reglab/statecodes huggingface dataset:
Michigan Administrative Code › Department - Labor and Economic Opportunity › Workers Compensation Agency › Workers' Disability Compensation Appeals Commission › Section R. 418.67 - Briefs; titles; filing

Current through Vol. 24-12, July 15, 2024
Rule 7.
(1) A brief
				must be entitled "appellant's brief," "appellee's brief," "cross appellant's
				brief," or "cross appellee's brief," or must be otherwise appropriately
				designated.
(2) An appellant's
				brief must be filed with the commission not more than 30 days after the
				transcript is filed. Where there are multiple transcripts, the 30-day period
				begins to run on the date the commission receives the last
				transcript.
(3) A cross appellant's
				brief must be filed with the commission not more than 30 days after the cross
				appellant receives an appellant's brief and a copy of the transcript.
(4) An appellee or a cross appellee need not
				file a brief. If the appellee or cross appellee wishes to do so, that brief
				must be filed with the commission within 30 days after first receipt of the
				appellant's or cross appellant's brief, with certification of the date of
				receipt. The failure to so certify creates a rebuttable presumption that
				receipt of appellant's or cross-appellant's brief occurred on the date the
				commission received the original document.
(5) The commission, in its discretion and for
				sufficient cause shown, may grant further time in which to file any
				brief.
(6) The commission may allow
				a party to file a supplemental brief. A supplemental brief may not raise new
				issues.
(7) Any party filing any
				brief shall certify in writing to the commission that a copy of this brief has
				been served upon all parties or their counsel, and the date and manner of the
				service.
Michigan Administrative Code › Department - Labor and Economic Opportunity › Workers Compensation Agency › Workers' Disability Compensation Appeals Commission › Section R. 418.68 - Motion practice

Current through Vol. 24-12, July 15, 2024
Rule 8.
(1) All
				motions must be in writing.
(2) A
				party filing a motion shall provide all other parties with a copy of the motion
				at the time of filing and shall certify to the commission that the party has
				done so.
(3) A party has 21 days
				from the date the motion was filed with the commission to file a response to
				the motion, and shall certify that a copy of the response has been provided to
				all other parties. The commission may consider a request to extend the time to
				file a response to a motion, if the request is filed before the motion is
				submitted to the panel for disposition. Such a request must be made in the form
				of a motion.
(4) After the
				expiration of the time for filing a response to a motion, the motion will be
				submitted to a panel for disposition.
(5) A motion or response to a motion
				representing the existence of facts not in the record or not within the
				personal knowledge of the signer of the motion or response must be supported by
				an affidavit signed by an individual with such personal knowledge, or those
				factual assertions may be disregarded.
Michigan Administrative Code › Department - Labor and Economic Opportunity › Workers Compensation Agency › Workers' Disability Compensation Appeals Commission › Section R. 418.69 - Disqualification and recusal

Current through Vol. 24-12, July 15, 2024
Rule 9.
(1) A
				commissioner may be recused, or disqualified, from a case based on the
				existence of bias, prejudice, interest, or any other cause provided for in this
				rule.
(2) A commissioner may be
				recused in any proceeding in which the impartiality of the commissioner might
				reasonably be questioned, including, but not limited to, instances in which the
				commissioner:
(a) Has a personal bias or
				prejudice concerning a party or a party's attorney.
(b) Has personal knowledge of disputed
				evidentiary facts concerning the proceeding.
(c) Has been consulted or employed as an
				attorney in the matter in controversy.
(d) Is or was a party.
(e) Was, within the preceding 2 years, a
				partner of or in an employment relationship with a party.
(f) Was, within the preceding 2 years,
				attorney for a party or a member of a law firm representing a party.
(g) Has been a material witness concerning
				the matter in controversy.
Michigan Administrative Code › Department - Labor and Economic Opportunity › Workers Compensation Agency › Workers' Compensation Board Of Magistrtes › Part 1 - GENERAL › Section R. 418.81 - Definitions

