compensation except as outlined in Section 34A-2-703 as in effect on the date of injury.

(b) The employer or its insurance carrier may not be required to pay compensation for any combination of disabilities of any kind, as provided in this section and Sections 34A-2-410 through 34A-2-412 and Sections 34A-2-501 through 34A-2-507 in excess of the amount of compensation payable over the initial 312 weeks at the applicable permanent total disability compensation rate under Subsection (2).

(c) Any overpayment of this compensation shall be reimbursed to the employer or its insurance carrier by the Employers' Reinsurance Fund and shall be paid out of the Employers' Reinsurance Fund's liability to the employee.

(d) After an employee has received compensation from the employee's employer, its insurance carrier, or the Employers' Reinsurance Fund for any combination of disabilities amounting to 312 weeks of compensation at the applicable permanent total disability compensation rate, the Employers' Reinsurance Fund shall pay all remaining permanent total disability compensation.

(e) Employers' Reinsurance Fund payments shall commence immediately after the employer or its insurance carrier has satisfied its liability under Subsection (3) or Section 34A-2-703.

(4) For claims resulting from an accident or disease arising out of and in the course of the employee's employment on or after July 1, 1994:

(a) The employer or its insurance carrier is liable for permanent total disability compensation.

(b) The employer or its insurance carrier may not be required to pay compensation for any combination of disabilities of any kind, as provided in this section and Sections 34A-2-410 through 34A-2-412 and Sections 34A-2-501 through 34A-2-507, in excess of the amount of compensation payable over the initial 312 weeks at the applicable permanent total disability compensation rate under Subsection (2).

(c) Any overpayment of this compensation shall be recouped by the employer or its insurance carrier by reasonably offsetting the overpayment against future liability paid before or after the initial 312 weeks.

(5) Notwithstanding the minimum rate established in Subsection (2), the compensation payable by the employer, its insurance carrier, or the Employers' Reinsurance Fund, after an employee has received compensation from the employer or the employer's insurance carrier for any combination of disabilities amounting to 312 weeks of compensation at the applicable total disability compensation rate, shall be reduced, to the extent allowable by law, by the dollar amount of 50% of the Social Security retirement benefits received by the employee during the same period.

(6) (a) A finding by the commission of permanent total disability is not final, unless otherwise agreed to by the parties, until:
(i) an administrative law judge reviews a summary of reemployment activities undertaken pursuant to Chapter 8, Utah Injured Worker Reemployment Act; (ii) the employer or its insurance carrier submits to the administrative law judge a reemployment plan as prepared by a qualified rehabilitation provider reasonably designed to return the employee to gainful employment or the employer or its insurance carrier provides the administrative law judge notice that the employer or its insurance carrier will not submit a plan; and
(iii) the administrative law judge, after notice to the parties, holds a hearing, unless otherwise stipulated, to consider evidence regarding rehabilitation and to review any reemployment plan submitted by the employer or its insurance carrier under Subsection (6)(a)(ii). (b) Prior to the finding becoming final, the administrative law judge shall order: (i) the initiation of permanent total disability compensation payments to provide for the employee's subsistence; and (ii) the payment of any undisputed disability or medical benefits due the employee. (c) The employer or its insurance carrier shall be given credit for any disability payments made under Subsection (6)(b) against its ultimate disability compensation liability under this chapter or Chapter 3, Utah Occupational Disease Act. (d) An employer or its insurance carrier may not be ordered to submit a reemployment plan. If the employer or its insurance carrier voluntarily submits a plan, the plan is subject to Subsections (6)(d)(i) through (iii). (i) The plan may include retraining, education, medical and disability compensation benefits, job placement services, or incentives calculated to facilitate reemployment funded by the employer or its insurance carrier. (ii) The plan shall include payment of reasonable disability compensation to provide for the employee's subsistence during the rehabilitation process. (iii) The employer or its insurance carrier shall diligently pursue the reemployment plan. The employer's or insurance carrier's failure to diligently pursue the reemployment plan shall be cause for the administrative law judge on the administrative law judge's own motion to make a final decision of permanent total disability.
(e) If a preponderance of the evidence shows that successful rehabilitation is not possible, the administrative law judge shall order that the employee be paid weekly permanent total disability compensation benefits.

(7) (a) The period of benefits commences on the date the employee became permanently totally disabled, as determined by a final order of the commission based on the facts and evidence, and ends: (i) with the death of the employee; or (ii) when the employee is capable of returning to regular, steady work.

