24.29.2855    RIGHTS OF THIRD-PARTY PROVIDERS UPON THE UEF'S PROPORTIONATE REDUCTION IN BENEFIT PAYMENTS -- APPLICABILITY

(1) In addition to the provisions of ARM 24.29.2853, providers of medical services who are subject to a proportionate reduction in reimbursement payments from the UEF pursuant to 39-71-510 , MCA, have a right to bring legal action against the uninsured employer for unpaid charges for medical services furnished to the injured worker as follows:

(a) If the UEF does not pay the fee schedule amount due to a proportionate reduction, a medical provider may pursue the uninsured employer for the unpaid portion of the fee schedule amount. The UEF will notify a provider to which services a proportionate reduction was applied.

(b) The uninsured employer has liability for primary medical services and secondary medical services approved by the UEF which are directly related to those conditions arising out of the industrial injury or occupational disease which the UEF accepted as a claim up to the $100,000 expenditure limit.

(2) Pursuant to 39-71-508 and 39-71-743 , MCA, the injured worker is not liable to the provider of medical services for the difference between the amount paid by the UEF and the fee schedule.

(3) This rule applies to claims arising on or after July 1, 2007.

History: 39-71-203, MCA; IMP, 39-71-503, 39-71-508, 39-71-510, 39-71-704, 39-71-727, 39-71-743, MCA; NEW, 2007 MAR p. 1446, Eff. 9/21/07.