Colorado § 8-46-208 - Applications - awards.

§ 8-46-208. Applications - awards.

(1) Payments from the major medical insurance fund shall be awarded by the director only after an application therefor has been filed by a claimant employee, the claimant's employer, or such employer's insurance carrier, or one on their behalf, for admission to the fund, in any case where the limits of liability provided under section 8-42-101 have been exhausted.

(2) Following the filing of an application, the director shall approve or disapprove the expenditure of further sums of money from the major medical insurance fund and in so doing may rely upon medical reports contained in the case file if the director deems them adequate, or the director may rely upon recommendations of the medical director, appointed pursuant to section 8-1-103, or the director may appoint a medical panel of not more than three medical experts to see and examine the applicant, each of whom shall render a report to the director, advising whether or not such expenditure of further sums of money will promote recovery, alleviate pain, or reduce disability, suggesting the form and manner of such treatment or services and suggesting the reasonable cost thereof. The director, in every case in which an award is made from this fund, shall review said case at such time as the total medical expenditures, including those expended under section 8-42-101, shall reach fifteen thousand dollars and at each ten thousand dollars increment thereafter to determine and enter an order regarding continuation or cessation of further payments from said fund.

(3) The director shall award, and the state treasurer shall pay from the major medical insurance fund, the reasonable fees and expenses of the appointed members of the medical panel when such procedure is used by the director.

Source: L. 90: Entire article R&RE, p. 548, § 1, effective July 1.

Editor's note: This section is similar to former § 8-66-108 as it existed prior to 1990.

ANNOTATION

Annotator's note. Since § 8-46-208 is similar to § 8-66-108 as it existed prior to the 1990 repeal and reenactment of the "Workers' Compensation Act of Colorado", articles 40 to 47 of this title, relevant cases construing that provision have been included in the annotations to this section.

Application under this section after limit of § 8-49-101 met. The general assembly established the limit of liability under § 8-49-101, and when this limit has been initially reached, application for major medical benefits under this section is appropriate. A later recovery or lack of recovery will only affect the employer's loss experience and premium charges; it cannot affect the question of whether the statutory limit of liability has been exhausted. Weaver-Beatty Motor Co. v. Billen, 36 Colo. App. 442, 541 P.2d 120 (1975).

Granting application for admission to major medical insurance fund is not necessarily an award of worker's compensation benefits. Brothers v. Indus. Comm'n, 733 P.2d 1217 (Colo. App. 1987).

Removing claimant from the major medical insurance fund once admitted was, in effect, a denial of her right to apply for medical benefits. Major Med. Ins. Fund v. Indus. Claim Appeals Office, 77 P.3d 867 (Colo. App. 2003).