Current through Register Vol. XLI, No. 41, October 11, 2024
Section 85-1-14 - Procedures for Suspension for Claimant Abuse14.1. When evidence is obtained justifying a finding that a claimant has engaged or is engaging in abuse, including, but not limited to, engaging in physical activities inconsistent with his or her compensable workers' compensation injury, or when evidence is obtained establishing a failure to undergo examinations or needed treatment, the responsible party will suspend the claimant's temporary total disability benefits.14.2. Abuse may also include working at an unreported job while drawing temporary total disability benefits, making false or misleading statements to the responsible party or a health care provider for the purpose of securing any benefit, and altering, falsifying, destroying, or concealing workers' compensation related records.14.3. Any claimant found to be engaging in abuse or who fails to undergo examinations or needed treatment shall receive a notice of benefit suspension. This notice is not protestable. The claimant has thirty (30) days to submit evidence justifying the reinstatement of benefits. If justification is not established, then the claimant will receive notice that the claim has been closed for temporary total disability payments. This notice is protestable. If justification is established, benefits will be reinstated with back benefits awarded.14.4. In claims pending prior to approval of a managed health care plan, the claimant's failure to select a treating physician from an approved managed health care plan within sixty (60) days of notification to do so will result in a suspension of medical and indemnity benefits until the claimant's selection is made, unless the claimant is eligible to opt out of the managed care plan network.