6.10.730 Workers’ Compensation Administrator.
(A) Administrator Authority. The Administrator shall act on behalf of the Gaming Enterprise in receiving, processing, and administering workers’ compensation claims under this article.
(B) Administrator Responsibilities. The responsibilities of the Administrator shall include, but are not limited to, the following:
(1) Determining the compensability of claims pursuant to the provisions of this article, including but not limited to the following:
(a) Eligibility for employee and dependency benefits;
(b) Applicable benefit amounts;
(c) Compensation rate and duration; and
(d) Allocation of dependency benefits.
(2) Approving or disapproving any change of an injured employee’s primary physician, referral to a referral physician, or surgical procedure.
(3) Making payments to claimants.
(4) Processing reports and paying bills submitted by medical care providers and other vendors.
(5) Managing a trust account for managing and paying the Gaming Enterprise’s workers’ compensation liabilities.
(6) Providing reports to the Tribe’s Human Resources Department regarding the workers’ compensation program and individual claims, where required.
(7) Providing reports to the insurance carrier regarding the workers’ compensation program and individual claims, where required.
(8) Providing notice to employees/claimants of the following:
(a) Notice of Choice of Physician. The Administrator shall notify an employee who has submitted a first report of injury that the employee is entitled to his or her choice of physician within the Gaming Enterprise’s medical provider network. If the Gaming Enterprise does not have a medical provider network, the employee is entitled to his or her choice of physician after thirty (30) days have elapsed from the date the injury is reported.
(b) Notice of Administrator’s Determination. Within ninety (90) days of receipt of a first report of injury, and based upon investigation and available information at the time, the Administrator shall determine the responsibility of the Gaming Enterprise for the injury; either accept or deny a claim; and advise the employee and Gaming Enterprise of its determination or the necessity of postponing that decision for another ninety (90) day period to obtain additional information necessary to rendering a decision. The Administrator will determine the reasonableness and necessity of medical care and charges and will determine amounts payable under this article.
(9) Causes of Action on Behalf of Gaming Enterprise. The Administrator shall, on behalf of the Gaming Enterprise, vigorously pursue any cause of action related to a compensable work injury assigned to the Gaming Enterprise under this article; provided, that the Administrator must first advise and obtain the consent of the Tribal Gaming Authority in order to do so. [Res. 19-R-083 § 11, 7/18/2019.]