24.29.3127    PERIODIC REVIEW OF CERTAIN REOPENED MEDICAL BENEFITS

(1) The department's medical director shall biennially review claims where medical benefits have been reopened and the recommended duration of the reopening is more than two years, in order to determine whether the previous recommendations should be changed.

(2) The department shall request that the worker and the insurer deliver to the department medical records created since the prior medical review, as well as any additional information the party wants considered.

(a) The department's request shall specify a deadline by which those records and additional information must be received by the department.

(b) Any medical records or other information submitted by a party which have not previously been provided to the other party must be sent to that other party at the same time the records or other information are delivered to the department.

(3) The biennial review will be based on the materials previously submitted by the parties at the time the original petition for reopening was considered, and the records and information sent pursuant to (2). If a party does not timely send updated medical records or additional information, the medical director shall base the review on the materials available.

(4) For parties which filed a joint petition for reopening and did not deliver medical records to the department:

(a) if they agree medical benefits should remain open until the next review, medical records are not required to be submitted for periodic review;

(b) if they do not agree medical benefits should remain open until the next review, they must notify the department within 14 days of notice of the review that they believe benefits should not continue.  The medical director will then conduct a review as set forth in ARM 24.29.3114, except the date the petition is filed is the date of notification of dispute.

(5) The prior report and recommendation regarding medical benefits is presumed to be correct. A previous recommendation may be changed only if it is based on the updated medical records and information sent to the department.

(6) Following the medical director's review, if the medical director believes there is reason to change the prior recommendation, the medical director shall:

(a) in cases where the original review was made by a medical review panel, convene a new medical review panel to review the updated medical records and information; or

(b) in cases where the original review was made solely by the medical director, issue a report and make recommendations as provided by (7).

(7) Following completion of the periodic review, the medical director shall issue a report and make recommendations with respect to continuing the reopening of medical benefits.

(8) 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. 204, Eff. 2/6/16; AMD, 2021 MAR p. 1210, Eff. 9/25/21.