24.29.954 CALCULATION OF AMOUNT OF ADMINISTRATION FUND ASSESSMENT
(1) The administration fund assessment is calculated on the total amount of paid losses as described at 39-71-201, MCA.
(2) 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 39-72-405, MCA.
(3) 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.
(4) With respect to medical benefits, the amount actually paid by the insurer, rather than the amount billed by the provider, is the basis for computation of benefits paid.
(5) 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. Co-payments actually made by the claimant are not considered to be "benefits paid" for the purposes of this rule.
(6) Each insurer must report in the format required by the department, the compensation paid and the medical benefits paid in the preceding year no later than March 1 of each year.
(a) The plan No. 3 insurer must report the amount of compensation benefits and medical benefits paid on old fund claims separately from those amounts expended on new fund claims.
(7) The administration fund assessment is payable directly to the department by the following entities:
(a) all plan No. 1 insurers;
(b) a plan No. 2 insurer that has paid compensation or medical benefits in the prior year, and has reported no premium earned in that prior year, must pay directly to the department an administration fund assessment pursuant to 39-71-201, MCA; and
(c) the plan No. 3 insurer for old fund claims.
(8) The minimum amount of the administration fund assessment for an insurer is calculated as outlined in 39-71-201, MCA.
(9) 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.
(10) In the event an insurer submits an amended report identifying compensation paid and medical benefits paid after the time specified in (6), the department will compare the amended report with the initial report and:
(a) if the amended report results in a change in the amount of administration fund assessment owed by the insurers identified in (7) of $100.00 or more, the department will bill each affected insurer for the additional amount owed;
(b) if the amended report indicates the insurers identified in (7) have overpaid their administration fund assessment by more than $100.00, the department may credit the overpayment to each affected insurer's following year's assessment period; or
(c) if the amended report results in a change in the amount of the administration fund assessment surcharge, the department will adjust the following year's administration fund assessment surcharge to reflect that change.
(11) The department may inspect the insurer's records to determine whether the insurer is properly reporting compensation paid and medical benefits paid.
(12) In determining the amount to be collected through the administration fund assessment, after considering the adjustments made in ARM 24.29.956, the department shall compare the amount actually collected for the administration fund in a given fiscal year to the actual amounts expended from the workers' compensation administration fund for that fiscal year.
(a) As described in 39-71-201, MCA, the "amount collected for a given fiscal year" includes monies intended to cover that fiscal year's assessment, which include:
(i) payment or remittance received by July 1 of the prior fiscal year;
(ii) payment, remittance, or other income received during the current fiscal year; and
(iii) payment or remittance received in the following fiscal year which arrives after the due date but prior to the calculation of the following year's assessment.
(b) The comparison must be done after the due date for the final premium surcharge payments applicable to that fiscal year to be received by the department.
(c) Any amount that is greater than the actual expenditures for the given fiscal year must be allocated to each plan on a proportionate basis toward the following year's calculation of the administration assessment.
(d) Any monies received after the following year's assessment surcharge has been calculated will be credited for the year in which those monies were received.
(e) In making the adjustments for the assessment calculations for FY05, the department shall compare the collections and expenditures for both FY02 and FY03 and make the appropriate adjustments. Beginning with the assessment calculations for FY06, the department will look back to the most recent completed fiscal year.
History: 39-71-203, MCA; IMP, 39-71-201, 39-71-203, 39-71-209, MCA; NEW, 2000 MAR p. 844, Eff. 3/30/00; AMD, 2004 MAR p. 1023, Eff. 3/26/04; AMD, 2012 MAR p. 1666, Eff. 8/24/12.