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§ 907. —  Medical services and supplies.



[Laws in effect as of January 24, 2002]
[Document not affected by Public Laws enacted between
  January 24, 2002 and December 19, 2002]
[CITE: 33USC907]

 
                TITLE 33--NAVIGATION AND NAVIGABLE WATERS
 
         CHAPTER 18--LONGSHORE AND HARBOR WORKERS' COMPENSATION
 
Sec. 907. Medical services and supplies


(a) General requirement

    The employer shall furnish such medical, surgical, and other 
attendance or treatment, nurse and hospital service, medicine, crutches, 
and apparatus, for such period as the nature of the injury or the 
process of recovery may require.

(b) Physician selection; administrative supervision; change of 
        physicians and hospitals

    The employee shall have the right to choose an attending physician 
authorized by the Secretary to provide medical care under this chapter 
as hereinafter provided. If, due to the nature of the injury, the 
employee is unable to select his physician and the nature of the injury 
requires immediate medical treatment and care, the employer shall select 
a physician for him. The Secretary shall actively supervise the medical 
care rendered to injured employees, shall require periodic reports as to 
the medical care being rendered to injured employees, shall have 
authority to determine the necessity, character, and sufficiency of any 
medical aid furnished or to be furnished, and may, on his own initiative 
or at the request of the employer, order a change of physicians or 
hospitals when in his judgment such change is desirable or necessary in 
the interest of the employee or where the charges exceed those 
prevailing within the community for the same or similar services or 
exceed the provider's customary charges. Change of physicians at the 
request of employees shall be permitted in accordance with regulations 
of the Secretary.

(c) Physicians and health care providers not authorized to render 
        medical care or provide medical services

    (1)(A) The Secretary shall annually prepare a list of physicians and 
health care providers in each compensation district who are not 
authorized to render medical care or provide medical services under this 
chapter. The names of physicians and health care providers contained on 
the list required under this subparagraph shall be made available to 
employees and employers in each compensation district through posting 
and in such other forms as the Secretary may prescribe.
    (B) Physicians and health care providers shall be included on the 
list of those not authorized to provide medical care and medical 
services pursuant to subparagraph (A) when the Secretary determines 
under this section, in accordance with the procedures provided in 
subsection (j) of this section, that such physician or health care 
provider--
        (i) has knowingly and willfully made, or caused to be made, any 
    false statement or misrepresentation of a material fact for use in a 
    claim for compensation or claim for reimbursement of medical 
    expenses under this chapter;
        (ii) has knowingly and willfully submitted, or caused to be 
    submitted, a bill or request for payment under this chapter 
    containing a charge which the Secretary finds to be substantially in 
    excess of the charge for the service, appliance, or supply 
    prevailing within the community or in excess of the provider's 
    customary charges, unless the Secretary finds there is good cause 
    for the bill or request containing the charge;
        (iii) has knowingly and willfully furnished a service, 
    appliance, or supply which is determined by the Secretary to be 
    substantially in excess of the need of the recipient thereof or to 
    be of a quality which substantially fails to meet professionally 
    recognized standards;
        (iv) has been convicted under any criminal statute (without 
    regard to pending appeal thereof) for fraudulent activities in 
    connection with any Federal or State program for which payments are 
    made to physicians or providers of similar services, appliances, or 
    supplies; or
        (v) has otherwise been excluded from participation in such 
    program.

    (C) Medical services provided by physicians or health care providers 
who are named on the list published by the Secretary pursuant to 
subparagraph (A) of this section shall not be reimbursable under this 
chapter; except that the Secretary shall direct the reimbursement of 
medical claims for services rendered by such physicians or health care 
providers in cases where the services were rendered in an emergency.
    (D) A determination under subparagraph (B) shall remain in effect 
for a period of not less than three years and until the Secretary finds 
and gives notice to the public that there is reasonable assurance that 
the basis for the determination will not reoccur.
    (E) A provider of a service, appliance, or supply shall provide to 
the Secretary such information and certification as the Secretary may 
require to assure that this subsection is enforced.
    (2) Whenever the employer or carrier acquires knowledge of the 
employee's injury, through written notice or otherwise as prescribed by 
the chapter, the employer or carrier shall forthwith authorize medical 
treatment and care from a physician selected by an employee pursuant to 
subsection (b) of this section. An employee may not select a physician 
who is on the list required by paragraph (1) of this subsection. An 
employee may not change physicians after his initial choice unless the 
employer, carrier, or deputy commissioner has given prior consent for 
such change. Such consent shall be given in cases where an employee's 
initial choice was not of a specialist whose services are necessary for 
and appropriate to the proper care and treatment of the compensable 
injury or disease. In all other cases, consent may be given upon a 
showing of good cause for change.

