(1) The department shall determine the right of an insurer to SIF reimbursement of medical and indemnity payments to an SIF-certified individual in accordance with the criteria outlined by this rule.

(2) The insurer shall provide written notice to the department no sooner than 150 days or later than 90 days before the SIF becomes liable to reimburse the insurer for medical or indemnity benefits paid on behalf of the SIF-certified individual.

(3) After an insurer's right to SIF reimbursement has been established, the department recommends the insurer request SIF reimbursement in writing at six-month intervals.

(a) The department may not reimburse the insurer for medical benefits paid to or on behalf of an SIF-certified individual during the first 104 weeks following the date of injury. The insurer shall submit copies of the SIF-certified individual's first report of injury and all related medical reports for department review.

(b) The department may not reimburse an insurer for indemnity benefits until after the insurer has paid a total of 104 weeks of indemnity benefits to the SIF-certified individual.

(4) Each reimbursement request must state the amount of reimbursement claimed for medical and indemnity payments and include the following documentation for the six-month reimbursement period:

(a) computer printout or comparable listing that identifies the type of indemnity payment to the SIF-certified individual (temporary partial disability, temporary total disability, permanent partial disability, or permanent total disability) and includes check numbers, dates checks were issued, dates of indemnity, total weeks of indemnity, and the total amount paid;

(b) computer printout or comparable listing of all medical bills paid, including check numbers, dates checks were issued, provider names, and dates of service; and

(c) copies of all medical bills with the corresponding explanations of benefits and directly related medical records.

(5) The insurer shall notify the SIF representative and the department at the outset of settlement negotiations involving an injured individual who is SIF-certified. The insurer shall waive the right to SIF contribution by failing to notify the department at the outset of settlement negotiations.

(6) The insurer shall submit any negotiated settlement agreement to the SIF representative and the department for approval prior to final settlement.

(7) Disputes arising over payment or reimbursement between the department and the insurer may be resolved by the contested case hearing process, pursuant to ARM 24.29.207, at the written request of the either party.