Mont. Admin. R. 24.29.4303 - DEFINITIONS
For the purpose of this subchapter, the following definitions apply, unless the context of the rule clearly indicates otherwise:
(1) "Closed " or "closed claim" means a claim
on which all medical and indemnity benefits have been paid, and there is no
expectation of future liability.
(2) "Data base system " means the electronic
repository for workers' compensation data established by
39-71-225,
MCA.
(3) "Electronic data
interchange ", or "EDI" means the intercompany exchange of standard business
documents in a machine readable and standardized form.
(4) "Indemnity benefits " means any payment
made directly to the worker (or the worker's beneficiaries), other than a
medical benefit. The term includes payments made pursuant to a reservation of
rights, or in settlement of a dispute over initial compensability of the claim.
The term does not include expense reimbursements for items such as meals,
travel or lodging.
(5) "Indemnity
claim " means a workers' compensation or occupational disease claim where
indemnity benefits in addition to medical benefits are being paid or are likely
to be paid in the future.
(6)
"IAIABC " means the International Association of Industrial Accident Boards and
Commissions, which is an international trade association that seeks to advance
the administration of workers' compensation systems through education, research
and information sharing. The IAIABC establishes standards for reporting
industrial accidents.
(7) "Plan 1 "
or "Plan 1 self-insurer" means an employer that has been properly bound by the
provisions of Title 39, chapter 71, part 21.
(8) "Plan 2 " or "Plan 2 private insurer"
means an insurer that provides workers' compensation insurance pursuant to the
provisions of Title 39, chapter 71, part 22.
(9) "Plan 3 " or "state fund" means the state
compensation insurance fund, established by Title 39, chapter 71, part 23,
MCA.
(10) "Reporting parties " means
any person, firm, corporation, or any other type of entity required by Title
39, chapter 71, part 2, MCA, to report information to the department.
(11) "Third-party administrator " means an
entity who contracts to administer all or part of an insurer's or employer's
workers' compensation business, which can include adjusting a claim on behalf
of the insurer or employer.
(12)
"Trading partner " means the entity which actually transmits the data to the
department, excluding the intermediary channels that are used to get it to that
final point, even if those channels include the legally responsible regulated
party.
(13) "UEF " means the
Uninsured Employers' Fund, established by
39-71-503,
MCA.
(14) "Workers' compensation
subsequent report " means a report required to communicate payment information
related to an indemnity claim , including both medical and indemnity
benefits .
Notes
39-71-203, MCA; IMP, 39-71-225, MCA;
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