(b) An employer or its insurance carrier may provide or locate for a permanently totally disabled employee reasonable, medically appropriate, part-time work in a job earning at least minimum wage provided that employment may not be required to the extent that it would disqualify the employee from Social Security disability benefits. (c) An employee shall fully cooperate in the placement and employment process and accept the reasonable, medically appropriate, part-time work. (d) In a consecutive four-week period when an employee's gross income from the work provided under Subsection (7)(b) exceeds $500, the employer or insurance carrier may reduce the employee's permanent total disability compensation by 50% of the employee's income in excess of $500. (e) If a work opportunity is not provided by the employer or its insurance carrier, a permanently totally disabled employee may obtain medically appropriate, part-time work subject to the offset provisions contained in Subsection (7)(d). (f) (i) The commission shall establish rules regarding the part-time work and offset. (ii) The adjudication of disputes arising under Subsection (7) is governed by Part 8, Adjudication. (g) The employer or its insurance carrier shall have the burden of proof to show that medically appropriate part-time work is available. (h) The administrative law judge may: (i) excuse an employee from participation in any job that would require the employee to undertake work exceeding the employee's medical capacity and residual functional capacity or for good cause; or (ii) allow the employer or its insurance carrier to reduce permanent total disability benefits as provided in Subsection (7)(d) when reasonable, medically appropriate, part-time employment has been offered but the employee has failed to fully cooperate.

(8) When an employee has been rehabilitated or the employee's rehabilitation is possible but the employee has some loss of bodily function, the award shall be for permanent partial disability.

(9) As determined by an administrative law judge, an employee is not entitled to disability compensation, unless the employee fully cooperates with any evaluation or reemployment plan under this chapter or Chapter 3, Utah Occupational Disease Act. The administrative law judge shall dismiss without prejudice the claim for benefits of an employee if the administrative law judge finds that the employee fails to fully cooperate, unless the administrative law judge states specific findings on the record justifying dismissal with prejudice.

(10) (a) The loss or permanent and complete loss of the use of both hands, both arms, both feet, both legs, both eyes, or any combination of two such body members constitutes total and permanent disability, to be compensated according to this section. (b) A finding of permanent total disability pursuant to Subsection (10)(a) is final. (11) (a) An insurer or self-insured employer may periodically reexamine a permanent total disability claim, except those based on Subsection (10), for which the insurer or self-insured employer had or has payment responsibility to determine whether the worker remains permanently totally disabled. (b) Reexamination may be conducted no more than once every three years after an award is final, unless good cause is shown by the employer or its insurance carrier to allow more frequent reexaminations. (c) The reexamination may include: (i) the review of medical records; (ii) employee submission to reasonable medical evaluations; (iii) employee submission to reasonable rehabilitation evaluations and retraining efforts; (iv) employee disclosure of Federal Income Tax Returns; (v) employee certification of compliance with Section 34A-2-110; and (vi) employee completion of sworn affidavits or questionnaires approved by the division. (d) The insurer or self-insured employer shall pay for the cost of a reexamination with appropriate employee reimbursement pursuant to rule for reasonable travel allowance and per diem as well as reasonable expert witness fees incurred by the employee in supporting the employee's claim for permanent total disability benefits at the time of reexamination. (e) If an employee fails to fully cooperate in the reasonable reexamination of a permanent total disability finding, an administrative law judge may order the suspension of the employee's permanent total disability benefits until the employee cooperates with the reexamination. (f) (i) Should the reexamination of a permanent total disability finding reveal evidence that reasonably raises the issue of an employee's continued entitlement to permanent total disability compensation benefits, an insurer or self-insured employer may petition the Division of Adjudication for a rehearing on that issue. The petition shall be accompanied by documentation supporting the insurer's or self-insured employer's belief that the employee is no longer permanently totally disabled. (ii) If the petition under Subsection

(11)(f)(i) demonstrates good cause, as determined by the Division of Adjudication, an administrative law judge shall adjudicate the issue at a hearing. (iii) Evidence of an employee's participation in medically appropriate, part-time work may not be the sole basis for termination of an employee's permanent total disability entitlement, but the evidence of the employee's participation in medically appropriate, part-time work under Subsection (7) may be considered in the reexamination or hearing with other evidence relating to the employee's status and condition. (g) In accordance with Section 34A-1-309, the administrative law judge may award reasonable attorneys fees to an attorney retained by an employee to represent the employee's interests with respect to reexamination of the permanent total disability finding, except if the employee does not prevail, the attorneys fees shall be set at $1,000. The attorneys fees shall be paid by the employer or its insurance carrier in addition to the permanent total disability compensation benefits due. (h) During the period of reexamination or adjudication if the employee fully cooperates, each insurer, self-insured employer, or the Employers' Reinsurance Fund shall continue to pay the permanent total disability compensation benefits due the employee.

