§ 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.
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\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.