Current through Vol. 24-12, July 15, 2024
Rule 1. As used in these rules:
(a) "Act" means the worker's disability
				  compensation act of 1969, 1969 PA 317, MCL 418.101 to 418.941.
(b) "Board" means the workers' compensation
				  board of magistrates.
(c) "JFPTC"
				  means joint and final pretrial conference.
(d) "JFPTO" means joint and final pretrial order.
Michigan Administrative Code › Department - Labor and Economic Opportunity › Workers Compensation Agency › Workers' Compensation Board Of Magistrtes › Part 1 - GENERAL › Section R. 418.82 - Scope

Current through Vol. 24-12, July 15, 2024
Rule 2 .
(1) These
				  rules apply to practice and procedures before the board.
(2) These procedural rules must be construed
				  to secure a fair and impartial determination of the issues presented in
				  contested cases consistent with due process.
Michigan Administrative Code › Department - Labor and Economic Opportunity › Workers Compensation Agency › Workers' Compensation Board Of Magistrtes › Part 1 - GENERAL › Section R. 418.83 - Hearing district explained

Current through Vol. 24-12, July 15, 2024
Rule 3.
(1) A
				  hearing district is an area of the state served by 1 or more magistrates as
				  designated by the chairperson of the board.
(2) The assignment of magistrates is as
				  required by caseload and determined by the chairperson of the board.
(3) The chairperson of the board is
				  responsible for implementing hearing procedures and has general supervisory
				  control of the board, consistent with section 213 of the act, MCL 418.213, and
				  Executive Reorganization Order No. 2019-13, MCL 125.1998.
Michigan Administrative Code › Department - Labor and Economic Opportunity › Workers Compensation Agency › Workers' Compensation Board Of Magistrtes › Part 1 - GENERAL › Section R. 418.84 - Computation of time

Current through Vol. 24-12, July 15, 2024
Rule 4.
(1) In
				  computing any period of time prescribed or allowed by these rules, the time in
				  which an act is to be done is computed by excluding the first day and including
				  the last, unless the last day is a Saturday, Sunday, or state legal holiday, in
				  which case the period will run until the end of the next day following the
				  Saturday, Sunday or state legal holiday.
(2) Unless otherwise specified by the
				  magistrate, rule, or statute, the date of receipt of a filing by the board is
				  the date used to determine whether a pleading or other paper has been timely
				  filed.
(3) Except where otherwise
				  specified, a period of time in these rules means calendar days, not just
				  business days.
Michigan Administrative Code › Department - Labor and Economic Opportunity › Workers Compensation Agency › Workers' Compensation Board Of Magistrtes › Part 1 - GENERAL › Section R. 418.85 - Appearances

Current through Vol. 24-12, July 15, 2024
Rule 5.
(1) Unless
				  otherwise indicated by the magistrate, the parties or their attorneys shall
				  personally appear at facilitations, motions, pre-trials, redemptions, hearings
				  on the merits, control dates, JFPTC, and any other types of hearings as may be
				  scheduled.
(2) With prior approval
				  of the magistrate, the parties or their attorneys may appear by telephone,
				  video conference, or other electronic means. The parties or their attorneys
				  shall be ready to proceed as previously directed by the magistrate.
(3) Failure of the petitioner or the
				  petitioner's attorney to appear in a timely manner and participate may subject
				  the application for hearing to dismissal. If the respondent or the respondent's
				  attorney fails to appear in a timely manner, then the magistrate may proceed in
				  the absence of the respondent or the respondent's attorney.
Michigan Administrative Code › Department - Labor and Economic Opportunity › Workers Compensation Agency › Workers' Compensation Board Of Magistrtes › Part 1 - GENERAL › Section R. 418.86 - Disqualification of magistrate

