The exams and treatment ACAA can require of you

It is Article 9 of Act 111-2020, titled "Examination, Analysis, Treatment and Rehabilitation of Injuries; Determination of Facts". It defines what ACAA may require of an injured claimant, and what it may require of third parties holding information about them: doctors, hospitals, clinics and public or private medical institutions, and employers.

It reaches any person whose physical or mental condition is relevant to a claim filed or about to be filed with ACAA for payment of past or future services and benefits. The duties to supply information reach medical-hospital providers that treated the injury — or that previously treated the injured person for any prior injury or condition that may be related — and every employer of the injured person.

• Submitting to the medical examinations the Administration determines are necessary, when your physical or mental condition is relevant to the claim.Verified against the official source
• Complying with orders for rehabilitation treatment or training that are reasonable and justified.Verified against the official source

Information pending verification.

1. 1

   Step 1: The exams it can order

   Paragraph A puts it thus: whenever a person’s physical or mental condition is relevant to a claim that has been filed or is about to be filed for the payment of past or future services and benefits, the Administration may order that person to submit to the medical examinations it determines are necessary. Note the reach: the claim need not already be filed; it is enough that it is about to be.

2. 2

   Step 2: What happens if you refuse

   Paragraph B leaves no room: if the person refuses to submit to a medical examination, or to comply with any order of the Administration under the preceding paragraph, the Administration shall make no payment to that person, or to their beneficiaries. Per the article’s wording it is not a reduction or a temporary suspension: it is that it shall make no payment, and it reaches the beneficiaries too.

3. 3

   Step 3: Rehabilitation too

   Paragraph C adds that the Administration may order any injured person to submit to rehabilitation treatment or training that is reasonable and justified. Here the language is slightly less absolute: refusing to comply with these orders may entail the loss of services and benefits. "May", not "shall make no payment". But the risk is the same and the two words that protect you are the ones qualifying the order: reasonable and justified.

4. 4

   Step 4: The toxicology test: the limit and the gap

   The Act sets ACAA a clear limit and then works around it. The limit: the Administration may not order a person to submit to a chemical-toxicological test. The workaround: it has the right to obtain a copy of a test performed, on medical judgement and in the course of medical treatment, by a medical-hospital provider under Department of Health regulations, and of those performed by the Department of Health or any other authorised government entity, through judicial orders obtained by law-enforcement officers, and those carried out under Act 22-2000. Paragraph D closes the circle: where a claiming driver consented to a chemical-toxicological or breath test, or one was performed on medical judgement, by judicial order or at a prosecutor’s or officer’s request, the Administration may use the analysis as part of the administrative file to determine eligibility for coverage, and is entitled to a true copy.

5. 5

   Step 5: Your doctors have thirty days

   Paragraph E requires every doctor, hospital, clinic or public or private medical institution that provided services related to the injury — or that previously treated the injured person for any prior injury or condition that may be related — to supply the Administration, on request, all information or a true copy of its records, including a written report of history, condition, treatment, dates and costs, and to permit inspection of all related records. The compliance term is thirty (30) calendar days from the request, and non-compliance is sufficient cause to rescind any contractual relationship the Administration has with that provider.

6. 6

   Step 6: And your employer opens the payroll

   Paragraph F requires every employer to allow the Administration, on request, to examine and copy, and to supply, the personnel file, payrolls, work records and sworn statements of the wages the injured person earned, plus any other document relevant to a claim, for the period after the date of the injuries and for the one (1) year before the accident date. That year backwards is what allows loss of income to be computed. Paragraph G adds that any employer, doctor, hospital, clinic or institution supplying information may be reimbursed the cost of doing so, per the rates the Administration sets.

7. 7

   Step 7: What ACAA knows about you is confidential

   Paragraph H protects it: information obtained by the Administration or its duly authorised employees, in the course of investigations conducted in exercise of this Act’s powers, shall be privileged and confidential, and may only be disclosed with the Executive Director’s authorisation, or a competent court’s when the injured claimant’s physical condition or medical treatment is a fact in controversy in a judicial proceeding. And in that last case, the court’s authorisation is understood to apply only to information relating to the claimant’s physical condition or treatment: it does not open the whole file.

There is nothing to apply for: these are powers ACAA exercises over a claim in progress or about to be filed. If you are called to an examination or ordered into rehabilitation, the communication will come from the Administration. The Act publishes no forms or addresses for these steps and we do not invent them here.

• Missing a medical examination ordered by ACAA: the Act says no payment will then be made, to you or your beneficiaries.
• Believing ACAA can compel a chemical-toxicological test: it cannot order one, though it may obtain a copy of one already performed.
• Thinking a test done at the hospital never reaches ACAA: the Act gives it the right to a copy and to use it to determine eligibility for coverage.
• Refusing rehabilitation without arguing whether it is reasonable and justified, the condition the Act attaches to the order.
• Assuming your employer need hand over nothing: it must open the personnel file, payrolls and records for the year before the accident.
• Believing the ACAA file is public: it is privileged and confidential, and its disclosure is limited.

These are the government pages this guide is based on.

• Administración de Compensaciones por Accidentes de Automóviles (ACAA)

  ACAA

  docs.pr.gov

• Automobile Accident Compensation Administration

  acaa

  www.acaa.pr.gov