(12) If any provision of this section, or the application of any provision to any person or circumstance, is held invalid, the remainder of this section shall be given effect without the invalid provision or application.


Death Benefits

Sections Omitted

(6)(a) If a surviving spouse, who is a dependent of a deceased employee and who is receiving the benefits of this chapter or Chapter 3 remarries, that individual's sole right after the remarriage to further payments of compensation shall be the right to receive in a lump sum the lesser of:

(i) the balance of the weekly compensation payments unpaid from the time of remarriage to the end of six years or 312 weeks from the date of the injury from which death resulted; or

(ii) an amount equal to 52 weeks of compensation at the weekly compensation the surviving spouse was receiving at the time of such remarriage.

(b)(i) If there are other dependents remaining at the time of remarriage, benefits payable under the chapter or Chapter 3, Utah Occupational Disease Act, shall be paid to such person as an administrative law judge may determine, for the use and benefit of the other dependents.

(ii) The weekly benefits to be paid under Subsection 6(b)(i) shall be paid at intervals of not less than four weeks.


Medical Evaluations

34A-2-601 Medical Panel, director or consultant- Findings and reports- Objections to report- Hearing- Expenses

1(a) The Division of Adjudication may refer the medical aspect of the case described in this Subsection (1)(a) to a medical panel appointed by an administrative law judge:

(i) upon the filing of a claim for compensation arising out of and in the course of employment for:

(a) disability by accident; or

(b) death by accident; and

(ii) if the employer or the employer's insurance carrier denies liability.


Physical examinations

34A-2-602 Physical Examinations.

(1) The division or an administrative law judge may require an employee claiming the right to receive compensation under this chapter to submit to a medical examination at any time, and from time to time, at a place reasonably convenient for the employee, and as may be provided by the rules of the commission.

(2) If an employee refuses to submit to an examination under Subsection (1), or obstruct the examination, the employee's right to have the employee's claim for compensation considered, if the employee's claim is pending before an administrative law judge, commissioner, or Appeals Board, or to receive any payments for compensation theretofore granted by a final order of the commission, shall be suspended during the period of the refusal or obstruction.


Procedure

34A-2-801. Initiating adjudicative proceedings -- Procedure for review of administrative action.

(1) (a) To contest an action of the employee's employer or its insurance carrier concerning a compensable industrial accident or occupational disease alleged by the employee, any of the following shall file an application for hearing with the Division of Adjudication:

(a) the employee; or

(b) a representative of the employee, the qualifications of whom are defined in rule by the commission.

(b) To appeal the imposition of a penalty or other administrative act imposed by the division on the employer or its insurance carrier for failure to comply with this chapter or Chapter 3, Utah Occupational Disease Act, any of the following shall file an application for hearing with the Division of Adjudication:
(i) the employer;
(ii) the insurance carrier; or
(iii) a representative of either the employer or the insurance carrier, the qualifications of whom are defined in rule by the commission.

(c) A physician, surgeon, or other health provider may file an application for hearing in accordance with Section 34A-2-407.

(d) An attorney may file an application for hearing in accordance with Section 34A-1-309.

(2) Unless a party in interest appeals the decision of an administrative law judge in accordance with Subsection (3), the decision of an administrative law judge on an application for hearing filed under Subsection (1) is a final order of the commission 30 days after the date the decision is issued.

(3) (a) A party in interest may appeal the decision of an administrative law judge by filing a motion for review with the Division of Adjudication within 30 days of the date the decision is issued.
(b) Unless a party in interest to the appeal requests under Subsection (3)(c) that the appeal be heard by the Appeals Board, the commissioner shall hear the review.
(c) A party in interest may request that an appeal be heard by the Appeals Board by filing the request with the Division of Adjudication:
(i) as part of the motion for review; or
(ii) if requested by a party in interest who did not file a motion for review, within 20 days of the date the motion for review is filed with the Division of Adjudication.

(d) A case appealed to the Appeals Board shall be decided by the majority vote of the Appeals Board.

(4) All records on appeals shall be maintained by the Division of Adjudication. Those records shall include an appeal docket showing the receipt and disposition of the appeals on review.

(5) Upon appeal, the commissioner or Appeals Board shall make its decision in accordance with Section 34A-1-303.

(6) The commissioner or Appeals Board shall promptly notify the parties to any proceedings before it of its decision, including its findings and conclusions.

