Claim for compensation: Duty of treating physician, chiropractic physician, physician assistant or advanced practice registered nurse to file or delegate duty; electronic filing; form and contents; provision of completed form to injured employee; maintenance of forms; penalty

1. Except as otherwise provided in this section, a treating physician, chiropractic physician, physician assistant or advanced practice registered nurse shall, within 3 working days after first providing treatment to an injured employee for a particular injury, complete and file a claim for compensation with the employer of the injured employee and the employer’s insurer. If the employer is a self-insured employer, the treating physician, chiropractic physician, physician assistant or advanced practice registered nurse shall file the claim for compensation with the employer’s third-party administrator. If the physician, chiropractic physician, physician assistant or advanced practice registered nurse files the claim for compensation by electronic transmission, the physician, chiropractic physician, physician assistant or advanced practice registered nurse shall, upon request, mail to the insurer or third-party administrator the form prescribed by the Administrator for a claim for compensation that is signed by the injured employee and the physician, chiropractic physician, physician assistant or advanced practice registered nurse. The form must be mailed within 7 days after receiving such a request. 2. A physician, chiropractic physician, physician assistant or advanced practice registered nurse who has a duty to file a claim for compensation pursuant to subsection 1 may delegate the duty to a physician assistant or an advanced practice registered nurse at a medical facility. If the physician, chiropractic physician, physician assistant or advanced practice registered nurse delegates the duty to a physician assistant or an advanced practice registered nurse at a medical facility: (a) The physician assistant or advanced practice registered nurse, as applicable, at the medical facility must comply with the filing requirements set forth in this section; and (b) The delegation must be in writing and signed by: (1) The delegating physician, chiropractic physician, physician assistant or advanced practice registered nurse; and (2) An authorized representative of the medical facility. 3. A claim for compensation required by subsection 1 must: (a) Be filed on a form prescribed by the Administrator; and (b) Be signed with the original or electronic signatures of the injured employee and: (1) The physician, chiropractic physician, physician assistant or advanced practice registered nurse who treated the injured employee; or (2) The physician assistant or advanced practice registered nurse to whom the duty to file a claim for compensation is delegated pursuant to subsection 2. 4. If a claim for compensation is accompanied by a certificate of disability, the certificate must include a description of any limitation or restrictions on the injured employee’s ability to work. 5. A copy of the completed form that is required to be filed pursuant to subsection 3 and which is fully executed with the required original or electronic signatures must be provided to the injured employee at the time of discharge. 6. Each physician, chiropractic physician, physician assistant, advanced practice registered nurse and medical facility that treats injured employees, each insurer, third-party administrator and employer, and the Division shall maintain at their offices a sufficient supply of the forms prescribed by the Administrator for filing a claim for compensation. 7. The Administrator may impose an administrative fine of not more than $1,000 for each violation of subsection 1 on: (a) A treating physician, chiropractic physician, physician assistant or advanced practice registered nurse; or (b) A physician assistant or advanced practice registered nurse at a medical facility if the duty to file the claim for compensation has been delegated to him or her pursuant to this section.