1999 Montana Legislature

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ASSESSMENT AS A POLICYHOLDER SURCHARGE BASED ON PREMIUM; AMENDING SECTIONS 39-9-401, 39-71-123, 39-71-201, 39-71-225, 39-71-432, 39-71-501, 39-71-503, 39-71-510, 39-71-517, 39-71-519, 39-71-605, 39-71-610, 39-71-725, 39-71-905, 39-71-915, 39-71-1004, 39-72-405, 39-72-608, AND 39-72-714, MCA; REPEALING SECTION 39-71-502, MCA; AND PROVIDING EFFECTIVE DATES, A RETROACTIVE APPLICABILITY DATE, AND A TERMINATION DATE.

Montana State Seal

AN ACT REVISING CERTAIN LAWS WITHIN THE WORKERS' COMPENSATION ACT THAT ARE ADMINISTERED BY THE DEPARTMENT OF LABOR AND INDUSTRY; PROVIDING A CHANGE IN THE WORKERS' COMPENSATION REGULATORY ASSESSMENT; PROVIDING THE DEPARTMENT OF LABOR AND INDUSTRY WITH RULEMAKING AUTHORITY FOR DATA COLLECTION FOR THE WORKERS' COMPENSATION DATABASE SYSTEM; PROVIDING FOR ELECTRONIC SUBMITTAL OF REPORTS BY INSURERS; ESTABLISHING THE UNINSURED EMPLOYERS' FUND AS A STATE SPECIAL REVENUE ACCOUNT; ESTABLISHING THAT A PURPOSE OF THE UNINSURED EMPLOYERS' FUND IS PAYMENT OF ADMINISTRATIVE EXPENSES; PROVIDING FOR CONFIDENTIALITY OF UNINSURED EMPLOYERS' FUND RECORDS IN THE WORKERS' COMPENSATION ACT; CLARIFYING THE QUALIFICATIONS FOR AN EXAMINATION PANEL MEMBER; PROVIDING FOR PAYMENT OF BENEFITS IN A DISPUTED CLAIM PRIOR TO MEDIATION; SPECIFYING TERMINATION OF BENEFITS AFTER MEDIATION; AUTHORIZING REIMBURSEMENT FOR BENEFITS PAID AFTER A HEARING BEFORE THE WORKERS' COMPENSATION COURT; INCREASING THE AMOUNT PAYABLE FOR BURIAL EXPENSES FROM $1,400 TO $4,000; AUTHORIZING THE CERTIFICATION OF A DISABILITY ON THE DATE THE APPLICATION IS APPROVED; CHANGING THE PERIOD USED FOR ASSESSMENTS FOR THE INDUSTRIAL ACCIDENT REHABILITATION ACCOUNT FROM FISCAL YEAR TO CALENDAR YEAR; AUTHORIZING THE DETERMINATION OF ADVISABILITY OF CONTINUED EMPLOYMENT FOR OCCUPATIONAL DISEASE CLAIMANTS BY PERSONS OTHER THAN THE MEDICAL PANEL; REQUIRING THAT THE COSTS OF EXAMINATIONS AND REPORTS BE BORNE BY THE REQUESTING PARTY; PROVIDING THAT AN INSURER MAY REDUCE OR SUSPEND COMPENSATION FOR A CLAIMANT ENGAGING IN AN UNSANITARY OR INJURIOUS PRACTICE THAT IMPERILS RECOVERY AND REQUIRING MEDIATION OF DISPUTES WHEN BENEFITS ARE TERMINATED DUE TO UNSANITARY OR INJURIOUS PRACTICES; ELIMINATING REDUNDANT LANGUAGE BY COMBINING STATUTES RELATING TO THE CREATION AND ADMINISTRATION OF THE UNINSURED EMPLOYERS' FUND; REQUIRING THAT PLAN NO. 2 INSURERS AND PLAN NO. 3, THE STATE FUND, IDENTIFY THE COSTS OF THE REGULATORY ASSESSMENT THAT IS COLLECTED FROM INSURERS AS A POLICYHOLDER SURCHARGE BASED ON PREMIUM; AMENDING THE SUBSEQUENT INJURY FUND ASSESSMENT TO PROVIDE THE STATE FUND WITH THE ABILITY TO IDENTIFY THE COST OF THE ASSESSMENT AS A POLICYHOLDER SURCHARGE BASED ON PREMIUM; AMENDING SECTIONS 39-9-401, 39-71-123, 39-71-201, 39-71-225, 39-71-432, 39-71-501, 39-71-503, 39-71-510, 39-71-517, 39-71-519, 39-71-605, 39-71-610, 39-71-725, 39-71-905, 39-71-915, 39-71-1004, 39-72-405, 39-72-608, AND 39-72-714, MCA; REPEALING SECTION 39-71-502, MCA; AND PROVIDING EFFECTIVE DATES, A RETROACTIVE APPLICABILITY DATE, AND A TERMINATION DATE.



BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MONTANA:



     Section 1.  Section 39-9-401, MCA, is amended to read:

     "39-9-401.  Violation -- infraction -- penalty -- disposition.  (1)  It is a violation of this chapter and an infraction for any construction contractor to:

     (a)  perform work as a construction contractor without being registered as required by this chapter;

     (b)  perform work as a construction contractor when the construction contractor's registration is suspended; or

     (c)  transfer a valid registration to an unregistered construction contractor or allow an unregistered construction contractor to work under a registration issued to another construction contractor.

