24.29.804    EXAMINERS AND THIRD-PARTY ADMINISTRATORS IN MONTANA

(1) All workers' compensation and occupational disease claims filed pursuant to the Montana Workers' Compensation and Occupational Disease Acts must be adjusted by a certified claims examiner in Montana. For the purposes of this rule a certified claims examiner must maintain an office that is located in Montana and adjust Montana claims from that office. The office may be in the examiner's personal residence located in Montana. The sole use of a mail box or mail drop located in Montana does not constitute maintaining an office in Montana.

(2) An insurer must maintain the documents related to each claim filed with the insurer under the Montana Workers' Compensation and Occupational Disease Acts at the office of the person adjusting the claim in Montana until the claim is settled. The documents may either be original documents, or duplicates of the original documents, and must be maintained in a manner which allows the documents to be retrieved from that office and copied at the request of the claimant or the department. Settled claim files stored outside of the certified claims examiner's office must be made available by the insurer within 48 hours of a request for a file. Electronic or optically imaged documents are permitted by this rule.

(3) For purposes of (2), a "settled claim" means a department-approved compromise of benefits between a claimant and an insurer. The term "settled claim" does not include a claim where there has only been a lump sum advance of benefits.

(4) At least 14 days in advance of a change in a third-party administrator responsible for workers' compensation claim examination services, the insurer must notify the department in writing, using the department's current Third-Party Administrator Change Form or by another format preapproved by the department. The written notification must be mailed, faxed, or e-mailed to the department's designated contact person.

(5) The insurer may delegate the duty to notify the department to a third-party administrator.

(6) Failure to timely notify the department of a change in a third-party administrator may result in the imposition of an administrative penalty against the insurer, pursuant to 39-71-107, MCA.

 

History: 39-71-107, 39-71-203, MCA; IMP, 39-71-105, 39-71-107, 39-71-320, MCA; Eff. 12/31/72; AMD, Eff. 2/5/76; AMD, 2000 MAR p. 2701, Eff. 10/6/00; AMD, 2013 MAR p. 841, Eff. 5/24/13; AMD, 2019 MAR p. 2119, Eff. 12/1/19.