Current through Vol. 24-12, July 15, 2024
Rule 6.
(1) A
				  party may bring a motion to disqualify a magistrate, or a magistrate may raise
				  the issue on his or her own initiative.
(2) A magistrate is disqualified when the
				  magistrate cannot impartially hear a case. Circumstances that warrant
				  disqualification include, but are not limited to, circumstances where the
				  magistrate:
(a) Is interested as a
				  party.
(b) Is personally biased or
				  prejudiced for or against a party or attorney.
(c) Has been consulted or employed as
				  counsel.
(d) Was a partner of a
				  party, attorney for a party, or a member of a law firm representing a party
				  within the preceding 2 years.
(e)
				  Is within the third degree under civil law of consanguinity or affinity to a
				  person acting as an attorney or within the sixth degree under civil law to a
				  party.
(f) Owns, or his or her
				  spouse or minor child owns, a stock, bond, security, or other legal or
				  equitable interest of a corporation that is a party. This subdivision does not
				  apply to any of the following:
(i)
				  Investments in securities traded on a securities exchange registered as a
				  national securities exchange under the Securities Exchange Act of 1934,
				  15
				  USC 78a to
				  78pp.
(ii) Shares of an investment company
				  registered under the Investment Company Act of 1940, 15 USC
				  80a-1to80a-64.
(iii) Securities of a public utility holding
				  company registered under the Public Utility Holding Company Act of 2005,
				  42
				  USC 16451(8).
(g) Is disqualified for any other
				  reason by law.
Michigan Administrative Code › Department - Labor and Economic Opportunity › Workers Compensation Agency › Workers' Compensation Board Of Magistrtes › Part 1 - GENERAL › Section R. 418.87 - Ex parte communications with a magistrate

Current through Vol. 24-12, July 15, 2024
Rule 7.
(1)
				  Counsel or the parties may not engage in substantive ex parte communications
				  with the magistrate concerning the action prior to the hearing. Routine
				  communication about administrative tasks, such as scheduling hearings, is not
				  prohibited.
(2) If a magistrate
				  receives direct or indirect communication prohibited by subrule (1) of this
				  rule, the magistrate shall promptly notify all parties or their attorneys of
				  the receipt of such communication and its content. A record of the
				  communication must be maintained in the agency file.
(3) Once a case has been referred to a
				  magistrate for hearing, all communication related to the case of a substantive
				  basis from any party should be administered through agency staff.
Michigan Administrative Code › Department - Labor and Economic Opportunity › Workers Compensation Agency › Workers' Compensation Board Of Magistrtes › Part 1 - GENERAL › Section R. 418.88 - Case development docket

Current through Vol. 24-12, July 15, 2024
Rule 8.
(1) All
				  cases are assigned to a magistrate on initial pre-trial date. Unless it is a
				  60-day case, the magistrate shall place the case on the case development docket
				  and schedule an initial control date. 60-day cases, as provided in section 205
				  of the act, MCL 418.205, must be placed on the trial docket, and scheduled for
				  a JFPTC and trial date in accordance with R 418.93.
The petitioner in a 60-day case may waive that status and
					 the case shall then be placed on the case development docket.
(2) Cases that are on the case development
				  docket are assigned control dates at the discretion of the magistrate at such
				  intervals and frequency as deemed appropriate. Appearance of the parties must
				  comply with R 418.85.
Michigan Administrative Code › Department - Labor and Economic Opportunity › Workers Compensation Agency › Workers' Compensation Board Of Magistrtes › Part 1 - GENERAL › Section R. 418.89 - Subpoena; provision to opposing party; submittal of subpoenaed records; disputes

Current through Vol. 24-12, July 15, 2024
Rule 9.
(1) A
				  subpoena must be on an agency approved form and comply with the following:
(a) The party requesting the subpoena shall
				  certify that the matter about which the subpoena is requested is pending before
				  the agency.
(b) Magistrates or
				  attorneys may sign subpoenas. A subpoena must be fully completed before
				  submission to a magistrate for signing.
(c) The return date indicated on the subpoena
				  must provide a reasonable time for compliance.
(d) Magistrates may sign a subpoena for a
				  case assigned to another magistrate unless the assigned magistrate has refused
				  to sign the subpoena.
Michigan Administrative Code › Department - Labor and Economic Opportunity › Workers Compensation Agency › Workers' Compensation Board Of Magistrtes › Part 1 - GENERAL › Section R. 418.90 - Motion practice