     (2)  (a) A determination by the department of a violation of this section subjects the person who commits the violation to a penalty of up to $500, as determined by the department. A person who has been determined to have violated this section may request that a hearing be held in accordance with the Montana Administrative Procedure Act. The hearing may be held by telephone or video conference. An appeal of the hearing decision must be made in the same manner as prescribed in 39-51-2403 and 39-51-2404.

     (b)  A penalty under this section does not apply to a violation that is determined to be an inadvertent error.

     (c)  A penalty collected under this section must be deposited in the uninsured employers' fund established in 39-71-502 39-71-503."



     Section 2.  Section 39-71-123, MCA, is amended to read:

     "39-71-123.  Wages defined. (1) "Wages" means all remuneration paid for services performed by an employee for an employer, or income provided for in subsection (1)(d). Wages include the cash value of all remuneration paid in any medium other than cash. The term includes but is not limited to:

     (a)  commissions, bonuses, and remuneration at the regular hourly rate for overtime work, holidays, vacations, and sickness periods;

     (b)  backpay or any similar pay made for or in regards to previous service by the employee for the employer, other than retirement or pension benefits from a qualified plan;

     (c)  tips or other gratuities received by the employee, to the extent that tips or gratuities are documented by the employee to the employer for tax purposes;

     (d)  income or payment in the form of a draw, wage, net profit, or substitute for money received or taken by a sole proprietor or partner, regardless of whether the sole proprietor or partner has performed work or provided services for that remuneration;

     (e)  board, lodging, rent, or housing if it constitutes a part of the employee's remuneration and is based on its actual value; and

     (f)  payments made to an employee on any basis other than time worked, including but not limited to piecework, an incentive plan, or profit-sharing arrangement.

     (2)  The term "wages" does not include any of the following:

     (a)  employee expense reimbursements or allowances for meals, lodging, travel, subsistence, and other expenses, as set forth in department rules;

     (b)  the amount of the payment made by the employer for employees, if the payment was made for:

     (i)  retirement or pension pursuant to a qualified plan as defined under the provisions of the Internal Revenue Code;

     (ii) sickness or accident disability under a workers' compensation policy;

     (iii) medical or hospitalization expenses in connection with sickness or accident disability, including health insurance for the employee or the employee's immediate family; or

     (iv) death, including life insurance for the employee or the employee's immediate family;

     (c)  vacation or sick leave benefits accrued but not paid; or

     (d)  special rewards for individual invention or discovery.

     (3)  (a) Except as provided in subsection (3)(b), for compensation benefit purposes, the average actual earnings for the four pay periods immediately preceding the injury are the employee's wages, except that if the term of employment for the same employer is less than four pay periods, the employee's wages are the hourly rate times the number of hours in a week for which the employee was hired to work.

     (b)  For good cause shown, if the use of the last four pay periods does not accurately reflect the claimant's employment history with the employer, the wage may be calculated by dividing the total earnings for an additional period of time, not to exceed 1 year prior to the date of injury, by the number of weeks in that period, including periods of idleness or seasonal fluctuations.

     (4)  (a) For the purpose of calculating compensation benefits for an employee working concurrent employments, the average actual wages must be calculated as provided in subsection (3). As used in this subsection, "concurrent employment" means employment in which the employee was actually employed at the time of the injury and would have continued to be employed without a break in the term of employment if not for the injury.

     (b)  The compensation benefits for a covered volunteer must be based on the average actual wages in the volunteer's regular employment, except self-employment as a sole proprietor or partner who elected not to be covered, from which the volunteer is disabled by the injury incurred.

     (c)  The compensation benefits for an employee working at two or more concurrent remunerated employments must be based on the aggregate of average actual wages of all employments, except self-employment as a sole proprietor or partner for the wages earned by individuals while engaged in the employments outlined in 39-71-401(3)(a) who elected not to be covered, from which the employee is disabled by the injury incurred."



     Section 3.  Section 39-71-201, MCA, is amended to read:

     "39-71-201.  (Temporary) Administration fund. (1) A workers' compensation administration fund is established out of which all costs of administering the Workers' Compensation and Occupational Disease Acts and the statutory occupational safety acts the department must administer is required to administer, with the exception of the subsequent injury fund, as provided for in 39-71-907, and the uninsured employers' fund, are to be paid upon lawful appropriation. The department shall collect and deposit in the state treasury to the credit of the workers' compensation administrative fund:

     (a)  all fees and penalties provided in 39-71-205, 39-71-223, 39-71-304, 39-71-307, 39-71-308, 39-71-315, 39-71-316, 39-71-401(6), 39-71-2204, 39-71-2205, and 39-71-2337; and

