Maine Revised Statutes

§355-C. Powers and duties of committee; reimbursement

The committee shall review and evaluate requests for reimbursement of workers' compensation benefits paid or payable under section 213, subsections 3 and 4. [2001, c. 448, §5 (NEW).]

1. Power to bind fund.  The committee has power to bind the fund with respect to the monetary value of each settlement reimbursable from the fund.
[ 2001, c. 448, §5 (NEW) .]
2. Request for reimbursement; information required.  A request for reimbursement from the fund must include:
A. If the claim for reimbursement is made pursuant to section 213, subsection 3, evidence that the claimant employee's date of injury is on or after January 1, 1993 and before January 1, 1998. If the claim for reimbursement is made under section 213, subsection 4, evidence that the claimant employee's date of injury is on or after January 1, 1993 and before January 1, 2000; [2001, c. 448, §5 (NEW).]
B. Complete medical reports, agreements or orders relating to the employee's permanent impairment; [2001, c. 448, §5 (NEW).]
C. Evidence that the insurer or self-insurer has paid or is liable for payment of 260 weeks of indemnity benefits pursuant to section 212 or 213; [2001, c. 448, §5 (NEW).]
D. Evidence that the benefit payments for which reimbursement is requested were paid or are payable under section 213; [2001, c. 448, §5 (NEW).]
E. Verification that the insurer or self-insurer has adjusted and is adjusting the claim for which reimbursement is requested in a manner that is consistent with usual and customary claims service provided by the insurer or self-insurer for claims that are not subject to reimbursement under section 213. At a minimum, verification must include evidence that the insurer or self-insurer has monitored the claimant employee's medical condition and investigated return-to-work options applicable in the circumstance; and [2001, c. 448, §5 (NEW).]
F. Such other information or requirements as the committee may prescribe. [2001, c. 448, §5 (NEW).]
[ 2001, c. 448, §5 (NEW) .]
3. Determinations.  The committee shall review requests for reimbursement within 14 days of receipt of the request or within a longer period of time if mutually acceptable to the parties. The committee shall issue a final determination, designated as such, to each insurer or self-insurer that has requested reimbursement. An insurer or self-insurer may petition the board for a hearing before an administrative law judge within 30 days of notice of the determination. Review by the board is limited to errors of law and abuse of discretion.
[ 2015, c. 297, §21 (AMD) .]
4. Effect of board decrees.  The fund and the committee are bound to the same extent as the employee and insurer or self-insurer by decrees of the board.
[ 2001, c. 448, §5 (NEW) .]
5. Effect of mediation agreement or consent decree.  The fund is bound as to any question of law or fact by reason of a mediation agreement under section 313 or a consent decree, provided the committee was given notice of the terms of the agreement or decree at least 21 days before the effective date of the agreement or decree and did not object. The fund is not bound by the agreement or decree if the committee provides a written objection to the proposed terms of the agreement or decree to the insurer or self-insurer.
[ 2001, c. 448, §5 (NEW) .]
6. Effect of independent medical examiner's report  . The fund is bound to the same extent as the employee and the insurer or self-insurer by findings contained in an independent medical examiner's report provided pursuant to section 312.
[ 2001, c. 448, §5 (NEW) .]
7. Service agent.  The committee, by contract, may delegate day-to-day business operations of the fund and duties and powers of the committee regarding reimbursement requests or assessments to a service agent qualified under this subsection. Pursuant to the contract, a service agent retained under this subsection must be held to account as a fiduciary in the administration of the assets of the fund and in the conduct of the business affairs of the fund.
A. The committee shall enter into written contracts with persons or entities qualified by good business reputation, training, education and experience to perform day-to-day duties in administering the fund's responsibilities set forth in section 213, subsections 3 and 4. Such a person is referred to in this section and sections 355-A, 355-B and 356 as the "service agent." A service agent must hold all licenses, registrations and permits required to engage in activities or undertake responsibilities delegated pursuant to the contract. [2001, c. 448, §5 (NEW).]
B. A service agent may subcontract with attorneys acceptable to the committee to advise or represent the fund in legal actions as necessary. Expenses of the service agent and attorneys retained by the service agent, upon approval by the committee, are paid from the fund. [2001, c. 448, §5 (NEW).]
C. A service agent shall acknowledge and reimburse claims of insurers and self-insurers consistent with terms of any proposed or executed settlement among parties to the settlement, provided that the service agent has been accorded notice and opportunity to participate regarding the terms and conditions of the settlement and that the commitment to reimburse the insurer or self-insurer is in the best interest of the fund. [2001, c. 448, §5 (NEW).]
D. A service agent may be empowered, by contract, to levy assessment in the name of the fund, institute assessment collection procedures, including legal action if necessary, process requests for reimbursement from the fund in a timely manner, deposit money in the fund with the Treasurer of State if such funds are not needed to meet immediate cash flow demands and commit the fund to agreed levels of insurer or self-insurer reimbursement based upon review and assessment of prospects of consensual settlements. [2001, c. 448, §5 (NEW).]
E. A service agent shall make recommendations to the committee regarding rule-making standards considered necessary to the proper administration of the fund. [2001, c. 448, §5 (NEW).]
[ 2001, c. 448, §5 (NEW) .]
2001, c. 448, §5 (NEW). 2015, c. 297, §21 (AMD).