C.R.S. Section 8-43-401.5
Financial incentives to deny or delay claim or medical care

  • prohibition
  • penalties

(1)

No insurer, employee or contractor of an insurer, self-insured employer, employee or contractor of a self-insured employer, health-care provider, or employee or contractor of a health-care provider treating an injured worker under the provisions of articles 40 to 47 of this title shall pay or receive any form of financial remuneration that is based on any of the following:

(a)

The number of days to maximum medical improvement;

(b)

The rate of claims approval or denial;

(c)

The number of medical procedures, diagnostic procedures, or treatment appointments approved; or

(d)

Any other criteria designed or intended to encourage a violation of any provision of articles 40 to 47 of this title.

(2)

Intentionally left blank —Ed.

(a)

Payment of remuneration in violation of this section constitutes an unfair act or practice in the business of insurance, and the insurer or self-insured employer who pays or directs the payment of the remuneration shall be subject to penalties in accordance with part 11 of article 3 of title 10, C.R.S.

(b)

In addition to, or as an alternative to, any penalties imposed pursuant to paragraph (a) of this subsection (2), an insurer or self-insured employer who is found to have violated subsection (1) of this section may be subject to fines as determined by the director pursuant to section 8-43-304 (1.5).

(3)

Nothing in this section:

(a)

Restricts or limits the ability of a claims adjuster or employee or contracted claims personnel to investigate, detect, or prevent fraud; or

(b)

Limits the payment or receipt of financial incentives for any other lawful purpose.

Source: Section 8-43-401.5 — Financial incentives to deny or delay claim or medical care - prohibition - penalties, https://leg.­colorado.­gov/sites/default/files/images/olls/crs2023-title-08.­pdf (accessed Oct. 20, 2023).

8‑43‑101
Record of injuries - occupational disease - reported to division - rules - definition
8‑43‑102
Notice to employer of injury - notice to employees - failure to report
8‑43‑103
Notice of injury - time limit
8‑43‑104
Electronic filings - rules
8‑43‑201
Disputes arising under “Workers’ Compensation Act of Colorado”
8‑43‑202
Director may refer taking of evidence in cases to appropriate officials of other states
8‑43‑203
Notice concerning liability - notice to claimants - notice of rights and claims process - rules
8‑43‑204
Settlements - rules
8‑43‑205
Mediation
8‑43‑206
Settlement conference procedures
8‑43‑206.5
Right to binding arbitration for resolution of disputes under articles 40 to 47
8‑43‑207
Hearings
8‑43‑207.5
Prehearing conferences - rules - definition
8‑43‑208
Investigations
8‑43‑209
Time schedule for hearings - establishment
8‑43‑210
Evidence
8‑43‑211
Notice - request for hearing
8‑43‑212
Compulsion of testimony
8‑43‑213
Transcripts
8‑43‑214
Transcript certified - evidence
8‑43‑215
Orders
8‑43‑217
Claims management - legislative declaration
8‑43‑218
Authority of director
8‑43‑219
Not a limitation on rights or privileges
8‑43‑220
Injured worker exit survey
8‑43‑301
Petitions to review
8‑43‑302
Corrected orders
8‑43‑303
Reopening
8‑43‑304
Violations - penalty - offset for benefits obtained through fraud - rules
8‑43‑304.5
Penalties in rate-making
8‑43‑305
Each day separate offense
8‑43‑306
Collection of fines, penalties, and overpayments
8‑43‑307
Appeals to court of appeals
8‑43‑308
Causes for setting aside award
8‑43‑309
Actions in court tried within thirty days
8‑43‑310
Error disregarded unless prejudicial
8‑43‑311
Court record transmitted to industrial claim appeals office - when
8‑43‑312
Court may remand case or order entry of award
8‑43‑313
Summary review by supreme court
8‑43‑314
Fees - costs - duty of district attorneys and attorney general
8‑43‑315
Witnesses and testimony - mileage - fees - costs
8‑43‑316
Appearance by officer for closely held entity
8‑43‑317
Service of documents
8‑43‑318
Remand of case or order - time limit for further proceedings consistent with ruling on appeal
8‑43‑401
District attorney or attorney of division to act for director or office - penalties for failure of insurer to pay benefits
8‑43‑401.5
Financial incentives to deny or delay claim or medical care - prohibition - penalties
8‑43‑402
False statement - felony
8‑43‑403
Attorney fees
8‑43‑404
Examination - refusal - personal responsibility - physicians to testify and furnish results - injured worker right to select treating physicians - injured worker right to third-party communications - definitions - rules
8‑43‑405
Payment as discharge of liability - conflicting claims
8‑43‑406
Compensation in lump sum
8‑43‑407
Election to waive vocational rehabilitation benefits and become subject to permanent partial disability provisions
8‑43‑408
Default of employer - additional liability
8‑43‑409
Defaulting employers - penalties - enjoined from continuing business - fines - procedure - definition - repeal
8‑43‑410
Right to compensation operates as lien - interest on award
8‑43‑501
Utilization review process - legislative declaration - cash fund
8‑43‑502
Independent medical examinations
8‑43‑503
Utilization review of health-care providers
8‑43‑601
Short title
8‑43‑602
Legislative declaration
8‑43‑603
Definitions
8‑43‑604
Performance programs
8‑43‑605
Due process
8‑43‑606
Enforcement
8‑43‑607
Filing with director
Green check means up to date. Up to date

Current through Fall 2024

§ 8-43-401.5’s source at colorado​.gov