Current through Vol. 24-12, July 15, 2024
Rule 10.
(1) All
				  requests for action addressed to the magistrate, other than during a hearing,
				  must be made in writing. Written requests for action must state specific
				  grounds and describe the action or order sought. A copy of all written motions
				  or requests for action must be served pursuant to
				  R
				  408.36(c). All motions must be
				  accompanied by a notice of hearing.
(2) All motions must be filed at least 14
				  days prior to the date set for hearing unless other scheduling provisions
				  prevent compliance with this timeline or the need for the motion could not
				  reasonably have been foreseen 14 days prior to the hearing.
(3) A response to a motion may be filed
				  within 7 days after service of the written motion unless otherwise ordered by
				  the magistrate. A party may request an expedited ruling.
(4) All motions and responses must include
				  citations of supporting authority and, if germane, supporting affidavits and
				  attachments to affidavits.
(5) A
				  ruling on a motion must be on the record and memorialized in a written order,
				  at the discretion of the magistrate or if requested by any party.
(6) Unless ordered by the magistrate or a
				  tribunal of higher authority, a claim for review filed in response to a ruling
				  issued under subrule (5) of this rule is not a stay of magistrate
				  proceedings.
Michigan Administrative Code › Department - Labor and Economic Opportunity › Workers Compensation Agency › Workers' Compensation Board Of Magistrtes › Part 1 - GENERAL › Section R. 418.92 - Exhibit admissibility hearing

Current through Vol. 24-12, July 15, 2024
Rule 12.
(1) After
				  the parties have had a reasonable opportunity to gather and exchange existing
				  medical and other documents upon stipulation of the parties, upon the motion of
				  a party, or at the discretion of the magistrate, the magistrate may schedule,
				  at a date, time, and place convenient to the parties, a hearing to determine
				  admissibility at trial of any specific proposed exhibit.
(2) A party seeking to introduce any specific
				  proposed exhibit under this rule shall provide a copy of such exhibit, unless
				  previously furnished to all other parties, at least 14 days prior to the
				  exhibit admissibility hearing.
(3)
				  Any objections to the proposed exhibit must be made by the parties at or before
				  the hearing and ruled upon by the magistrate consistent with R 418.97. Upon
				  finding that a proposed exhibit under this rule is not authentic or was created
				  specifically for purposes of the litigation, the magistrate may exclude the
				  proposed exhibit. Any decision on any objections are subject to R 418.90(5) and
				  (6).
(4) All exhibits found
				  admissible by the magistrate must be identified with specificity in an order
				  and admitted at the time of trial.
(5) A party may attempt to cure or remedy any
				  sustained objections to the admission of exhibit raised by an opposing party at
				  the exhibit admissibility hearing. This rule does not preclude a magistrate
				  from subsequently admitting the proposed documents once the parties have had
				  the opportunity to cure or remedy any objections raised. This rule does not
				  preclude a party from offering other documentary evidence prior to the JFPTC or
				  during trial.
(6) If an exhibit is
				  found to be admissible, any party opposing admission of the exhibit may
				  schedule the deposition of the person or entity that prepared the record at
				  that party's expense. The magistrate may limit the physician charges for such
				  cross examination to a reasonable fee under section 858 of the act, MCL
				  418.858. The party offering the evidence is entitled to examine the person or
				  entity during such a deposition.
Michigan Administrative Code › Department - Labor and Economic Opportunity › Workers Compensation Agency › Workers' Compensation Board Of Magistrtes › Part 2 - HEARINGS › Section R. 418.94 - Hearing procedures