(7) The decision of the commissioner or Appeals Board is final unless within 30 days after the date the decision is issued further appeal is initiated under the provisions of this section or Title 63, Chapter 46b, Administrative Procedures Act.

(8) (a) Within 30 days after the date the decision of the commissioner or Appeals Board is issued, any aggrieved party may secure judicial review by commencing an action in the court of appeals against the commissioner or Appeals Board for the review of the decision of the commissioner or Appeals Board.
(b) In an action filed under Subsection (8)(a):
(i) any other party to the proceeding before the commissioner or Appeals Board shall be made a party; and
(ii) the commission shall be made a party.
(c) A party claiming to be aggrieved may seek judicial review only if the party has exhausted the party's remedies before the commission as provided by this section.
(d) At the request of the court of appeals, the commission shall certify and file with the court all documents and papers and a transcript of all testimony taken in the matter together with the decision of the commissioner or Appeals Board.


Time Limits for Filing Claims

34A-2-407. Reporting of industrial injuries -- Regulation of health care providers.

(1) Any 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. If the employee is unable to provide notification, the employee's next-of-kin or attorney may provide notification of the injury to the employee's employer.

(2) Any employee who fails to notify the employee's employer or the division within 180 days of an injury is barred for any claim of benefits arising from the injury.

(3) The following constitute notification of injury:

(a) an employer's or physician's injury report filed with the division, employer, or insurance carrier; or
(b) the payment of any medical or disability benefits by the employer or the employer's insurance carrier.

(4) (a) In the form prescribed by the division, each employer shall file a report with the division of any:
(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) The employer shall file the report required by Subsection (4)(a) within seven days after:
(i) the occurrence of a fatality or injury;
(ii) the employer's first knowledge of the fatality or injury; or
(iii) the employee's notification of the fatality or injury.
(c) Each employer shall file a subsequent report with the division of any previously reported injury that later resulted in death. The subsequent report shall be filed with the division within seven days following:
(i) the death; or
(ii) the employer's first knowledge or notification of the death.
(d) A report is not required for minor injuries, such as cuts or scratches that require first-aid treatment only, unless a treating physician files, or is required to file, the Physician's Initial Report of Work Injury or Occupational Disease with the division.

(5) Each employer 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.

(6) Each employer shall maintain a record in a manner prescribed by the division 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.

(7) Any employer who refuses or neglects to make reports, to maintain records, or to file reports with the division as required by this section is guilty of a class C misdemeanor and subject to citation under Section 34A-6-302 and a civil assessment as provided under Section 34A-6-307, unless the division finds that the employer has shown good cause for submitting a report later than required by this section.

(8) (a) Except as provided in Subsection (8)(c) all physicians, surgeons, and other health providers attending injured employees shall:
(i) comply with all the rules, including the schedule of fees, for their services as adopted by the commission; and
(ii) make reports to the division at any and all times as required as to the condition and treatment of an injured employee or as to any other matter concerning industrial cases they are treating.
(b) A physician, as defined in Subsection 34A-2-111(2), who is associated with, employed by, or bills through a hospital is subject to Subsection (8)(a).
(c) A hospital is not subject to the requirements of Subsection (8)(a).
(d) The commission's schedule of fees may reasonably differentiate remuneration to be paid to providers of health 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) Subsection (8) does not modify contracts with providers of health services relating to the pricing of goods and services existing on May 1, 1995.
(f) In accordance with Title 63, Chapter 46b, Administrative Procedures Act, a physician, surgeon, or other health provider may file with the Division of Adjudication an application for hearing to appeal a decision or final order to the extent it concerns the fees charged by the physician, surgeon, or other health provider in accordance with this section.

(9) A copy of the physician's initial report shall be furnished to:
(a) the division;
(b) the employee; and
(c) the employer or its insurance carrier.

(10) Any physician, surgeon, or other health provider, excluding any hospital, who refuses or neglects to make any report or comply with this section is guilty of a class C misdemeanor for each offense, unless the division finds that there is good cause for submitting a late report.

(11) (a) Subject to appellate review under Section 34A-1-303, the commission has exclusive jurisdiction to hear and determine whether the treatment or services rendered to employees by physicians, surgeons, or other health providers are:
(i) reasonably related to industrial injuries or occupational diseases; and
(ii) compensable pursuant to this chapter or Chapter 3, Utah Occupational Disease Act.
(b) Except as provided in Subsection (11)(a), Subsection 34A-2-211(7), 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 of a physician's, surgeon's, or other health provider's billing for treatment or services that are compensable under this chapter or Chapter 3, Utah Occupational Disease Act.