Current through Register Vol. 18, September 20, 2024
(1) Compensation benefits paid include
periodic and lump-sum payments for:
(a)
permanent total disability;
(b)
permanent partial disability;
(c)
temporary total disability;
(d)
temporary partial disability;
(e)
loss of hearing, whether under the Workers' Compensation or Occupational
Disease Act for occupational diseases that occurred prior to July 1,
2005;
(f) rehabilitation benefits
(biweekly compensation paid to claimants);
(g) death benefits;
(h) disfigurement payments;
(i) SIF cases, to the extent paid by the
insurer and not reimbursed by the SIF;
(j) settlement amounts paid pursuant to
39-71-741, MCA, except to the
extent any portion of the settlement is reported as being medical benefits
paid;
(k) benefits paid pursuant to
39-71-608, MCA; and
(l) settlement amounts paid pursuant to
39-71-405,
MCA.
(2) Medical benefits
paid include payments for:
(a) medical and
dental treatment;
(b) prescription
drugs;
(c) prosthetics and
orthotics;
(d) other durable
medical goods;
(e) hospital
care;
(f) domiciliary
care;
(g) diagnostic examinations
for the purpose of determining what treatment is necessary;
(h) medical benefits paid pursuant to
39-71-615, MCA; and
(i) hearing loss treatment, whether under the
Workers' Compensation or Occupational Disease Act for occupational diseases
that occurred prior to July 1, 2005.
(3) Miscellaneous expense costs are not
included in the calculation of the administration fund assessment.
Miscellaneous expense costs are all workers' compensation or occupational
disease costs incurred by an insurer other than compensation or medical
benefits paid. These costs include, but are not limited to:
(a) rehabilitation services provided by a
licensed rehabilitation provider or the Department of Public Health and Human
Services;
(b) rehabilitation
expenses, such as books and tuition, or auxiliary rehabilitation benefits, such
as relocation expenses;
(c)
administrative costs for the processing of claims, such as the costs of
investigating or adjusting the claim;
(d) independent medical examinations
requested by the insurer, where the purpose of the examination(s) is not for
the diagnosis or treatment of the claimant's condition;
(e) matching payments to a catastrophically
injured worker's family; and
(f)
various other miscellaneous costs that do not constitute a compensation benefit
or medical benefit provided to the claimant or beneficiary.
(4) Benefits paid include any
amount paid by the insurer or the employer, regardless of any deductible paid
by the employer or reimbursements to the insurer from reinsurance or excess
insurance other than by the claimant. Copayments actually made by the claimant
are not considered to be "benefits paid" for the purposes of this
rule.
(5) The department may
inspect the insurer's records to determine whether the insurer is properly
reporting compensation paid and medical benefits paid.
AUTH:
39-71-203, MCA; IMP:
39-71-201,
39-71-306,
39-71-915,
39-71-1049,
50-71-128,
MCA
