Practice Tips for New July 1, 2024 Legislation
As we have noted in prior updates, there are two new statutes that go into effect on July 1, 2024. The first is Virginia Code Section 65.2-601.3, which creates a new requirement for adjusters when denying a workers’ compensation claim. After a claim is reviewed and a denial has been determined, adjusters will now be required to put the following language in all denial letters:
EMPLOYEE RIGHT TO DISPUTE DENIAL OF WORKERS’ COMPENSATION BENEFITS.
IF YOU DISAGREE WITH THIS DENIAL, YOU HAVE THE RIGHT TO DISPUTE THE DECISION BY FILING A REQUEST FOR A HEARING WITH THE VIRGINIA WORKERS’ COMPENSATION COMMISSION. IT IS YOUR RESPONSIBILITY TO DISPUTE THE DECISION AS SOON AS PRACTICABLE. THE WORKERS’ COMPENSATION COMMISSION IS A STATE AGENCY RESPONSIBLE FOR MAKING FINAL DECISIONS ON DISPUTED WORKERS’ COMPENSATION CLAIMS. HOWEVER, SUCH CLAIM MAY BE LOST IF YOU DO NOT FILE IT WIT HIN THE TIME LIMIT PROVIDED BY LAW, WHICH IS TYPICALLY TWO YEARS AFTER THE INJURY.
It is also required that the address, telephone number, and website through which the employee may contact the Commission to dispute the denial is included in the denial letter.
Practice Tip: While not subject to fines under Virginia Code Section 65.2-902, it is not clear whether if intentional noncompliance could lead to other ramifications for employers and carriers, such as contempt orders. Therefore, we recommend using this language in all future denial letters beginning July 1, 2024.
A concern with this new statute is that if a pro se claimant receives a denial letter without the required language, they could use noncompliance with this statute to argue for tolling of the statute of limitations.
We anticipate an increase in hearings on claims with pro se claimants as a result of this new statute, as it provides more information to claimants regarding their rights to dispute denied claims that they may not have been aware of before.
The second piece of notable legislation is an amendment to the existing statute Virginia Code section 65.2-605.1
As of July 1, 2024, section 65.2-605.1 creates a new time limitation for the recovery of medical provider bills. Specifically, 65.2-605.1 removes “July 1, 2014,” from subsections (E) and (F). The effect of this change is that employers and carriers cannot seek recovery of a payment made to a health care provider for health care services given to a claimant unless such recovery is sought less than one year from the date payment was made to the health care provider, except in cases of fraud. Prior to this amendment, employers and carriers were restricted from seeking recovery for health care services rendered after July 1, 2014.
More importantly, the change to subsection (F) states that health care providers can no longer contest the sufficiency of payment for health care services rendered to a claimant unless the claim is filed within one year of the date the last payment is received by the health care provider. Prior to this amendment, health care providers were restricted from contesting the sufficiency of payment for services rendered after July 1, 2014.
Practice Tip: With all medical provider claims, strict attention must be made regarding the date the provider was last paid, as well as the date of the services that are being contested. All claims must be reviewed closely prior to payment of medical bills.
If you receive a medical provider application for any pre-2014 services in the next few weeks, and it appears that all relevant documents in your file have not been retained in the ordinary course of business, the defense of laches still remains and has been successful for these types of claims in the past.
Over the past few months, we have seen a large influx of medical provider applications being filed. This is because after July 1, 2024, many of those applications can no longer be filed due to the new filing restrictions. We may continue to see a large amount of medical provider applications throughout the end of this month, but they should slow down as the July 1 deadline passes.
As you know, it can be difficult to defend claims seeking payment for services that are ten or more years old. Fortunately, this new code section will restrict the ability to file those old claims by restricting the filing of those claims significantly. Moving forward, health care providers cannot file claims contesting the sufficiency of payments unless (1) the claim is filed within one year of the date the last payment was received by the health care provider, or (2) if the employer denies/contests payment for any portion of the services, then as to that portion denied/contested, the claim is filed within one year of the date of the medical award covering that date of service for a specific item or treatment in question becomes final.
Should you have any questions about the issues discussed here or other legal issues, please do not hesitate to contact the lawyers at Ford Richardson.
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