24.29.3124    REVIEW BY MEDICAL REVIEW PANEL - REPORT AND RECOMMENDATIONS

(1) Unless both the worker and the insurer agree to have a petition for reopening reviewed solely by the department's medical director, the petition will be reviewed by a three-member panel of physicians. The members of the medical review panel may consult with nonphysician medical providers if the medical issues presented for review make it appropriate to do so.

(2) The medical review panel may recommend that medical benefits be reopened only if:

(a) the worker's medical condition is a direct result of the compensable injury or occupational disease; and

(b) the worker needs additional medical benefits in order to:

(i) continue to work; or

(ii) return to work.

(3) Each member of the medical review panel shall prepare a report as to the panel member's evaluation of the medical records submitted for review and any additional information that has been submitted. The panel member must determine whether the evidence submitted demonstrates that further medical benefits meet the criteria of (2). The panel member's report must state the reason(s) and rationale for the recommendation.

(4) If a panel member concludes that additional medical benefits are necessary, the medical benefits should be provided for not more than two years before being subject to a biennial review. The analysis must include the reasons and rationale that explain:

(a) the extent of the duration of the benefits expected to be needed; and

(b) whether and how the recommendations are consistent with the department's current utilization and treatment guidelines.

(5) Following the medical review panel members' individual reviews, the medical director shall issue a report and make recommendations on behalf of the panel with respect to the reopening of medical benefits that reflect the views of the majority of the panel members.

(6) A party disagreeing with the medical director's report and recommendations may bring the dispute to the Workers' Compensation Court after following the mediation requirements provided by law.

 

History: 39-71-203, MCA; IMP, 39-71-717, MCA; NEW, 2016 MAR p. 586, Eff. 2/6/16; AMD, 2018 MAR p. 2527, Eff. 1/1/19.