     (b)  all fees paid by an assessment on each plan No. 1 employer, plan No. 2 insurer, and plan No. 3, the state fund. The assessments must be levied against the preceding calendar year's gross annual payroll of the plan No. 1 employers and the gross annual direct premiums collected in Montana on the policies of the plan No. 2 insurers, insuring employers covered under the chapter, during the preceding calendar year. However, an assessment of the plan No. 1 employer or plan No. 2 insurer may not be less than $500. If at any time during the fiscal year a plan No. 1 employer is granted permission to self-insure or a plan No. 2 insurer is authorized to insure employers under this chapter, that plan No. 1 employer or plan No. 2 insurer is subject to assessment. The assessments must be sufficient to fund the direct costs identified to the three plans and an equitable portion of the indirect costs based on the ratio of the preceding fiscal year's indirect costs distributed to the plans, using proper accounting and cost allocation procedures. Plan No. 3 must be assessed an amount sufficient to fund the direct costs and an equitable portion of the indirect costs of regulating plan No. 3 costs of the department's administration of the Workers' Compensation and Occupational Disease Acts and the statutory occupational safety acts administered by the department. The assessment must be equitably apportioned between the three plans using proper accounting and cost allocation procedures. Other sources of revenue, including unexpended funds from the preceding fiscal year, must be used to reduce the costs before levying the assessments.

     (2)  The administration fund must be debited with expenses incurred by the department in the general administration of the provisions of this chapter, including the salaries of its members, officers, and employees and the travel expenses of the members, officers, and employees, as provided for in 2-18-501 through 2-18-503, as amended, incurred while on the business of the department either within or without the state.

     (3)  Disbursements from the administration money must be made after being approved by the department upon a claim. (Terminates June 30, 1999--sec. 8, Ch. 385, L. 1997.)

     39-71-201.  (Effective July 1, 1999) Administration fund. (1) A workers' compensation administration fund is established out of which all costs of administering the Workers' Compensation and Occupational Disease Acts and the statutory occupational safety acts the department must administer, with the exception of the subsequent injury fund, as provided for in 39-71-907, and the uninsured employers' fund, are to be paid upon lawful appropriation. The department shall collect and deposit in the state treasury to the credit of the workers' compensation administrative fund:

     (a)  all fees and penalties provided in 39-71-205, 39-71-223, 39-71-304, 39-71-307, 39-71-308, 39-71-315, 39-71-316, 39-71-401(6), 39-71-2204, 39-71-2205, and 39-71-2337; and

     (b)  all fees paid by an assessment on each plan No. 1 employer, plan No. 2 insurer, and plan No. 3, the state fund. The assessments must be 2.6% of the following benefits paid during the preceding calendar year for injuries covered by the Workers' Compensation Act and the Occupational Disease Act without regard to the application of any deductible whether the employer or the insurer pays the losses:

     (i)  total compensation benefits paid; and

     (ii) except for medical benefits in excess of $200,000 per occurrence that are exempt from assessment, total medical benefits paid for medical treatment rendered to an injured worker, including hospital treatment and prescription drugs.

     (2)  Each plan No. 1 employer, plan No. 2 insurer subject to the provisions of this section, and plan No. 3, the state fund, shall file annually on March 31 in the form and containing the information required by the department a report of paid losses pursuant to subsection (1)(b).

     (3)  An assessment of the plan No. 1 employer or plan No. 2 insurer may not be less than $500. If at any time during the fiscal year a plan No. 1 employer is granted permission to self-insure or a plan No. 2 insurer is authorized to insure employers under this chapter, that plan No. 1 employer or plan No. 2 insurer is subject to an initial assessment equal to the minimum assessment against plan No. 1 employers and plan No. 2 insurers.

     (4)  Payment of the assessment required by this section must be submitted by the employer under plan No. 1, plan No. 2, or plan No. 3 in:

     (a)  one installment made on or before July 1; or

     (b)  two equal installments made on or before July 1 and December 31 of each year. If an employer or insurer fails to pay the assessment required under this section, the department may impose a fine of $100 plus interest on the delinquent amount at the annual interest rate of 12%.

     (5)  The administration fund must be debited with expenses incurred by the department in the general administration of the provisions of this chapter, including the salaries of its members, officers, and employees and the travel expenses of the members, officers, and employees, as provided for in 2-18-501 through 2-18-503, as amended, incurred while on the business of the department either within or without the state.

     (6)  Disbursements from the administration money must be made after being approved by the department upon claim for disbursement."



     Section 4.  Section 39-71-201, MCA, is amended to read:

     "39-71-201.  (Temporary) Administration fund. (1) A workers' compensation administration fund is established out of which all costs of administering the Workers' Compensation and Occupational Disease Acts and the statutory occupational safety acts the department must administer, with the exception of the subsequent injury fund, as provided for in 39-71-907, and the uninsured employers' fund, are to be paid upon lawful appropriation. The department shall collect and deposit in the state treasury to the credit of the workers' compensation administrative fund:

     (a)  all fees and penalties provided in 39-71-205, 39-71-223, 39-71-304, 39-71-307, 39-71-308, 39-71-315, 39-71-316, 39-71-401(6), 39-71-2204, 39-71-2205, and 39-71-2337; and

