HAR §12-15-42. Consultations

(a) A consultation includes those services rendered by another physician whose opinion or advice is requested in the evaluation and treatment of an injured employee’s injury. A consultation may be requested by the attending physician, the injured employee, the employer, or the director. Consultation referrals shall be to a physician with expertise and experience on the subject and upon authorization by the employer or upon order of the director. The attending physician shall provide the consultant with all available medical information. (b) When requesting consideration for consultation, the attending physician shall obtain permission from the employer prior to initiating such referral. The name, business address, discipline, and specialty of the consulting physician and the reasons for the consultation shall be submitted in writing to the employer at least seven calendar days prior to referral. (c) Whenever a request for consultation is received, the employer shall respond within seven calendar days after postmark of such request, giving authorization or stating in writing the reason for refusal, to the attending physician, the injured employee, and the director. The refusal shall explicitly state that failure to request a review by the director of the employer’s denial within fourteen calendar days after postmark of the employer’s denial shall be construed as acceptance of the employer’s denial. If a request for consultation with the same medical specialty has been denied, the attending physician may not resubmit the same request for consultation with the same medical specialty for forty-five calendar days after postmark of the employer’s denial. Failure by the employer to respond within seven calendar days shall constitute approval of the request. (d) The attending physician or the injured employee 20 may request in writing that the director review the employer’s denial of the request for consultation. The request for review shall be filed with the director, copying the employer, within fourteen calendar days after postmark of the employer’s denial. A copy of the denied consultation request shall be submitted with the request for review. Failure to file a request for review of the employer’s denial to the director within fourteen calendar days after postmark of the employer’s denial shall be deemed acceptance of the employer’s denial, and the attending physician may not resubmit the same request for consultation with the same medical specialty for forty-five calendar days after postmark of the employer’s denial. The director shall hold a hearing on the request for review, and issue a decision approving or denying the request for consultation based on the evidence presented (inclusive of records on file). The decision shall be final unless appealed pursuant to section 386-87, HRS. The appeal shall not stay the director’s decision. (e) When consultation is required immediately because the condition is life-threatening or could cause serious harm, the attending physician shall notify the employer as soon as possible. (f) The consultant shall provide a copy of the consultation report to the attending physician and the employer within fourteen calendar days of the date of the examination. (g) When the consulting physician assumes the continuing care of the patient, this subsequent service will no longer be considered a consultation. If the industrial injury or condition necessitates the concurrent medical services and skills in accordance with section l2- l5-40 of two or more physicians, each physician shall be entitled to the listed fee for services rendered. (h) Fees for consultations requested by the attending physician, the injured employee, or the employer shall be paid by the employer. Fees for consultations requested by the director shall be paid from funds appropriated by the legislature for use by the department. (i) For groups of physicians or hospitals with satellite clinics, when service is rendered by a member of a group and the patient is referred to another physician in the group for consultation, fees for such consultation may be allowed. [Eff 1/1/96; am 1/1/97; am 12/17/01] (Auth: HRS §§386-2l, 386-26, 386-72) (Imp: HRS §§386-21, 386-26) §§12-15-43 to 12-15-49 (Reserved) 21