Terms defined in 39-71-116, MCA, are used in subchapter 31 as they are defined by statute. As used in subchapter 31, the following definitions apply unless the context clearly indicates otherwise:
(1) "Accepted" means the petition has been evaluated by the department and was found to be eligible to be considered for medical review.
(2) "Additional information" means information other than a medical record, supplied by a worker or an insurer, and tendered as being relevant to the reopening of medical benefits.
(3) "Approved" means that after the medical review has been performed, medical benefits are reopened for not more than two years before being subject to a biennial review.
(4) "Denied" means that after the medical review has been performed, medical benefits are not reopened.
(5) "Department" means the Department of Labor and Industry.
(6) "Dismissed" means the petition has been evaluated by the department and was found to be ineligible to be considered for medical review.
(7) "Filed" means the status of a petition once it has been accepted by the department for medical review.
(8) "Joint petition" means a petition for reopening that has been signed by both the worker and the insurer, with agreed-to terms concerning the reopening of medical benefits.
(9) "Medical records" means documents related to the medical condition of the worker, and includes but is not limited to, notes, reports, and letters prepared by health care providers. The term does not include medical billing materials.
(10) "Medical review panel" means the department's medical director and two additional physicians selected from a pool of available physicians, who can review a petition for the reopening of medical benefits, as provided for in 39-71-717, MCA.
(11) "Periodic review" means the every-two-years consideration by the medical review panel or the medical director as to whether the recommendations previously made should be continued or changed.
(12) "Petition" means the department-provided form upon which a party requests that medical benefits which have been terminated by the operation of 39-71-704, MCA, be reopened.
(13) "Physician" means a health care provider who takes part in a medical review panel under subchapter 31. A physician must be licensed in Montana in one or more of the following categories:
(a) medical doctor;
(e) physician assistant; or
(f) advanced practice registered nurse.
(14) "Received" means a petition which has been delivered to the department, but has not yet been accepted and filed by the department.
(15) "Reopened" means medical benefits which had terminated by operation of law, and which are now to be furnished by the insurer as recommended by the medical report.
(16) "Report" means the written recommendations of the medical director or medical review panel concerning whether or not medical benefits should be reopened, and if reopened, to what extent those benefits should be furnished.
(17) "Returned" means the petition has been evaluated by the department and has been found to be incomplete.
(18) "Submission," as used in 39-71-717(8), MCA, means the same as being filed with the department.
(19) "Submit," as used in 39-71-717(6), MCA, means to deliver medical records or additional information to the department.
(20) "Work" means supplying labor or services for remuneration, although not necessarily in employment by another.
(21) "Worker" means the individual who suffered the workplace injury or occupational disease upon which basis a claim for benefits was made to the insurer.
(22) "Year" means 12 calendar months.
History: 39-71-203, MCA; IMP, 39-71-116, 39-71-717, MCA; NEW, 2016 MAR p. 204, Eff. 2/6/16; AMD, 2018 MAR p. 2527, Eff. 1/1/19.