R 408.32a Medical benefits; reimbursement application.

Rule 2a. (1) To be reimbursed for payments made in accordance with the provisions of section 862(2) of the act, MCL 418.862, medical benefits must have been required by the terms of an award and been paid in accordance with section 315 of the act and the rules promulgated under section 315 of the act, MCL 418.315. In providing benefits as required by section 862(2) of the act, MCL 418.862, a carrier shall require that the employee and the provider comply with the requirements of section 315 of the act, MCL 418.315. (2) Reimbursement shall apply only to cases for which an initial application for mediation or hearing is filed after March 31, 1986, under section 847 of the act, MCL 418.847. Claims must be made on forms provided by and submitted to the agency. If other insurance coverage is or was available to cover medical benefits paid under section 862(2) of the act, MCL 418.862, then the agency will not make reimbursement. (3) Applications for reimbursement from the agency must be made not less than 30 days after the benefit amount is reduced or rescinded by a final determination. An application for reimbursement must be made not later than 1 year after a final determination is entered that reduces or rescinds benefits. (4) Reimbursement from the agency must be consistent with benefits awarded in the magistrate’s decision. Reimbursement will only be made for medical benefits that were provided between the agency mailing date of the magistrate’s award and the mailing date of the final determination of the appeal or for a shorter period as specified in the award. A copy of the magistrate’s order and all subsequent appellate decisions must accompany each request for reimbursement. (5) A copy of the medical bills, proof of payment, and a medical report with sufficient documentation to demonstrate that the medical services provided fall within the provision of the magistrate’s decision must accompany each request for reimbursement. Proof of payment must include certification from the carrier that it has paid the medical bills or, if requested by the agency, must include a receipt from the provider that shows that payment has been made. (6) Reimbursement may not be paid if the claim was redeemed before the final determination or if the carrier has not provided proper documentation. (7) The agency shall not pay interest on reimbursable amounts. (8) If the agency determines that all or part of the request for reimbursement is not proper, then the agency shall notify the carrier in writing. If the carrier disputes the determination, then it may file an application for mediation or hearing.