Current through Vol. 24-12, July 15, 2024
Rule 14.
(1) The
				  party filing the application for mediation or hearing must first present
				  evidence in support of the application.
(2) Unless the magistrate orders otherwise,
				  only 1 attorney for each party may examine or cross-examine a
				  witness.
(3) The magistrate may
				  call witnesses, issue subpoenas, and order the production of books, records,
				  accounts, and papers that are necessary for the purpose of making a decision. A
				  magistrate may direct the attorneys to submit briefs.
(4) The magistrate may require such
				  information from the parties as may be necessary to monitor the progress of the
				  case, assist in the voluntary exchange of information between parties, and
				  assist in the scheduling of cases.
(5) The hearing completion time shall be at
				  the discretion of the magistrate, but it must not be more than 30 days after
				  the date the hearing commenced unless the magistrate allows an extension beyond
				  this time for good cause shown.
(6)
				  Unless provided in accord with R 418.92 and R 418.93, all records, or other
				  exhibits of any kind that any party intends to offer as evidence in the
				  proceeding must be exchanged between the parties no later than 14 days before
				  the JFPTC. This will not preclude admission at trial of any additional records
				  or exhibits and does not constitute preclusion of records or exhibits not in
				  the possession of either party, or newly discovered relevant evidence from
				  being admitted.
(7) At their own
				  expense, a party may schedule the cross-examination of the person or entity
				  that prepared a proposed exhibit. The magistrate may limit the physician's
				  charges for such cross-examination to a reasonable fee under section 858 of the
				  act, MCL 418.858.
(8) This rule
				  does not affect the magistrate's discretion to rule on newly discovered
				  evidence.
(9) A case may be placed
				  on the redemption docket upon request of the parties if it appears that the
				  case will be resolved by way of redemption. The parties must be given necessary
				  time to resolve any issues regarding medical bills or liens; Medicare or
				  Medicaid compliance; friend of the court liens; or any other such liens,
				  claims, or issues that may arise. If the parties are ultimately unable to
				  resolve the case by way of redemption, the case must be returned to the
				  development or trial docket, at the discretion of the magistrate.
(10) Upon finding the willful failure of a
				  party to comply with this rule, the magistrate may prohibit that party from
				  proceeding under the act.
Michigan Administrative Code › Department - Labor and Economic Opportunity › Workers Compensation Agency › Workers' Compensation Board Of Magistrtes › Part 2 - HEARINGS › Section R. 418.95 - Stipulations

Current through Vol. 24-12, July 15, 2024
Rule 15. In addition to stipulations in the JFPTO:
(1) The parties may agree upon facts, or any
				  portion of facts, by written stipulation or by a statement entered into the
				  record.
(2) Stipulations must be
				  used as evidence at the hearing or subsequent proceedings.
(3) Stipulations are binding on the parties
				  that have acknowledged acceptance of the stipulations.
(4) The parties may stipulate to limit the
				  issues to be decided by the magistrate. The stipulation only applies to that
				  issue and is not considered a waiver of any rights not addressed by the
				  stipulation.
Michigan Administrative Code › Department - Labor and Economic Opportunity › Workers Compensation Agency › Workers' Compensation Board Of Magistrtes › Part 2 - HEARINGS › Section R. 418.96 - Record

Current through Vol. 24-12, July 15, 2024
Rule 16.
(1) The
				  agency shall maintain an official record of each case or proceeding.
(2) The record must include all of the
				  following:
(a) Notice of hearings and records
				  of adjournments.
(b) JFPTO and any
				  other prehearing orders.
(c)
				  Motions, pleadings, briefs, applications, requests, opinions, and
				  orders.
(d) Evidence
				  admitted.
(e) Statements of matters
				  officially noticed.
(f) Offers of
				  proof, objections, and rulings.
(g)
				  Clearly marked offered but rejected evidence.
(h) Recordings and transcripts of the
				  proceedings before the magistrate that have been obtained by the
				  parties.
(i) Written notations of
				  any ex parte communications.
Michigan Administrative Code › Department - Labor and Economic Opportunity › Workers Compensation Agency › Workers' Compensation Board Of Magistrtes › Part 2 - HEARINGS › Section R. 418.97 - Evidence admissibility; objections, submission in written form

Current through Vol. 24-12, July 15, 2024
Rule 17.
(1)
				  Except as provided in these rules, the Michigan rules of evidence, as applied
				  in a civil case in circuit court, must be followed in all proceedings as far as
				  practicable, but a magistrate may admit and give probative effect to evidence
				  of a type commonly relied upon by reasonably prudent persons in the conduct of
				  their affairs.
(2) The following
				  governs admissibility of medical records at trial:
(a) Absent an objection sustained by the
				  magistrate, authenticated treating medical records, including bills, must be
				  admitted.
(b) A report of an
				  independent medical examiner under section 385 of the act, MCL 418.385, shall
				  be admitted into evidence if offered by the injured employee. A report by an
				  independent medical examiner requested by the injured employee must be admitted
				  into evidence if offered by defendant.
(c) Properly authenticated diagnostic reports
				  must be admitted into evidence if prepared by treating medical providers and
				  commonly relied upon by other treating physicians including, but not limited
				  to, x-rays, MRI reports, CT scans, EMG's, nerve conduction studies,
				  ultrasounds, and laboratory results.
Michigan Administrative Code › Department - Labor and Economic Opportunity › Workers Compensation Agency › Workers' Compensation Board Of Magistrtes › Part 2 - HEARINGS › Section R. 418.98 - Testimonial evidence

