C.R.S. Section 8-43-605
Due process

(1)

At least forty-five days before disclosing the results of a performance program, an insurer shall give a provider written notice of the availability of the provider’s individual result, specific instructions on how the provider can access the result, and a description of the implications to the provider. The written notice shall describe the procedures by which the provider may request:

(a)

The information required to be disclosed under subsection (2) of this section; and

(b)

An appeal of the result pursuant to subsection (3) of this section.

(2)

Intentionally left blank —Ed.

(a)

Within ten business days after receiving a request by or on behalf of a provider, an insurer shall disclose, in a manner that is reasonably understandable and that allows the provider to verify the data against his or her records, the methodology and all data upon which a provider’s performance program result was calculated, with sufficient detail to allow the provider to determine the effect of the methodology on the data reviewed.

(b)

An insurer shall not use the “Uniform Trade Secrets Act”, article 74 of title 7, C.R.S., to avoid compliance with this section.

(3)

Insurers shall establish procedures for providers to appeal the results of a performance program. Such procedures, in addition to the disclosures and the written notice furnished, shall provide:

(a)

A reasonable method by which the provider may submit notice of the desire to appeal;

(b)

The name, title, qualifications, and relationship to the insurer of any person responsible for deciding the appeal, who shall be authorized to uphold, modify, or reject results or require additional action to ensure that results are fair, reasonable, accurate, and comply with the requirements of this part 6;

(c)

An opportunity for a provider to submit or have considered corrected data or other information relevant to the results or the appropriateness of the methodology used. If requested, a provider may appear at a face-to-face meeting with those responsible for the appeal decision at a location reasonably convenient to the provider or by teleconference. The provider shall submit in writing any corrected data or information in advance of the meeting.

(d)

The provider’s right to be assisted by a representative, including an attorney;

(e)

A detailed written decision regarding the appeal that states the reasons for upholding, modifying, or rejecting the appeal;

(f)

Resolution of the appeal within forty-five days after the date upon which the data and methodology are disclosed unless otherwise agreed to by the parties to the appeal; and

(g)

A stay on the implementation, use, and disclosure of and action upon the individual results of the performance program until the appeal and any subsequent hearing requested pursuant to section 8-43-207 has become final.

Source: Section 8-43-605 — Due process, 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

§ 8-43-605’s source at colorado​.gov