     (b)    all fees paid by an assessment on each plan No. 1 employer, plan No. 2 insurer, and plan No. 3, the state fund. The assessments must be levied against the preceding calendar year's gross annual payroll of the plan No. 1 employers and the gross annual direct premiums collected in Montana on the policies of the plan No. 2 insurers, insuring employers covered under the chapter, during the preceding calendar year. However, an assessment of the plan No. 1 employer or plan No. 2 insurer may not be less than $500. If at any time during the fiscal year a plan No. 1 employer is granted permission to self-insure or a plan No. 2 insurer is authorized to insure employers under this chapter, that plan No. 1 employer or plan No. 2 insurer is subject to assessment. The assessments must be sufficient to fund the direct costs identified to the three plans and an equitable portion of the indirect costs based on the ratio of the preceding fiscal year's indirect costs distributed to the plans, using proper accounting and cost allocation procedures. Plan No. 3 must be assessed an amount sufficient to fund the direct costs and an equitable portion of the indirect costs of regulating plan No. 3. Other sources of revenue, including unexpended funds from the preceding fiscal year, must be used to reduce the costs before levying the assessments.

     (2)  The administration fund must be debited with expenses incurred by the department in the general administration of the provisions of this chapter, including the salaries of its members, officers, and employees and the travel expenses of the members, officers, and employees, as provided for in 2-18-501 through 2-18-503, as amended, incurred while on the business of the department either within or without the state.

     (3)  Disbursements from the administration money must be made after being approved by the department upon a claim. (Terminates June 30, 1999--sec. 8, Ch. 385, L. 1997.)

     39-71-201.  (Effective July 1, 1999) Administration fund. (1) A workers' compensation administration fund is established out of which all costs of administering the Workers' Compensation and Occupational Disease Acts and the statutory occupational safety acts the department must administer is required to administer, with the exception of the subsequent injury fund, as provided for in 39-71-907, and the uninsured employers' fund, are to be paid upon lawful appropriation. The department shall collect and deposit in the state treasury to the credit of the workers' compensation administrative fund:

     (a)  all fees and penalties provided in 39-71-205, 39-71-223, 39-71-304, 39-71-307, 39-71-308, 39-71-315, 39-71-316, 39-71-401(6), 39-71-2204, 39-71-2205, and 39-71-2337; and

     (b)  all fees paid by an assessment on each plan No. 1 employer, plan No. 2 insurer, and plan No. 3, the state fund. The assessments must be 2.6% 3% of the following benefits paid during the preceding calendar year for injuries covered by the Workers' Compensation Act and the Occupational Disease Act without regard to the application of any deductible whether the employer or the insurer pays the losses:

     (i)  total compensation benefits paid; and

     (ii) except for medical benefits in excess of $200,000 per occurrence that are exempt from assessment, total medical benefits paid for medical treatment rendered to an injured worker, including hospital treatment and prescription drugs.

     (2)  Each plan No. 1 employer, plan No. 2 insurer subject to the provisions of this section, and plan No. 3, the state fund, shall file annually on March 31 1 in the form and containing the information required by the department a report of paid losses pursuant to subsection (1)(b).

     (3)  An assessment of the plan No. 1 employer or plan No. 2 insurer may not be less than $500. If at any time during the fiscal year a plan No. 1 employer is granted permission to self-insure or a plan No. 2 insurer is authorized to insure employers under this chapter, that plan No. 1 employer or plan No. 2 insurer is subject to an initial assessment equal to the minimum assessment against plan No. 1 employers and plan No. 2 insurers.

     (4)  Payment of the assessment required by this section must be submitted by the employer or insurer under plan No. 1, plan No. 2, or plan No. 3 in:

     (a)  one installment made on or before July 1; or

     (b)  two equal installments made on or before July 1 and December 31 of each year. If an employer or insurer fails to pay the assessment required under this section, the department may impose a fine of $100 plus interest on the delinquent amount at the annual interest rate of 12%.

     (5) (a) Beginning July 1, 2000, each plan No. 2 insurer providing workers' compensation insurance and plan No. 3, the state fund, shall collect from the insurer's policyholders an amount equal to the insurer's assessment through a surcharge based on premium. When collected, assessments may not constitute an element of loss for the purpose of establishing rates for workers' compensation insurance but, for the purpose of collection, must be treated as separate costs imposed upon insured employers.

     (b) The total of this assessment must be stated as a separate cost on an insured employer's policy or on a separate document submitted to the insured employer and must be identified as "workers' compensation regulatory assessment surcharge". Each assessment surcharge must be shown as a percentage of the total workers' compensation policyholder premium.

     (c) The portion of the plan No. 2 assessment identified as a premium surcharge for an individual plan No. 2 insured employer must be calculated as a percentage to be applied to premium. The percentage applied must be determined by the amount of the plan No. 2 assessment, as determined in subsection (1)(b), divided by the total net premium as calculated under 33-2-705 paid by all plan No. 2 insured employers during the preceding calendar year.

     (d) The portion of the plan No. 3 assessment identified as a premium surcharge for an individual plan No. 3 insured employer must be calculated as a percentage to be applied to premium. The percentage applied must be determined by the amount of the plan No. 3 assessment, as determined in subsection (1)(b), divided by the total net premium as calculated under 33-2-705 paid by all plan No. 3 insured employers during the preceding fiscal year.

     (e) On or before March 31, 2000, and each March 31 thereafter, the department, in consultation with the advisory organization designated pursuant to 33-16-1023, shall notify plan No. 2 insurers and plan No. 3, the state fund, of the insurer assessment identified as the premium surcharge percentage to be effective for policies written or renewed annually on and after July 1 of that year.