(d) Request of treatment or services prerequisite to recovery of 
        expenses; formal report of injury and treatment; suspension of 
        compensation for refusal of treatment or examination; 
        justification

    (1) An employee shall not be entitled to recover any amount expended 
by him for medical or other treatment or services unless--
        (A) the employer shall have refused or neglected a request to 
    furnish such services and the employee has complied with subsections 
    (b) and (c) of this section and the applicable regulations; or
        (B) the nature of the injury required such treatment and 
    services and the employer or his superintendent or foreman having 
    knowledge of such injury shall have neglected to provide or 
    authorize same.

    (2) No claim for medical or surgical treatment shall be valid and 
enforceable against such employer unless, within ten days following the 
first treatment, the physician giving such treatment furnishes to the 
employer and the deputy commissioner a report of such injury or 
treatment, on a form prescribed by the Secretary. The Secretary may 
excuse the failure to furnish such report within the ten-day period 
whenever he finds it to be in the interest of justice to do so.
    (3) The Secretary may, upon application by a party in interest, make 
an award for the reasonable value of such medical or surgical treatment 
so obtained by the employee.
    (4) If at any time the employee unreasonably refuses to submit to 
medical or surgical treatment, or to an examination by a physician 
selected by the employer, the Secretary or administrative law judge may, 
by order, suspend the payment of further compensation during such time 
as such refusal continues, and no compensation shall be paid at any time 
during the period of such suspension, unless the circumstances justified 
the refusal.

(e) Physical examination; medical questions; report of physical 
        impairment; review or reexamination; costs

    In the event that medical questions are raised in any case, the 
Secretary shall have the power to cause the employee to be examined by a 
physician employed or selected by the Secretary and to obtain from such 
physician a report containing his estimate of the employee's physical 
impairment and such other information as may be appropriate. Any party 
who is dissatisfied with such report may request a review or 
reexamination of the employee by one or more different physicians 
employed or selected by the Secretary. The Secretary shall order such 
review or reexamination unless he finds that it is clearly unwarranted. 
Such review or reexamination shall be completed within two weeks from 
the date ordered unless the Secretary finds that because of 
extraordinary circumstances a longer period is required. The Secretary 
shall have the power in his discretion to charge the cost of examination 
or review under this subsection to the employer, if he is a self-
insurer, or to the insurance company which is carrying the risk, in 
appropriate cases, or to the special fund in section 944 of this title.

(f) Place of examination; exclusion of physicians other than examining 
        physician of Secretary; good cause for conclusions of other 
        physicians respecting impairment; examination by employer's 
        physician; suspension of proceedings and compensation for 
        refusal of examination

    An employee shall submit to a physical examination under subsection 
(e) of this section at such place as the Secretary may require. The 
place, or places, shall be designated by the Secretary and shall be 
reasonably convenient for the employee. No physician selected by the 
employer, carrier, or employee shall be present at or participate in any 
manner in such examination, nor shall conclusions of such physicians as 
to the nature or extent of impairment or the cause of impairment be 
available to the examining physician unless otherwise ordered, for good 
cause, by the Secretary. Such employer or carrier shall, upon request, 
be entitled to have the employee examined immediately thereafter and 
upon the same premises by a qualified physician or physicians in the 
presence of such physician as the employee may select, if any. 
Proceedings shall be suspended and no compensation shall be payable for 
any period during which the employee may refuse to submit to 
examination.

