Mich. Admin. Code R. 408.33 - Disputed claims; late payment penalty
Rule 3.
(1) On or
before the fourteenth day after the employer has notice or knowledge of an
alleged injury or death, the carrier, PEGSISF, and self-insurers' security fund
shall notify the agency on form WC-107, or its electronic
equivalent, if the right of the injured or dependent to compensation is
disputed. A copy of the form WC-107, notice of dispute, must be
provided to the injured employee.
(2) The following subdivisions govern the
administration and enforcement of the penalty provisions under section 801 of
the act, MCL 418.801:
(a) Under section 801(1)
of the act, MCL 418.801, compensation must be paid promptly and directly to the
person entitled to compensation. Weekly benefits become due and payable on the
fourteenth day after the employer has notice or knowledge of the disability or
death. On that date, all compensation that has accrued must be paid. If
benefits are not paid within 30 days of becoming due and payable, then the
carrier shall pay to the employee $50.00 per day for each day after 30 days
that the benefits remain unpaid, not to exceed $1,500.00.
(b) If a case is in litigation and the
defendant agrees to pay benefits on a voluntary basis, then the magistrate
shall specify the weekly compensation rate, the period of time for which
accrued benefits have become due, and which medical bills shall be paid by the
carrier as a result of the injury or disability. If the benefits agreed to are
not paid within 30 days of the date the agreement is formalized by the
magistrate, then the carrier shall pay to the employee $50.00 per day for each
day after 30 days that the benefits remain unpaid, not to exceed
$1,500.00.
(c) A medical bill
becomes due and payable when the carrier or employer has received reasonable
proof and the itemized bill. If there is a dispute resulting in a delay in
paying the medical bills, then the carrier shall advise the employee and doctor
of the reasons for the delay in writing. If there is no dispute and the bill
remains unpaid 30 days after the carrier has received notice of nonpayment by
certified mail, then the carrier shall pay to the employee $50.00 for each day
after 30 days that the bill remains unpaid, not to exceed $1,500.00.
(d) The travel allowance for medical
examination, treatment, or rehabilitation is provided in
R
408.45. The employee shall be notified by the carrier,
in writing, of any dispute resulting in a delay in paying travel allowance
payments. If the expenses are not paid within 30 days of the date of the
carrier's receipt of notification of non-payment by certified mail, and if the
expenses are not disputed, then the carrier shall pay the employee $50.00 for
each day after 30 days that the expenses remain unpaid, not to exceed
$1,500.00.
(e) Under section 801(4)
of the act, an employer may be liable for all or a portion of the penalty
provided in section 801(2) of the act, MCL 418.801. If there is a dispute
between an employer and insurance carrier as to who is liable for the payment
of the penalty, the carrier shall be liable for paying the penalties, but may
be entitled to reimbursement from the employer.
(f) Any employee who may be entitled to
penalty payments under section 801 of the act, MCL 418.801, and who has not
received the payments may apply by notifying the agency in writing. A copy of
the request must be forwarded to the carrier. In all cases, the agency shall
respond within a reasonable period of time and shall act, as it deems
appropriate, to resolve any disputes involving the penalty provisions of
section 801 of the act, MCL 418.801. If a dispute continues beyond a
determination by the agency or if the director believes there is a question of
compliance with the act, then the dispute may be set for a hearing under
R
408.35. A party to a dispute may request a formal
hearing before a magistrate.
(g) A
carrier shall pay any penalty amounts due an injured employee as a result of
the penalty provisions specified in section 801 of the act, MCL 418.801, in a
separate check. Penalty amounts are not a part of the basic benefits to which
an employee is entitled for the purpose of loss or assessment.
(h) Benefits, allowances, or bills are
presumed paid within 30 days if a check is mailed within 27 days of becoming
due and payable under these rules.
Notes
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