Current through Register Vol. XLI, No. 50, December 13, 2024
Section 85-15-6 - Implementation of the Rehabilitation Plan6.1. Until the termination of the Commission, an employer is permitted to object to the plan pursuant to section 5.4 of this rule. However, the implementation of the plan will proceed notwithstanding the objection. In the event that the employer is successful in challenging the plan, the employer's account will be adjusted to reflect the appropriate charge associated with the rehabilitation plan. In the event the plan has not been completed at the time of the ultimate decision on the protest, the plan will be modified, if necessary, to conform with the ultimate decision. a. Upon termination of the Commission, the private carrier, and not the employer, will register objections and adjudicate claims matters on behalf of the employer in appropriate cases.6.2. Upon request of any party or upon a determination by the Commission, Insurance Commissioner, self-insured employer or private carrier, whichever is applicable, the Commission, Insurance Commissioner, self-insured employer or private carrier, whichever is applicable, may order the suspension, termination, or modification of a rehabilitation plan based upon a showing of good cause including, but not limited to: a. A change in the injured worker's physical condition which does not allow the injured worker to continue pursuing the rehabilitation plan;b. The injured worker's lack of satisfactory progress which indicates that he or she cannot complete the plan successfully;c. A finding that an injured worker is not cooperating with a plan;d. A finding that the rehabilitation plan is no longer necessary for the injured worker's re-employment;e. A finding that a change in economic conditions has caused the rehabilitation plan to be inappropriate.f. A finding that the injured worker's employer is not cooperating and the failure to cooperate is an impediment to plan completion shall result in plan modification as necessary to accomplish the rehabilitation goal.6.3. All physical and/or vocational rehabilitation services must be delivered in accordance with the rehabilitation plan developed under section 5 of this rule. The Commission, Insurance Commissioner, self-insured employer or private carrier, whichever is applicable, may authorize the qualified rehabilitation professional to monitor compliance with and progress under the rehabilitation plan. Once authorized, the qualified rehabilitation professional must contact the injured worker and all other participating parties on a regular basis to monitor compliance with and progress under the plan. Report of these contacts must be submitted to the Commission, Insurance Commissioner, self-insured employer or private carrier, whichever is applicable, in thirty (30) day intervals, unless otherwise directed by the Commission, self-insured employer or private carrier, whichever is applicable. Failure to so report may result in the denial of payment for services provided during the thirty (30) days and thereafter until the required report is received.6.4. In the event it is later determined the rehabilitation services provided will not meet the goal of the plan, the vocational rehabilitation service provider and/or the qualified rehabilitation professional must notify the Commission, Insurance Commissioner, self-insured employer or private carrier, whichever is applicable, and recommend plan modifications as appropriate.6.5. If the injured worker is not compliant with the rehabilitation plan, or is not making satisfactory progress under the plan, the vocational rehabilitation service provider and/or the qualified rehabilitation professional must immediately notify the Commission, Insurance Commissioner, self-insured employer or private carrier, whichever is applicable. The determination of whether satisfactory progress is being made shall be a collaborative effort involving the Commission, Insurance Commissioner, self-insured employer or private carrier, whichever is applicable, and the vocational rehabilitation services provider. Failure to notify the Commission, Insurance Commissioner, self-insured employer or private carrier, whichever is applicable, may result in a closing of the file, a mandated return of the file to the Commission, Insurance Commissioner, self-insured employer or private carrier, whichever is applicable, the finding of an overpayment to the vocational rehabilitation service provider and/or qualified rehabilitation service provider in an amount equal to the sum of all services provided to date on the file.6.6. If, based upon reports of the qualified rehabilitation professional or other reliable evidence, the injured worker is not compliant with the rehabilitation plan, or is not making satisfactory progress under the plan, in the sole discretion of the Commission, Insurance Commissioner, self-insured employer or private carrier, whichever is applicable, all benefits payable to the injured worker may be suspended until such time as the injured worker becomes compliant or begins to make satisfactory progress under the plan.