(g) Fees and charges for examinations, treatment, or service; 
        limitation; regulations

    All fees and other charges for medical examinations, treatment, or 
service shall be limited to such charges as prevail in the community for 
such treatment, and shall be subject to regulation by the Secretary. The 
Secretary shall issue regulations limiting the nature and extent of 
medical expenses chargeable against the employer without authorization 
by the employer or the Secretary.

(h) Third party liability

    The liability of an employer for medical treatment as herein 
provided shall not be affected by the fact that his employee was injured 
through the fault or negligence of a third party not in the same employ, 
or that suit has been brought against such third party. The employer 
shall, however, have a cause of action against such third party to 
recover any amounts paid by him for such medical treatment in like 
manner as provided in section 933(b) of this title.

(i) Physicians' ineligibility for subsection (e) physical examinations 
        and reviews because of workmen's compensation claim employment 
        or fee acceptance or participation

    Unless the parties to the claim agree, the Secretary shall not 
employ or select any physician for the purpose of making examinations or 
reviews under subsection (e) of this section who, during such 
employment, or during the period of two years prior to such employment, 
has been employed by, or accepted or participated in any fee relating to 
a workmen's compensation claim from any insurance carrier or any self-
insurer.

(j) Procedure; judicial review

    (1) The Secretary shall have the authority to make rules and 
regulations and to establish procedures, not inconsistent with the 
provisions of this chapter, which are necessary or appropriate to carry 
out the provisions of subsection (c) of this section, including the 
nature and extent of the proof and evidence necessary for actions under 
this section and the methods of taking and furnishing such proof and 
evidence.
    (2) Any decision to take action with respect to a physician or 
health care provider under this section shall be based on specific 
findings of fact by the Secretary. The Secretary shall provide notice of 
these findings and an opportunity for a hearing pursuant to section 556 
of title 5 for a provider who would be affected by a decision under this 
section. A request for a hearing must be filed with the Secretary within 
thirty days after notice of the findings is received by the provider 
making such request. If a hearing is held, the Secretary shall, on the 
basis of evidence adduced at the hearing, affirm, modify, or reverse the 
findings of fact and proposed action under this section.
    (3) For the purpose of any hearing, investigation, or other 
proceeding authorized or directed under this section, the provisions of 
section \1\ 49 and 50 of title 15 (relating to the attendance of 
witnesses and the production of books, papers, and documents) shall 
apply to the jurisdiction, powers, and duties of the Secretary or any 
officer designated by him.
---------------------------------------------------------------------------
    \1\ So in original. Probably should be ``sections''.
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    (4) Any physician or health care provider, after any final decision 
of the Secretary made after a hearing to which he was a party, 
irrespective of the amount in controversy, may obtain a review of such 
decision by a civil action commenced within sixty days after the mailing 
to him of notice of such decision, but the pendency of such review shall 
not operate as a stay upon the effect of such decision. Such action 
shall be brought in the court of appeals of the United States for the 
judicial circuit in which the plaintiff resides or has his principal 
place of business, or the Court of Appeals for the District of Columbia. 
As part of his answer, the Secretary shall file a certified copy of the 
transcript of the record of the hearing, including all evidence 
submitted in connection therewith. The findings of fact of the 
Secretary, if based on substantial evidence in the record as a whole, 
shall be conclusive.

(k) Refusal of treatment on religious grounds

    (1) Nothing in this chapter prevents an employee whose injury or 
disability has been established under this chapter from relying in good 
faith on treatment by prayer or spiritual means alone, in accordance 
with the tenets and practice of a recognized church or religious 
denomination, by an accredited practitioner of such recognized church or 
religious denomination, and on nursing services rendered in accordance 
with such tenets and practice, without suffering loss or diminution of 
the compensation or benefits under this chapter. Nothing in this 
subsection shall be construed to except an employee from all physical 
examinations required by this chapter.
    (2) If an employee refuses to submit to medical or surgical services 
solely because, in adherence to the tenets and practice of a recognized 
church or religious denomination, the employee relies upon prayer or 
spiritual means alone for healing, such employee shall not be considered 
to have unreasonably refused medical or surgical treatment under 
subsection (d) of this section.

