WAC 110-50-0960. Limitations for third party liability reimbursement

(1) The department will: (a) Follow these reimbursement limitations when determining reimbursement amounts for the licensed caregiver third party liability program claims: (i) The total amount the department will pay as the result of one occurrence must not exceed: (A) $25,000 for all property damages and personal injury; (B) $5,000 for emergency medical expenses; or (C) $3,000 for claims related to the ownership or operation of a motor vehicle; (ii) The total reimbursement cost is assessed for each occurrence separately and includes the costs for each item in the occurrence; (iii) The limitations for each occurrence must apply regardless of whether there are multiple claims from the same occurrence; (iv) The total reimbursement cost for property damages, personal injuries, and emergency medical expenses are limited to the costs: (A) Not covered in any insurance policies, up to the maximum occurrence costs in (a)(i) of this subsection; and (B) Of the insurance policy deductible and any out-of-pocket expenses, up to the maximum occurrence costs in (a)(i) of this subsection; and (v) Dental or vision appliances are limited to comparable replacements up to the maximum occurrence costs in (a)(i) of this subsection; (b) Consider damages from the same occurrence claimed by one or more licensed caregivers in the same household as a single occurrence; (c) Pay comparable replacement costs only if the: (i) Item cannot be cleaned or repaired; or (ii) The comparable replacement cost of the item is less than the cleaning or repair cost; (d) Reimburse for labor expenses for the amount payable to a licensed business; (e) Not reimburse claims if the licensed caregivers are not liable to the third party or the child's or youth's birth or adoptive parents or guardians because of: (i) Immunities; (ii) Limitations; or (iii) Exclusions provided by law; and (f) Not require licensed caregivers to use their insurance policy but will only consider reimbursement for the insurance deductible, coinsurance amounts, and any out-of-pocket expenses up to the limit of the occurrence as outlined in (a)(i) of this subsection. (2) Licensed caregivers must: (a) Notify the department if their property damages or losses were paid, will be paid, or are covered by a homeowner's, motor vehicle, or other public, personal, or business insurance policy; and (b) Provide detailed medical bills and insurance statements or explanation of benefits showing the amount covered for emergency medical expenses.