     (f) The assessment provided for in subsection (1)(b), which will be identified as a premium surcharge, must be collected at the same time and in the same manner that the premium for the coverage is collected. This premium surcharge must be excluded from the definition of premiums for all purposes, including computation of insurance producers' commissions or premium taxes, except that an insurer may cancel a workers' compensation policy for nonpayment of the premium surcharge. Cancellation must be in accordance with the procedures applicable to the nonpayment of premium.

     (5)(6)  The administration fund must be debited with expenses incurred by the department in the general administration of the provisions of this chapter, including the salaries of its members, officers, and employees and the travel expenses of the members, officers, and employees, as provided for in 2-18-501 through 2-18-503, as amended, incurred while on the business of the department either within or without the state.

     (6)(7)  Disbursements from the administration money must be made after being approved by the department upon claim for disbursement."



     Section 5.  Section 39-71-225, MCA, is amended to read:

     "39-71-225.  Workers' compensation database system. (1) The department shall develop a workers' compensation database system to generate management information about Montana's workers' compensation system. The database system must be used to collect and compile information from insurers, employers, medical providers, claimants, adjusters, rehabilitation providers, and the legal profession.

     (2)  Data collected must be used to provide:

     (a) management information to the legislative and executive branches for the purpose of making policy and management decisions, including but not limited to:

     (i)  performance information to enable the state to enact remedial efforts to ensure quality, control abuse, and enhance cost control;

     (ii) information on medical, indemnity, and rehabilitation costs, utilization, and trends;

     (iii) information on litigation and attorney involvement for the purpose of identifying trends, problem areas, and the costs of legal involvement;

     (b)  current and prior claim information to any insurer that is at risk on a claim, or that is alleged to be at risk in any administrative or judicial proceeding, to determine claims liability or for fraud investigation. The department may release information only upon written request by the insurer and may disclose only the claimant's name, claimant's identification number, prior claim number, date of injury, body part involved, and name and address of the insurer and claim adjuster on each claim filed. Information obtained by an insurer pursuant to this section must remain confidential and may not be disclosed to a third party except to the extent necessary for determining claim liability or for fraud investigation; and

     (c)  current and prior claim information to law enforcement agencies for purposes of fraud investigation or prosecution.

     (3)  The department is authorized to collect from insurers, employers, medical providers, the legal profession, and others the information necessary to generate the workers' compensation database system.

     (4)  The workers' compensation database system must be designed in accordance with the following principles:

     (a)  avoidance of duplication and inconsistency;

     (b)  reasonable availability of data elements;

     (c)  value of information collected to be commensurate with the cost of retrieving the collected information;

     (d)  uniformity to permit efficiency of collection and to allow interstate comparisons;

     (e)  a workable mechanism to ensure the accuracy of the data collected and to protect the confidentiality of collected data;

     (f)  reasonable availability of the data at a fair cost to the user;

     (g)  a broad application to plan No. 1, plan No. 2, and plan No. 3 insurers;

     (h)  compatibility with electronic data reporting;

     (i)  reporting procedures that can be handled through private data collection systems that adhere to the provisions of subsections (4)(a) through (4)(h);

     (j)  implementation of reporting requirements that allow reasonable lead time for compliance.

     (5)  The department shall publish an annual report on the information compiled.

     (6)  Users of information obtained from the workers' compensation database under this section are liable for damages arising from misuse or unlawful dissemination of database information.

     (7) Beginning July 1, 2000, an insurer or a third-party administrator who submitted 50 or more "first reports of injury" to the department in the preceding calendar year shall electronically submit the reports and any other reports related to the reported claims in a nationally recognized format specified by department rule.

     (8) The department may adopt rules to implement this section."



     Section 6.  Section 39-71-432, MCA, is amended to read:

     "39-71-432.  Definitions. As used in 39-71-433, the following definitions apply:

     (1)  "Business entity" means a business enterprise owned by a single person, corporation, organization, business trust, trust, partnership, limited liability company, limited liability partnership, joint venture, association, or other business entity.

     (2)  "Group" means two or more business entities that join together, with the approval of the department, to purchase individual workers' compensation insurance policies covering each business entity that is part of a group."



     Section 7.  Section 39-71-501, MCA, is amended to read:

     "39-71-501.  Definition of uninsured employer. For the purposes of 39-71-501 through, 39-71-503 through 39-71-511, and 39-71-515 through 39-71-520, "uninsured employer" means an employer who has not properly complied with the provisions of 39-71-401."



     Section 8.  Section 39-71-503, MCA, is amended to read:

     "39-71-503.  Administration Uninsured employers' fund -- purpose and administration of fund -- appropriation. (1) The department shall administer the fund and shall pay from it all expenses of administering the fund, all loss adjustment expenses for claims of injured employees of uninsured employers, and all proper benefits to injured employees of underinsured and uninsured employers There is created an uninsured employers' fund in the state special revenue account to pay:

     (a) to an injured employee of an uninsured employer the same benefits the employee would have received if the employer had been properly enrolled under compensation plan No. 1, 2, or 3, except as provided in subsection (3);

     (b) the costs of investigating and prosecuting workers' compensation fraud under 2-15-2015; and

     (c) the expenses incurred by the department in administering the uninsured employers' fund.

