HI HB1637

Private health care plans must by default pay for medical care, services, and supplies for controverted workers' compensation claims pending acceptance or determination of compensability.

If a claim is accepted or deemed compensable, the private health care plan may seek reimbursement from the employer for reasonable and necessary medical expenses authorized by workers' compensation law.

Injured employees must be reimbursed directly for any copayments related to the covered injury.

Claims not accepted by the employer are deemed denied regardless of modifiers such as "denied pending investigation."

Private health care plans violating this section face a penalty of $10,000 or triple the amount of medical costs incurred during investigation, whichever is greater.