(Mar. 4, 1927, ch. 509, Sec. 7, 44 Stat. 1427; May 26, 1934, ch. 354, 
Sec. 1, 48 Stat. 806; June 25, 1938, ch. 685, Secs. 2, 3, 52 Stat. 1165; 
Pub. L. 86-757, Sept. 13, 1960, 74 Stat. 900; Pub. L. 92-576, Sec. 6, 
Oct. 27, 1972, 86 Stat. 1254; Pub. L. 98-426, Sec. 7, Sept. 28, 1984, 98 
Stat. 1642.)


                               Amendments

    1984--Subsec. (b). Pub. L. 98-426, Sec. 7(a), inserted ``or where 
the charges exceed those prevailing within the community for the same or 
similar services or exceed the provider's customary charges''.
    Subsec. (c). Pub. L. 98-426, Sec. 7(b), substituted provisions 
respecting physicians and health care providers not authorized to render 
medical care or services under this chapter for former provision 
respecting physicians designated by the Secretary as authorized to 
render such care and whose names shall be available to employees through 
posting or in such other form as the Secretary may prescribe.
    Subsec. (d). Pub. L. 98-426, Sec. 7(c), substituted provisions for 
the recovery by the employee of amounts spent on medical services which 
the employer failed to provide; for the procedure to be followed for 
recovery; and for suspension of any payments made if the employee 
unreasonably refuses to submit to treatment or examination for former 
provisions which required a request for treatment or services and the 
filing of a physician's report for recovery, and permitted the Secretary 
to excuse a failure to file a report when justified and to suspend 
payment if the employee unreasonably refuses treatment or examination.
    Subsec. (j). Pub. L. 98-426, Sec. 7(d), added subsec. (j).
    Subsec. (k). Pub. L. 98-426, Sec. 7(e), added subsec. (k).
    1972--Subsec. (a). Pub. L. 92-576 reenacted provisions without 
change.
    Subsec. (b). Pub. L. 92-576, substituted provisions for employee's 
choosing of an attending physician authorized by the Secretary, for 
prior provisions for such a choosing from a panel of physicians named by 
the employer and employer's selection of a physician for an employee 
when nature of injury requires immediate medical treatment and care for 
prior provisions for employer's selection of a physician from the panel; 
required Secretary's supervision of medical care rendered and periodic 
reports of medical care furnished; provided for initiative of the 
Secretary or the request of the employer for making change of hospitals 
or physicians and that the change be in the interest of the employee; 
provided for change of physicians pursuant to regulations of the 
Secretary; and deleted prior provision authorizing a second choice of a 
physician from the panel and for selection of physicians for specialized 
services.
    Subsec. (c). Pub. L. 92-576 substituted provisions respecting 
Secretary's designation of physicians in community authorized to render 
medical care and posting of their names for prior provisions respecting 
deputy commissioner's determination of size of panel of physicians 
(named by employer) following statutory criteria and approval of their 
qualifications, and requirement of posting of names and addresses of 
physicians so as to afford reasonable notice.
    Subsec. (d). Pub. L. 92-576 substituted the Secretary for the deputy 
commissioner as the person to exercise the various authorities, struck 
out introductory provisions respecting employer's failure to maintain a 
panel of physicians for examination purposes or to permit the employee 
to choose an attending physician from the panel and employee's 
procurement of treatment and services and selection of a physician at 
expense of employer, decreased from twenty to ten days the period within 
which to make the formal report of injury and treatment, and authorized 
suspension of compensation for refusal to submit to an examination by a 
physician of the employer.
    Subsec. (e). Pub. L. 92-576 substituted provisions respecting 
physical examination to determine medical questions by a physician 
employed or selected by the Secretary, such physician's report of the 
physical impairment, review or reexamination of the employee, and the 
charging of costs to an employer, who is a self-insurer, or the 
insurance company carrying the risk or the special fund for prior 