     (2) The department may refer to the workers' compensation fraud office, established in 2-15-2015, cases involving:

     (a) false or fraudulent claims for benefits; and

     (b) criminal violations of 45-7-501.

     (2)(3)  Surpluses and reserves may not be kept for the fund. The department shall make payments that it considers appropriate as funds become available from time to time. The payment of weekly disability benefits takes precedence over the payment of medical benefits. Lump-sum payments of future projected benefits, including impairment awards, may not be made from the fund. The board of investments shall invest the money of the fund, and the investment income must be deposited in the fund.

     (3)(4)  The amounts necessary for the payment of benefits from this fund are statutorily appropriated, as provided in 17-7-502, from this fund."



     Section 9.  Section 39-71-510, MCA, is amended to read:

     "39-71-510.  Limitation on benefit entitlement under fund. Notwithstanding the provisions of 39-71-407, 39-71-502, and 39-71-503, injured employees or an employee's beneficiaries who pursue a claim for benefits from the uninsured employers' fund are not granted an entitlement by this state for full workers' compensation benefits from the fund. Benefits from the fund must be paid in accordance with the sums in the fund. If the department determines at any time that the sums in the fund are not adequate to fully pay all claims, the department may make appropriate proportionate reductions in benefits to all claimants. The reductions do not entitle claimants to retroactive reimbursements in the future."



     Section 10.  Section 39-71-517, MCA, is amended to read:

     "39-71-517.  Requirement to serve papers. In pursuing remedies under 39-71-501 through, 39-71-503 through 39-71-511, and 39-71-515 through 39-71-520, an injured employee or the employee's beneficiaries shall serve all pleadings and all other litigation papers on the department and the uninsured employer, regardless of whether the department or the uninsured employer is a party to the particular action to which the papers relate."



     Section 11.  Section 39-71-519, MCA, is amended to read:

     "39-71-519.  Settlement. The department, the uninsured employer, the injured employee or the employee's beneficiaries, a third party who shares liability as defined in 39-71-412, or a fellow employee who shares liability as defined in 39-71-413 may enter into a settlement agreement to finally settle the rights and liabilities under 39-71-501 through, 39-71-503 through 39-71-511, and 39-71-515 through 39-71-520 of any or all of the parties. The settlement is subject to department approval in accordance with 39-71-741."



     Section 12.  Section 39-71-605, MCA, is amended to read:

     "39-71-605.  Examination of employee by physician -- effect of refusal to submit to examination -- report and testimony of physician -- cost. (1) (a) Whenever in case of injury the right to compensation under this chapter would exist in favor of any employee, the employee shall, upon the written request of the insurer, submit from time to time to examination by a physician, psychologist, or panel that must be provided and paid for by the insurer and shall likewise submit to examination from time to time by any physician, psychologist, or panel selected by the department or as ordered by the workers' compensation judge.

     (b)  The request or order for an examination must fix a time and place for the examination, with regard for the employee's convenience, physical condition, and ability to attend at the time and place that is as close to the employee's residence as is practical. An examination that is conducted by a physician, psychologist, or panel licensed in another state is not precluded under this section. The employee is entitled to have a physician present at any examination. If the employee, after written request, fails or refuses to submit to the examination or in any way obstructs the examination, the employee's right to compensation must be suspended and is subject to the provisions of 39-71-607. Any physician, psychologist, or panel employed by the insurer or the department who makes or is present at any examination may be required to testify as to the results of the examination.

     (2)  In the event of a dispute concerning the physical condition of a claimant or the cause or causes of the injury or disability, if any, the department or the workers' compensation judge, at the request of the claimant or insurer, as the case may be, shall require the claimant to submit to an examination as it considers desirable by a physician, psychologist, or panel within the state or elsewhere that has had adequate and substantial experience in the particular field of medicine concerned with the matters presented by the dispute. The physician, psychologist, or panel making the examination shall file a written report of findings with the claimant and insurer for their use in the determination of the controversy involved. The requesting party shall pay the physician, psychologist, or panel for the examination.

     (3)  As used in this section, a panel includes a practitioner having substantial experience in the field of medicine concerned with the matters presented by the dispute and whose licensure would qualify the practitioner to act as a treating physician, as defined in 39-71-116, and may include a psychologist.

     (4)  A claimant is required, upon a written request of an insurer, to submit to a functional capacities evaluation conducted by a licensed physical therapist.

     (5)  This section does not apply to impairment evaluations provided for in 39-71-711."



     Section 13.  Section 39-71-610, MCA, is amended to read:

     "39-71-610.  Termination of benefits by insurer -- department order to pay disputed benefits prior to hearing or mediation -- limitation on order -- right of reimbursement. If an insurer terminates biweekly compensation benefits and the termination of compensation benefits is disputed by the claimant, the department may, upon written request, order an insurer to pay additional biweekly compensation benefits prior to a hearing or mediation, but in no event may the biweekly compensation benefits be ordered to be paid under this section for a period exceeding 49 days or for any period subsequent to the date of a the hearing or mediation. If after a hearing before the workers' compensation court it is held that the insurer was not liable for the compensation payments ordered by the department, the insurer has the right to be reimbursed for such the payments by the claimant."