Current through Vol. 24-12, July 15, 2024
Rule 18.
(1) The
				  testimony of all witnesses must be upon oath or affirmation.
(2) Witnesses must be sequestered at the
				  request of a party or by the magistrate on his or her own initiative.
(3) Opposing parties are entitled to
				  cross-examine witnesses subject to the provisions of R 418.94(2).
(4) The testimony of medical experts and
				  vocational consultants may be taken by deposition. A party taking a deposition
				  shall give reasonable notice to all parties. The magistrate may limit the time,
				  manner, and place where the deposition occurs.
(5) At the discretion of the magistrate,
				  other witnesses may testify by deposition before trial. The magistrate may
				  limit the time, manner, and place where the deposition testimony
				  occurs.
(6) At the discretion of
				  the magistrate, and for good cause shown, the testimony of medical experts and
				  vocational consultants not presented at the scheduled trial date may be taken
				  by deposition after the conclusion of the lay testimony in accordance with the
				  following:
(a) The plaintiff shall take such
				  depositions within 42 days after the trial date.
(b) The defendants shall take such
				  depositions within 56 days after the trial date.
(c) Transcripts must be filed with the
				  magistrate within 72 days of the completion of lay testimony.
Michigan Administrative Code › Department - Labor and Economic Opportunity › Workers Compensation Agency › Workers' Compensation Board Of Magistrtes › Part 2 - HEARINGS › Section R. 418.99 - Case resolution by order and opinion; redemptions of liability; attorney briefs; correction of mistakes in order or opinion

Current through Vol. 24-12, July 15, 2024
Rule 19.
(1) A
				  case that is assigned to a magistrate must be resolved by an order and, when
				  applicable, an opinion. The order, and when applicable, the opinion, must be
				  written within 42 days of the closing of the record, except under extenuating
				  circumstances as determined by the chairperson of the board.
(2) Except under extenuating circumstances as
				  determined by the chairperson of the board, all cases assigned to a magistrate
				  that proceed to hearing must be resolved by opinion written within 42 days of
				  closing the record and must be prepared for mailing.
(3) All redemption hearings agreements must
				  be either approved or denied by the issuance of a redemption order.
(4) A reversionary interest clause contained
				  in a redemption agreement must be clearly labeled and disclosed to the
				  magistrate, who shall make an express finding as to whether the clause is in
				  the best interests of the employee as required by section 836(1)(a) of the act,
				  MCL 418.836.
(5) All lump sum
				  applications must be either approved or denied by the issuance of an
				  order.
(6) In cases that are
				  resolved by voluntary payment, there must be a written voluntary pay agreement
				  and an order dismissing the application.
(7) In cases that are resolved by voluntary
				  withdrawal of an application, there must be a written order of
				  dismissal.
(8) Within the appeal
				  period provided, a magistrate may on his or her own initiative correct a
				  mistake in the order or opinion. Parties may stipulate to the corrections
				  pursuant to section 851 of the act, MCL 418.851. Any corrections require a
				  corrected order or opinion, or both, and must specify the corrections
				  made.
Michigan Administrative Code › Department - Labor and Economic Opportunity › Workers Compensation Agency › Workers' Compensation Health Care Services Rules › Part 1 - GENERAL PROVISIONS › Section R. 418.10102 - Claim filing limitations

Current through Vol. 24-12, July 15, 2024
Rule 102.
(1) A
				  provider shall bill a carrier within one year of the date of service for
				  consideration of payment.
(2) The
				  one year filing rule shall not apply if the provider bills after the one year
				  requirement under subrule (1) of this rule due to litigation or
				  subrogation.
Michigan Administrative Code › Department - Labor and Economic Opportunity › Workers Compensation Agency › Workers' Compensation Health Care Services Rules › Part 1 - GENERAL PROVISIONS › Section R. 418.10104 - Reimbursement to injured worker or to health insurer for compensable medical services

