Section 309 – Add-on fees.

• (1) As used in this section:
  • (a) “Carrier” means a workers’ compensation insurance carrier, the Uninsured Employers’ Fund, an employer that does not carry workers’ compensation insurance, or a self-insured employer as defined in Section 34A-2-201.5.
  • (b) “Indemnity compensation” means a workers’ compensation claim for indemnity benefits that arises from or may arise from a denial of a medical claim.
  • (c) “Medical claim” means a workers’ compensation claim for medical expenses or recommended medical care.
  • (d) “Unconditional denial” means a carrier’s denial of a medical claim:
    • (i) after the carrier completes an investigation; or
    • (ii) 90 days after the day on which the claim was submitted to the carrier.

• (2)
  • (a) The commission may award an add-on fee to a claimant to be paid by the carrier if:
    • (i) a medical claim is at issue;
    • (ii) the carrier issues an unconditional denial of the medical claim;
    • (iii) the claimant hires an attorney to represent the claimant during the formal adjudicative process before the commission;
    • (iv) after the carrier issues the unconditional denial, the commission orders the carrier or the carrier agrees to pay the medical claim; and
    • (v) any award of indemnity compensation in the case is less than $5,000.
  • (b) An award of an add-on fee under this section is in addition to:
    • (i) the amount awarded for the medical claim or indemnity compensation; and
    • (ii) any amount for attorney fees agreed upon between the claimant and the claimant’s attorney.
  • (c) An award under this section is governed by the law in effect at the time the claimant files an application for hearing with the Division of Adjudication.

• (3) If the commission awards an add-on fee under this section, the commission shall award the add-on fee in the following amount:
  • (a) the lesser of 25% of the medical expenses the commission awards to the claimant or $25,000, for a case that is resolved at the commission level;
  • (b) the lesser of 30% of the medical expenses the Utah Court of Appeals awards to the claimant or $30,000, for a case that is resolved on appeal before the Utah Court of Appeals; or
  • (c) the lesser of 35% of the medical expenses that the Utah Supreme Court awards to the claimant or $35,000, for a case that is resolved on appeal before the Utah Supreme Court.

• (4) If a court invalidates any portion of this section, the entire section is invalid.

Repealed and Re-enacted by Chapter 15, 2019 General Session