Code of Maine Rules
02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION
031 - BUREAU OF INSURANCE
Chapter 530 - PROVISIONAL MEDICAL OR DISABILITY PAYMENTS TO WORKERS' COMPENSATION CLAIMANTS
Section 031-530-5 - Offset
Current through 2024-38, September 18, 2024
A. The health carrier may exercise the right of offset at any time after receiving a request for payment pursuant to Section 4, by notifying the workers' compensation carrier in writing of the amount of provisional payment that has been or will be made and requesting reimbursement. A notice of offset is effective immediately upon receipt and remains in effect until expressly rescinded in writing.
B. If the health carrier is no longer liable for provisional payments, pursuant to Section 4, and a notice of offset is in effect, the workers' compensation carrier is obligated to reimburse the health carrier in such amounts and at such times as it would otherwise be obligated to pay the claimant, until the amount requested, reduced by any amount the health carrier has not yet paid or has already sought to recover directly from the claimant, has been paid in full.
C. If the workers' compensation carrier makes any payment directly to the claimant or health care provider within the meaning of 39-A M.R.S.A. §206, rather than to the health carrier, while a notice of offset is in effect, the full amount of that payment shall be considered an obligation to the claimant for purposes of Subsection 5(B), and the appropriate reimbursement to the health carrier shall be due immediately from the workers' compensation carrier. Any resulting overpayment may be recovered from the claimant by the workers' compensation carrier once the health carrier has been paid.
D. If the health carrier accepts a claim and pays provisional benefits, the workers' compensation carrier must treat the services as medically necessary and as rendered by an appropriate provider in compliance with all applicable procedural requirements. However, this Subsection does not exempt claimants or providers from compliance with notice requirements set forth in Subsection 206(9) and Section 208 of the Workers' Compensation Act, Title 39-A M.R.S.A., or in rules adopted by the Workers' Compensation Board, to the extent that such requirements by their terms are generally applicable to controverted claims.