Current through Vol. 24-12, July 15, 2024
Rule 104.
(1)
				  Notwithstanding any other provision of these rules, if an injured worker has
				  paid for a health care service and at a later date a carrier is determined to
				  be responsible for the payment, then the injured worker shall be fully
				  reimbursed by the carrier.
(2) The
				  injured worker may submit the request for reimbursement on a medical or dental
				  claim form, but shall supply to the carrier a copy of a statement including the
				  provider name, the date of service, the procedure and diagnosis and
				  documentation of the amount paid.
(3) When a health insurer pays for a medical
				  service to treat an injured worker and subsequently requests reimbursement from
				  the workers' compensation carrier, the health insurer is not required to submit
				  the request on a CMS 1500, or a UB-04 claim form, or other medical or dental
				  claim form. The health insurer shall supply to the workers' compensation
				  carrier, or the carrier's designee, a claim detail showing the date of service,
				  the amount billed and paid, the procedure code and diagnosis for the rendered
				  services. The workers' compensation carrier shall reimburse the health insurer
				  the provider's usual and customary fee or the maximum allowable fee, whichever
				  is less, for the compensable medical services in accordance with these rules.
				  If the health insurer reimbursed the provider less than the amount allowed by
				  these rules, then the workers' compensation carrier shall reimburse the amount
				  paid by the health insurer.
Michigan Administrative Code › Department - Labor and Economic Opportunity › Workers Compensation Agency › Workers' Compensation Health Care Services Rules › Part 1 - GENERAL PROVISIONS › Section R. 418.10105 - Balance billing amounts in excess of fees

Current through Vol. 24-12, July 15, 2024
Rule 105. The provider shall not bill the injured worker
					 for any amount for health care services, or for late fees incurred, provided
					 for the treatment of a covered injury or illness when the amount is disputed by
					 the carrier pursuant to its utilization review program or when the amount
					 exceeds the maximum allowable payment established by these
					 rules.
Michigan Administrative Code › Department - Labor and Economic Opportunity › Workers Compensation Agency › Workers' Compensation Health Care Services Rules › Part 1 - GENERAL PROVISIONS › Section R. 418.10106 - Procedure codes; relative value units; other billing information

Current through Vol. 24-12, July 15, 2024
Rule 106.
(1) Upon
				  annual promulgation of
				  R 418.10107, the health care
				  services division of the agency shall provide separate from these rules a
				  manual, tables, and charts containing all of the following information on the
				  agency's website,
www.michigan.gov/leo/bureaus-agencies/wdca
:
(a) All Current Procedural Terminology (CPT)
				  procedure codes used for billing healthcare services.
(b) Medicine, surgery, and radiology
				  procedures and their associated relative value units.
(c) Hospital maximum payment
				  ratios.
(d) Billing forms and
				  instruction for completion.
Michigan Administrative Code › Department - Labor and Economic Opportunity › Workers Compensation Agency › Workers' Compensation Health Care Services Rules › Part 1 - GENERAL PROVISIONS › Section R. 418.10107 - Source documents; adoption by reference