provisions respecting examination of employee by a physician selected by 
the deputy commissioner (who shall submit a report of the disability) 
whenever the deputy commissioner was of the opinion that the employer's 
physician was partial in his estimate of the degree of permanent 
disability or the extent of temporary disability and charging cost of 
examination to the employer, if he was a self-insurer, or to the 
insurance company which was carrying the risk when the physician's 
estimate was not impartial.
    Subsec. (f). Pub. L. 92-576 added subsec. (f). Former subsec. (f) 
redesignated (g).
    Subsec. (g). Pub. L. 92-576 redesignated former subsec. (f) as (g) 
and substituted ``medical examinations, treatment, or service'' for 
``such treatment or service'', ``charges as prevail in the community for 
such treatment'' for ``charges as prevail in the same community for 
similar treatment of injured persons of like standard of living'', 
``regulation by the Secretary'' for ``regulation by the deputy 
commissioner'', and prescribed issuance of regulations respecting 
medical expenses chargeable against employer. Former subsec. (g) 
redesignated (h).
    Subsec. (h). Pub. L. 92-576 redesignated former subsec. (g) as (h) 
and inserted ``that'' before ``suit''.
    Subsec. (i). Pub. L. 92-576 added subsec. (i).
    1960--Subsec. (a). Pub. L. 86-757 designated first sentence as 
subsec. (a). Remainder of former subsec. (a) redesignated (d).
    Subsecs. (b), (c). Pub. L. 86-757 added subsecs. (b) and (c). Former 
subsecs. (b) and (c) redesignated (e) and (f).
    Subsec. (d). Pub. L. 86-757 redesignated all but first sentence of 
former subsec. (a) as (d), substituting ``If the employer fails to 
provide the medical or other treatment, services, and supplies required 
to be furnished by subsec. (a) of this section, after request by the 
injured employee, or fails to maintain a panel of physicians as required 
by subsec. (c) of this section, or fails to permit the employee to 
choose an attending physician from such panel, such injured employee may 
procure such medical or other treatment, services, and supplies and 
select a physician to render treatment and services at the expense of 
the employer'' for ``If the employer fails to provide the same, after 
request by the injured employee, such injured employee may do so at the 
expense of the employer.'' Former subsec. (d) redesignated (g).
    Subsecs. (e) to (g). Pub. L. 86-757 redesignated former subsecs. (b) 
to (d) as (e) to (g), striking out ``unless and until notice of election 
to sue has been given as required by section 933(a) of this title'' and 
``without the giving of such notice'' before and after ``or suit has 
been brought against such third party'' in subsec. (g).
    1938--Subsec. (a). Act June 25, 1938, Sec. 2, authorized deputy 
commissioner to excuse failure to furnish prescribed medical report.
    Subsec. (d). Act June 25, 1938, Sec. 3, added subsec. (d).
    1934--Subsec. (a). Act May 26, 1934, authorized deputy commissioner 
to suspend payment of compensation for refusal, without justification, 
to submit to medical or surgical treatment.


                    Effective Date of 1984 Amendment

    Amendment by section 7(a), (e) of Pub. L. 98-426 effective 90 days 
after Sept. 28, 1984, and applicable both with respect to claims filed 
after such 90th day and to claims pending on such 90th day, and 
amendment by section 7(b)-(d) of Pub. L. 98-426 effective 90 days after 
Sept. 28, 1984, see section 28(b), (e)(2) of Pub. L. 98-426, set out as 
a note under section 901 of this title.


                    Effective Date of 1972 Amendment

    Amendment by Pub. L. 92-576 effective 30 days after Oct. 27, 1972, 
see section 22 of Pub. L. 92-576, set out as a note under section 902 of 
this title.


               Claims Filed Under Black Lung Benefits Act

    Section 28(h)(1) of Pub. L. 98-426 provided that: ``The amendments 
made by section 7 of this Act [amending this section] shall not apply to 
claims filed under the Black Lung Benefits Act (30 U.S.C. 901 et 
seq.).''

                  Section Referred to in Other Sections

    This section is referred to in sections 904, 906, 928, 931, 933, 944 
of this title; title 30 section 932.



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