Alabama § 16-1A-5 - Public Education Employee Injury Compensation Program.

§ 16-1A-5. Public Education Employee Injury Compensation Program.

(a) There is established the Public Education Employee Injury Compensation Program.

(b)(1) Except as provided in this section, the program implemented pursuant to this section shall not be subject to Chapter 5 of Title 25, or its successor, otherwise known as the Alabama Workers’ Compensation Act.

(2) Notwithstanding subdivision (1), if an employee is subject to this chapter, then compensation, in accordance with the Alabama Workers’ Compensation Act, shall be paid by the Public Education Employee Injury Compensation Trust Fund, as established under this chapter, in accordance with the statutes, provisions, defenses, and calculation methods set forth in the Alabama Workers’ Compensation Act and any case law interpreting the same.

(c)(1) For injured employees covered by PEEHIP, payments made to physicians licensed to practice medicine or other medical providers for services to injured employees shall be paid by PEEHIP in accordance with the PEEHIP fee schedule. The board shall reimburse such injured employees for copayments and deductibles not paid for by PEEHIP; provided, that the board shall not be required to pay such copayments or deductibles for any medical treatment or attention, physical rehabilitation, medicine, medical or surgical supplies, crutches, artificial members, or other apparatus, other than as may be reasonably necessary and otherwise owed under the Alabama Workers’ Compensation Act.

(2) For injured employees not covered by PEEHIP, the board shall provide payments for medical treatment for an on-the-job injury. The liability of the board for payment of services rendered by physicians, as well as any other medical services, shall not exceed the maximum fees established under Section 25-5-313. Employees shall not be liable to physicians, or for any other medical services, for any amount in excess of the schedule of maximum fees established under Section 25-5-313, and consistent with Section 25-5-314. This language shall not prohibit the board from negotiating any rates, fees, or levels of reimbursement, which shall be mutually agreed upon between the physicians, hospitals, any other healthcare providers, and the board.

(d)(1) All undisputed medical reimbursements or payments shall be made within 25 working days of receipt of claims in the form specified in Section 25-5-3.

(2) An amount equal to 10 percent of any unpaid balance shall be added to any undisputed medical invoice which is not paid within 25 working days.

(e) Any regulation, policy, or program directive for the conduct of utilization review, bill screenings, and medical necessity determinations related to services provided by physicians licensed to practice medicine shall comply with the rules adopted by the Workers’ Compensation Medical Services Board under Section 25-5-312.

(f) Any rules adopted by the board shall be subject to the Alabama Administrative Procedure Act, and a final determination as to benefits payable under the program shall be subject to review by the Circuit Court in Montgomery County in the manner prescribed by the Alabama Administrative Procedure Act.

(g) Employers shall continue to make all required health insurance contributions until any separation from employment.

(h) The board shall establish procedures for employers to be reimbursed by the fund for the costs of an employee’s compensation and benefits under this chapter; except for salary and benefits provided by employers under Section 16-1-18.1.

(i) PEEHIP and the Public Education Employee Injury Compensation Trust Fund established under Section 16-1A-3, as to their respective payments, may subrogate, seek reimbursement, or seek credit for any amount paid to an injured employee under the program from any third party, or the employee’s insurer, responsible for the injury. Any action to recover shall be filed in the Circuit Court of Montgomery County.

(j) Any on-the-job injuries suffered by individuals not covered by this chapter, such as part-time, substitute, temporary, non-full-time employees and volunteers, shall be conducted in accordance with the Board of Adjustment process outlined in Article 4 of Chapter 9 of Title 41.