R 408.32 Compensation supplement fund; "maximum benefit" defined.

Rule 2. (1) A carrier, second injury fund, PEGSISF, or self-insurers’ security fund shall claim reimbursement from the compensation supplement fund for payments made in accordance with section 352 of the act, MCL 418.352. A carrier, second injury fund, PEGSISF, or self-insurers’ security fund shall make a claim on the form WC-114, or its electronic equivalent, application for reimbursement. (2) A carrier, second injury fund, PEGSISF, or self-insurers’ security fund shall make an initial application for reimbursement not later than 3 months after the end of the quarter for which the right to reimbursement first accrues. The right to reimbursement first accrues on the first day of the quarter following any quarter for which supplemental benefits are first paid or ordered to be paid. (3) A carrier, second injury fund, PEGSISF, or self-insurers’ security fund may make subsequent application for reimbursement quarterly, but not later than 1 year after the closing date of the quarter for which reimbursement is being requested. (4) A carrier, second injury fund, PEGSISF, or self-insurers’ security fund shall submit a separate form WC-114, or its electronic equivalent, for each quarter for which reimbursement is requested. A quarter, as used in this rule, is based on a calendar year as identified by the agency on an annual basis. (5) Upon a proper showing of a claim for reimbursement, the compensation supplement fund shall make payment within a reasonable time after the receipt of the claim. The compensation supplement fund shall normally make reimbursement within 3 months after the receipt of form WC-114, or its electronic equivalent, unless a dispute arises. (6) For the purpose of these rules, "maximum benefit" means the statutory maximum for the year of injury upon which benefits are based; 2/3 of the employee’s average weekly wage on the date of injury; the minimum compensation rate in effect on the date of injury; or a maximum compensation rate established by agency order. If an employee, or his or her dependents, is receiving maximum benefits as defined in this subrule, there will be a presumption that benefits are being paid under section 351 or 321 of the act, MCL 418.351 and 418.321. (7) A compensation supplement may not be paid for any of the following received by an eligible employee or dependent: (a) Benefits received for any period of disability before January 1, 1982. (b) Benefits received under an agreement to redeem the liability of the carrier. (c) A lump sum payment for remarriage under section 335 of the act, MCL 418.335. (d) Interest paid on benefits awarded by a magistrate. (e) Partial compensation paid under section 361(1) of the act, MCL 418.361. (8) In a case involving a lump sum advance payment, supplemental benefits are not part of the advance payment, but must continue to be paid weekly. (9) In a case involving the carrier’s right to subrogation in a third-party recovery, the amount of supplemental benefits is based on the weekly compensation rate that the employee would have been receiving on January 1, 1982. (10) If compensation supplement benefits have been paid and if the employee is later found to be entitled to total and permanent disability benefits, then the second injury fund shall reimburse the compensation supplement fund for the appropriate amount of benefits paid by the compensation supplement fund, and the second injury fund shall reimburse the carrier for the balance of benefits that would have otherwise been paid by the compensation supplement fund. (11) If the second injury fund is paying differential benefits directly to the injured employee and if the amount of differential benefits increases, then the second injury fund either shall reimburse the compensation supplement fund for any overpayment of money that the compensation supplement fund has already reimbursed the carrier or shall reimburse the carrier directly in cases where the compensation supplement fund has not yet reimbursed the carrier. (12) If a case is on appeal over the issue of whether the injured employee is totally and permanently disabled and if the claimant is receiving 70% of the amount of differential benefits that would be owed if total and permanent disability is found to apply, the amount of supplement that is due may be reduced or offset by the 70% amount that is being paid. (13) If the compensation supplement fund has reimbursed a carrier for the supplemental benefits paid, and if it is later found that the amount reimbursed included an overpayment, then the compensation supplement fund is entitled to recoupment of the overpayment from the carrier. The carrier is entitled to recoup the overpayment from the employee. (14) Section 357 of the act, MCL 418.357, may not be applied when the amount of supplemental benefit, as provided for in section 352 of the act, MCL 418.352, is calculated for eligible employees whose date of personal injury is before July 1, 1968. (15) After the supplemental benefit has been computed in accordance with section 352(1) of the act, MCL 418.352, based on the weekly compensation rate that the employee or dependent of a deceased employee is receiving or is entitled to receive on January 1, 1982, had the employee been receiving benefits at that time, the supplemental benefit may not be reduced or increased by changes to the weekly compensation rate that occur after January 1, 1982, except as provided in section 352 of the act, MCL 418.352, and in this rule.