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RULE 58 MANAGED CARE - DISPUTE RESOLUTION
A Disputes that arise between the employee, health care provider, managed care plan, insurer, risk management pool, or employer, involving the question ofinappropriate, excessive, or not medically necessary treatment, medical disputes, and those disputes listed under Rule 56,C shall first be processed without charge to the employee or health care provider through the dispute resolution procedure ofthe managed care plan. The managed care plan dispute resolution procedure must be completed within 30 days ofreceipt ofa written request.
B Under section 48-120.02, an employee shall exhaust the dispute resolution procedure ofthe certified managed care plan prior to filing a petition or otherwise seeking relieffrom the court on an issue related to managed care. Ifan employee has exhausted the dispute resolution procedure ofthe managed care plan, the employee may submit the dispute to the court for informal dispute resolution or may seek a medical finding by an independent medical examiner. No petition may be filed with the court pursuant to section 48-173 solely on the issue ofthe reasonableness and necessity ofmedical treatment unless a medical finding on such issue has been rendered by an independent medical examiner, but such finding shall not thereafter preclude the filing ofa petition. A petition may be filed with the court for the purpose ofavoiding the running ofthe applicable statute oflimitations in which case the petition shall be deemed filed with the court for purposes ofthe statute oflimitations and will be held in abeyance until the medical finding on the issue has been received from the independent medical examiner.
Sections 48-120.02, 48-134.01, 48-173, RRS. 2010, and 48-120, RS. Supp., 2016.
Effective date: July 1, 1997.