§ 640. Medical benefits; assistive devices; home and automobile modifications
(a) An employer subject to the provisions of this chapter shall furnish to an injured
employee reasonable surgical, medical, and nursing services and supplies, including
prescription drugs and durable medical equipment. The employer shall provide assistive
devices and modification to vehicles and residences reasonably necessary to permit
an injured worker who is determined to have or expected to suffer a permanent disability,
such as an ambulatory disability as defined in 20 V.S.A. § 2900 or blindness as defined in 20 V.S.A. § 2900, that substantially and permanently prevents or limits the worker’s ability to continue
to live at home or perform basic life functions. In determining what devices and modifications
are reasonably necessary, consideration shall be given to factors that include ownership
of the residence to be modified, the length of time the worker is expected to utilize
and benefit from the devices or modifications, and the extent to which the devices
or modifications enhance or improve the worker’s independent functioning. The employer
shall also furnish reasonable hospital services and supplies, including surgical,
medical, and nursing services while the injured employee is confined in a hospital
for treatment and care.
(b) An employer may designate the treating health care provider to initially treat an
injured employee immediately following a compensable injury. Thereafter, the employee
may select another health care provider upon giving the employer written notice of
the employee’s reasons for dissatisfaction with the health care provider designated
by the employer and the name and address of the health care provider selected by the
employee. The Commissioner may permit an employer to refuse to reimburse a health
care provider selected by the employee if notice required in this subsection is not
provided to the employer unless the failure to provide notice is due to excusable
neglect or inadvertence.
(c) An employer shall not withhold any wages from an employee for the employee’s absence
from work for treatment of a work injury or to attend a medical examination related
to a work injury. If the employee selects a new health care provider in accordance
with subsection (b) of this section, the employer shall have the right to require
other medical examinations as provided in this chapter.
(d) The liability of the employer to pay for medical, surgical, hospital, and nursing
services and supplies, prescription drugs, and durable medical equipment provided
to the injured employee under this section shall not exceed the maximum fee for a
particular service, prescription drug, or durable medical equipment as provided by
a schedule of fees and rates prepared by the Commissioner. The reimbursement rate
for services and supplies in the fee schedule shall include consideration of medical
necessity, clinical efficacy, cost-effectiveness, and safety, and those services and
supplies shall be provided on a nondiscriminatory basis consistent with workers’ compensation
and health care law. The Commissioner shall authorize reimbursement at a rate higher
than the scheduled rate if the employee demonstrates to the Commissioner’s satisfaction
that reasonable and necessary treatment, prescription drugs, or durable medical equipment
is not available at the scheduled rate. An employer shall establish direct billing
and payment procedures and notification procedures as necessary for coverage of medically-necessary
prescription medications for chronic conditions of injured employees, in accordance
with rules adopted by the Commissioner.
(e)(1) In the case of a work-related, first-aid-only injury, the employer shall file the
first report of injury with the Department of Labor. The employer shall file the first
report of injury with the workers’ compensation insurance carrier or pay the medical
bill within 30 days after the injury.
(2) If the employer contests a claim, a first report of injury shall be forwarded to the
Department of Labor and the insurer within five days after notice.
(3) If additional treatment or medical visits are required or if the employee loses more
than one day of work, the claim shall be promptly reported to the workers’ compensation
insurer, which shall adjust the claim.
(4) “Work-related, first-aid-only-treatment” means any one-time treatment that generates
a bill for less than $750.00 and for which the employee loses no time from work except
for the time for medical treatment and recovery not to exceed one day of absence from
work. (Amended 1959, No. 36, eff. March 12, 1959; 1961, No. 148, § 1; 1967, No. 122, § 5; 1989, No. 165 (Adj. Sess.); 1993, No. 225 (Adj. Sess.), § 4; 1999, No. 41, § 1; 2003, No. 132 (Adj. Sess.), § 11, eff. May 26, 2004; 2007, No. 208 (Adj. Sess.), § 8; 2017, No. 74, § 41; 2023, No. 85 (Adj. Sess.), § 128, eff. July 1, 2024.)