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.

History: 39-71-203, MCA; IMP, 39-71-225, MCA; NEW, 1994 MAR p. 2630, Eff. 10/1/94; AMD, 2000 MAR p. 2701, Eff. 10/6/00; AMD, 2003 MAR p. 2297, Eff. 10/17/03; AMD, 2006 MAR p. 546, Eff. 2/24/06.