     Section 14.  Section 39-71-725, MCA, is amended to read:

     "39-71-725.  Payment of burial expense. There shall must be paid, in case of the death of an employee, which whose death is the result of an accidental injury arising out of the employment and happening in the course of the employment, the reasonable burial expenses of the employee, not exceeding $1,400, and such $4,000. The payment is not a part of the compensation which that might be paid but is a benefit in addition to and separate and apart from compensation."



     Section 15.  Section 39-71-905, MCA, is amended to read:

     "39-71-905.  Certification as person with a disability. A person who wishes to be certified as a person with a disability for purposes of this part shall apply to the department on forms furnished by the department. The department shall conduct an investigation and shall issue a certificate to a person who, in the department's discretion, meets the requirements for certification. A person shall apply for certification before employment or within 60 days after the person becomes employed or reemployed and before an injury occurs that is covered by this part. The certification is effective on the date of employment or reemployment. Certification is effective on the date the application is approved for a person who applies for certification more than 60 days after employment or reemployment, but before an injury occurs. Failure to apply before employment or within 60 days after employment or reemployment precludes the employer from the protection and benefits of this part."



     Section 16.  Section 39-71-915, MCA, is amended to read:

     "39-71-915.  Assessment of insurers -- definition. (1) As used in this section, "paid losses" means the following benefits paid during the preceding calendar year for injuries covered by the Montana Workers' Compensation Act without regard to the application of any deductible regardless of whether the employer or the insurer pays the losses:

     (a)  total compensation benefits paid; and

     (b)  except for medical benefits in excess of $200,000 per occurrence that are exempt from assessment, total medical benefits paid for medical treatment rendered to an injured worker, including hospital treatment and prescription drugs.

     (2)  The fund must be maintained by assessing each plan No. 1 employer, each plan No. 2 insured employer insurer, and plan No. 3, the state fund. The assessment amount is the total amount of paid losses reimbursed from the fund in the preceding calendar year and the expenses of administration less other income. The total assessment amount collected must be allocated among plan No. 1 employers, plan No. 2 insured employers insurers, and plan No. 3, the state fund, based on paid losses for the calendar year preceding the year in which the assessment is collected. The board of investments shall invest the money of the fund, and the investment income must be deposited in the fund.

     (3)  On or before March 31 each year, the department shall notify each plan No. 1 employer, plan No. 2 insurer, and plan No. 3, the state fund, of the amount to be assessed against the employer, plan No. 2 insurer, or the state fund for that calendar year. On or before March 31 each year, the department, in consultation with the advisory organization designated under 33-16-1023, shall notify plan No. 2 insurers and plan No. 3 of the premium surcharge rate to be effective for policies written or renewed on and after January 1 July 1 in that calendar year.

     (4)  The portion of the plan No. 1 assessment assessed against an individual plan No. 1 employer is a proportionate amount of total plan No. 1 paid losses during the preceding calendar year that is equal to the percentage that the total paid losses of the individual plan No. 1 employer bore to the total paid losses of all plan No. 1 employers during the preceding calendar year.

     (5)  The portion of the plan No. 2 assessment subject to premium surcharge for an individual plan No. 2 insured employer is a proportionate amount of total plan No. 2 paid losses during the preceding calendar year that is equal to the percentage that the total paid losses of the individual plan No. 2 insured employer bore to the total paid losses of all plan No. 2 insurers during the preceding calendar year.

     (6) The portion of the state fund assessment subject to premium surcharge for a state fund insured employer is a proportionate amount of total state fund paid losses during the preceding calendar year that is equal to the percentage that the total paid losses of the individual state fund insured employer bore to the total paid losses of state fund insured employers during the preceding calendar year.

     (6)(7)  Payment of assessments due must be made to the department semiannually on June 30 and December 31 of the year following the calendar year on which the assessment is based.

     (7)(8)  Each plan No. 2 insurer providing workers' compensation insurance and plan No. 3, the state fund, may shall collect from each of its policyholders an amount equal to the insured employer's fund the assessment through a surcharge based on premium in subsection (2). When collected, assessments may not constitute an element of loss for the purpose of establishing rates for workers' compensation insurance but, for the purpose of collection, must be treated as separate costs imposed upon insured employers. The total of this assessment must be stated as a separate cost on an insured employer's policy or on a separate document submitted by the insured employer and must be identified as "workers' compensation policyholder subsequent injury fund surcharge". Each assessment must be shown as a percentage of the total workers' compensation policyholder premium. The This premium surcharge must be collected at the same time and in the same manner that the premium for the coverage is collected. The premium surcharge must be excluded from the definition of premiums for all purposes, including computation of insurance producers' commissions or premium taxes, except that an insurer may cancel a workers' compensation policy for nonpayment of the premium surcharge. Cancellation must be in accordance with the procedures applicable to the nonpayment of premium.

     (8)(9)  All assessments paid to the department must be deposited in the fund."



