Section 65-05-07 - Injured employee given medical and hospital service required - Furnished artificial limbs and appliances for rehabilitation - Fee approvalThe fund shall furnish to an injured employee reasonable and appropriate medical, surgical, and hospital service and supplies necessary to treat a compensable injury. The fund may furnish artificial members and replacements the organization determines necessary to rehabilitate an injured employee.
1. The allied health care professional must be acting within the scope of the allied health care professional's license or fees will be denied.2. Fees may not be approved for more than one allied health care professional in a case in which treatment is provided over the same period of time except for the services of a consulting doctor, assistant surgeon, or anesthetist or in an emergency.3. The organization, in cooperation with professional organizations of allied health care professionals, shall establish a system of peer review to determine reasonableness of fees and payment denials for unjustified treatments, hospitalization, or visits. The allied health care professional may appeal adverse decisions of the organization in accordance with the medical aid rules adopted by the organization.4. An allied health care professional may not bill an injured employee for a service rendered as a result of the compensable work injury.5. Under this section, the organization may modify real estate and may provide for adaptations and modifications to motor vehicles as follows:a. In the case of an injured employee who sustained a catastrophic injury, as defined in chapter 65-05.1, the organization may pay an amount not to exceed seventy-five thousand dollars to provide permanent additions, remodeling, or adaptations to real estate it determines necessary. The dollar limit is for the life of the injured employee, regardless of any subsequent claim. This subdivision does not allow the organization to purchase any real estate.b. In the case of an injured employee who sustained a catastrophic injury, as defined in chapter 65-05.1, the organization may pay an amount not to exceed one hundred fifty thousand dollars to provide the most cost-effective, specially equipped motor vehicle or vehicle adaptations the organization determines medically necessary. The organization may establish factors to be used in determining whether a specially equipped motor vehicle or adaptation is necessary. Under this subdivision, the organization may not pay for insurance of or maintenance of the motor vehicle. Within the dollar limit and under this subdivision, the organization may pay for vehicle or adaptation replacement purchases. The dollar limit is for the life of the injured employee, regardless of any subsequent claim.c. In the case of an injured employee who has not sustained a catastrophic injury, as defined in chapter 65-05.1, the organization may provide the benefits under subdivisions a and b if the organization determines the benefits would be cost-effective and appropriate because of exceptional circumstances as determined by the organization.6. If an allied health care professional who has treated or provided services to an injured employee fails or refuses without just cause to file with the organization a report required by section 65-05-02, 65-05-08, or 65-05-08.1, within thirty days of examination, treatment, or provision of other services rendered in connection with a compensable work injury, or within thirty days of a request for the report made by the claimant, the claimant's representative, or the organization, the organization shall assess as a penalty a sum of one hundred dollars. Health care providers and allied health care professionals may not bill an injured worker for a penalty assessed by the organization under this subsection.7. The filing of an accident report or the rendering of treatment to an injured worker who comes under the organization's jurisdiction constitutes acceptance of the organization's medical aid rules and compliance with the organization's rules and fees.8. The organization may not pay for:a. Personal items for the injured employee's personal use or hygiene, including toothbrushes, slippers, shampoo, and soap.b. A product or item including clothing or footwear unless the items are considered orthopedic devices and are prescribed by the treating allied health care professional.c. Furniture except hospital beds, shower stools, wheelchairs, or whirlpools if prescribed by the treating allied health care professional.d. Vitamins and food supplements except in those cases in which the injury causes severe dietary problems, the injury results in the employee's paraplegia or quadriplegia, or the employee becomes wheelchair-bound due to the injury.e. Eye examinations unless there is a reasonable potential for injury to the employee's eyes as a result of the injury.f. Private hospital or nursing home rooms except in cases of extreme medical necessity and only when directed by the attending doctor. If the employee desires better accommodations than those ordered by the attending doctor, the employee will pay the difference in cost.g. Serological tests, including VDRL and RPR, or other tests for venereal disease or pregnancy, or any other routine tests unless clearly necessitated by the injury.h. Aids or programs primarily intended to help the employee lose weight or stop smoking unless ordered by the organization.i. Home gymnasium or exercise equipment unless ordered by the organization.j. Memberships or monthly dues to health clubs, unless ordered by the organization.k. Massage, unless ordered by the organization.Amended by S.L. 2019, ch. 523 (SB 2184),§ 7, eff. 8/1/2019.Amended by S.L. 2017, ch. 434 (HB 1156),§ 2, eff. 8/1/2017.Amended by S.L. 2013, ch. 503 (SB 2178),§ 1, eff. 8/1/2013.Amended by S.L. 2011, ch. 512 (SB 2114),§ 3, eff. 8/1/2011.Amended by S.L. 2011, ch. 509 (HB 1453),§ 1, eff. 8/1/2011. See S.L. 2017, ch. 434 (HB 1156), § 4. See S.L. 2013, ch. 503 (SB 2178), § 2. See S.L. 2011, ch. 509 (HB 1453), § 2.