     Section 17.  Section 39-71-1004, MCA, is amended to read:

     "39-71-1004.  Industrial accident rehabilitation account. (1) The payments provided in 39-71-1003 must be made from the industrial accident rehabilitation account in the state special revenue fund. Payments to the account must be made each year upon an assessment by the department as follows:

     (a)  by each employer operating under the provisions of plan No. 1 of the Workers' Compensation Act, an amount to be assessed by the department, not exceeding 1% of the compensation paid to the employer's injured employees in Montana for the preceding fiscal calendar year;

     (b)  by each insurer insuring employers under the provisions of plan No. 2 of the Workers' Compensation Act, an amount to be assessed by the department, not exceeding 1% of the compensation paid to injured employees of its insured in Montana during the preceding fiscal calendar year;

     (c)  by the state fund, an amount to be assessed by the department, not exceeding 1% of the compensation paid by the state fund to injured employees in Montana during the preceding fiscal calendar year.

     (2)  Separate accounts of the amounts that were collected and disbursements that were made from the industrial accident rehabilitation account in the state special revenue fund must be kept for each of the plans. If in any fiscal year the amount that was collected from the employers under any plan exceeds the amount of payments for employees of the employers under the plan, the assessment against the employers under the plan for the following year must be reduced.

     (3)  The payments provided for in this section must be made to the department, which shall credit the sums paid to the industrial accident rehabilitation account in the custody of the state treasurer. Disbursements from the account must be made after approval by the department.

     (4)  The funds allocated or contributed as provided in this section may not be used for payment of administrative expenses of the department.

     (5)  The methods and processes used to disburse rehabilitation expense payments to eligible disabled workers are procedural and do not affect the substantive rights of those disabled workers."



     Section 18.  Section 39-72-405, MCA, is amended to read:

     "39-72-405.  General limitations on payment of compensation. (1) Compensation may not be paid when the last day of the injurious exposure of the employee to the hazard of the occupational disease has occurred prior to July 1, 1959.

     (2)  When an employee in employment on or after January 1, 1959, because the employee has an occupational disease incurred in and caused by the employment that is not yet disabling, and is discharged or transferred from the employment in which the employee is engaged or when the employee ceases employment and it is in fact medically, as determined by the medical panel, inadvisable for the employee on account of a nondisabling occupational disease to continue in employment and the employee suffers wage loss by reason of the discharge, transfer, or cessation, compensation may be paid, not exceeding $10,000, by an agreement between the insurer and the claimant. If the parties fail to reach an agreement, the mediation procedures in Title 39, chapter 71, part 24, must be followed."



     Section 19.  Section 39-72-608, MCA, is amended to read:

     "39-72-608.  Payment of medical examination, report, and autopsy expenses. The expense of the first medical examination and report as provided in 39-72-602 must be borne by the insurer. The expense of a reexamination and panel report must be borne by the dissatisfied party requesting the reexamination. The expense of the periodic medical examinations and reports, as provided in 39-72-607, must be borne by the party requesting the periodic medical examination. The expense of the autopsy, as provided for in 39-72-606, must be borne by the party requesting the autopsy. When the occupational disease causes death, the The expense of any examinations and reports, as provided in 39-72-605, must be borne by the party requesting the examination."



     Section 20.  Section 39-72-714, MCA, is amended to read:

     "39-72-714.  Reduction or suspension of compensation for unsanitary or injurious practices or refusal to submit to medical or surgical treatment. The department insurer may reduce or suspend the compensation of an employee a claimant who persists in unsanitary or injurious practices tending to imperil or retard his recovery or who refuses to submit to such medical or surgical treatment as is reasonably essential to promote his the claimant's recovery. If a dispute arises between a claimant and an insurer regarding the reduction or suspension of compensation, the mediation procedures provided in Title 39, chapter 71, part 24, must be followed."



     Section 21.  Confidentiality of records -- exception for use by public employees. Information obtained from any individual under this part is confidential and may not be disclosed, sold, or opened to public inspection except to department employees when necessary to allow them to perform their public duties under Title 39, chapters 71 and 72, or to provide relevant and necessary information to other public entities or pursuant to a subpoena issued upon a showing of compelling state interest.



     Section 22.  Repealer. Section 39-71-502, MCA, is repealed.



     Section 23.  Codification instruction. [Section 21] is intended to be codified as an integral part of Title 39, chapter 71, part 5, and the provisions of Title 39, chapter 71, part 5, apply to [section 21].



     Section 24.  Severability. If a part of [this act] is invalid, all valid parts that are severable from the invalid part remain in effect. If a part of [this act] is invalid in one or more of its applications, the part remains in effect in all valid applications that are severable from that invalid applications.



     Section 25.  Effective dates. (1) [Sections 2, 3, 23, 24, 26, and 27 and this section] are effective on passage and approval.

     (2) [Sections 1, 4 through 15, and 17 through 22] are effective July 1, 1999.

     (3) [Section 16] is effective July 1, 2000.



     Section 26.  Retroactive applicability. [Section 3] applies retroactively, within the meaning of 1-2-109, to occurrences after June 30, 1991.



     Section 27.  Termination. [Section 3] terminates June 30, 1999.

- END -

I hereby certify that the within bill,

SB 0117, originated in the Senate.









Secretary of the Senate









President of the Senate



Signed this day

of , 1999.









Speaker of the House



Signed this day

of , 1999.






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