Current through Vol. 24-12, July 15, 2024
Rule 107. The following documents are adopted by reference
					 in these rules and are available for distribution from the indicated sources,
					 at the cost listed in subdivisions (a) to (h) of this rule:
(a) "Current Procedural Terminology (CPT)
				  2023 Professional Edition," published by the American Medical Association, P.O.
				  Box 74008935, Chicago, Illinois 60674-8935, item #EP054123, 1-800-621-8335. The
				  publication may be purchased through the AMA"s website at
www.amastore.com
. The list price is
				  $134.95 at the time of adoption of these rules. Permission to use this
				  publication is on file in the agency.
(b) "HCPCS 2023 Level II Professional
				  Edition," published by the American Medical Association, P.O. Box 74008935,
				  Chicago, Illinois 60674-8935, item #OP231523, customer service 1-800-621-8335.
				  The publication may be purchased through the AMA"s website at
www.amastore.com
. The list price is
				  $106.95 at the time of adoption of these rules.
(c) "Medicare RBRVS 2023: The Physicians'
				  Guide," published by The American Medical Association, P.O. Box 74008935,
				  Chicago, Illinois 60674-8935, item #OP059623, 1-800-621-8335. The publication
				  may be purchased through the AMA"s website at
www.amamstore.com
. The list price is $159.95 at
				  the time of adoption of these rules.
(d) "International Classification of
				  Diseases, ICD-10-CM 2023: The Complete Official Codebook," American Medical
				  Association, P.O. Box 74008935, Chicago, Illinois 60674-8935, item #OP201423,
				  1-800-621-8335. The publication may be purchased through the AMA"s website at
www.amamstore.com
. The list price is
				  $112.95 at the time of adoption of these rules.
(e) "International Classification of
				  Diseases, ICD-10-PCS 2023: The Complete Official Codebook," American Medical
				  Association, P.O. Box 74008935, Chicago, Illinois 60674-8935 item #OP201123,
				  1-800-621-8335. The publication may be purchased through the AMA"s website at
www.amastore.com
. The list price is
				  $112.95 at the time of adoption of these rules.
(f) Merative" Micromedex Red Book online
				  subscription service of Merative, which can be purchased at
https://www.ibm.com/products/micromedex-red-book
or from Merative, 100 Phoenix Drive, Ann Arbor, Michigan 48108,
				  1-800-525-9083.
(g) Medi-Span Drug
				  Information Database, a part of Wolters Kluwer Health, which can be purchased
				  from
http://www.wolterskluwercdi.com
or 1-855-633-0577.
(h) "Official
				  UB-04 Data Specifications Manual 2023, July 1, 2022" adopted by the National
				  Uniform Billing Committee, Copyright 2022 American Hospital Association. As of
				  the time of adoption of these rules, the cost of this eBook for a single user
				  is $170.00 and is available at
www.nubc.org
.
Michigan Administrative Code › Department - Labor and Economic Opportunity › Workers Compensation Agency › Workers' Compensation Health Care Services Rules › Part 1 - GENERAL PROVISIONS › Section R. 418.10108 - Definitions; A to I

Current through Vol. 24-12, July 15, 2024
Rule 108. As used in these rules:
(a) "Acquisition cost" means the provider's
				  purchase cost established by an invoice detailing the line-item cost to the
				  provider from a manufacturer or wholesaler net of any rebates or
				  discounts.
(b) "Act" means the
				  worker"s disability compensation act of 1969, 1969 PA 317, MCL
				  418.101 to
				  418.941.
(c) "Adjust" means that a carrier or a
				  carrier's agent reduces a healthcare provider's request for payment to the
				  maximum fee allowed by these rules, to a provider's usual and customary charge,
				  or, when the maximum fee is by report, to a reasonable amount. "Adjust" also
				  means when a carrier re-codes a procedure or reduces payment as a result of
				  professional review.
(d) "Agency"
				  means the workers' disability compensation agency.
(e) "Ambulatory surgical center" (ASC) means
				  an entity that operates exclusively for providing surgical services to patients
				  not requiring hospitalization and has an agreement with the centers for
				  Medicare and Medicaid services (CMS) to participate in Medicare.
(f) "Appropriate care" means healthcare that
				  is suitable for a particular individual, condition, occasion, or
				  place.
(g) "Biologics" or
				  "biologicals" include drugs or other products that are derived from life forms.
				  Biologics are biology-based products used to prevent, diagnose, treat, or cure
				  disease or other conditions in humans and animals. Biologics generally include
				  products such as vaccines, blood, blood components, allergenics, somatic cells,
				  genes, proteins, DNA, tissues, skin substitutes, recombinant therapeutic
				  proteins, microorganisms, antibodies, immunoglobins, and others, including, but
				  not limited to, those that are produced using biotechnology and are made from
				  proteins, genes, antibodies, and nucleic acids.
(h) "BR" or "by report" means that the
				  procedure is not assigned a relative value unit or a maximum fee and requires a
				  written description.
(i) "Carrier"
				  means an organization that transacts the business of workers' compensation
				  insurance in this state and that may be any of the following:
(i) A private insurer.
(ii) A self-insurer.
(iii) One of the funds in chapter 5 of the
				  act, MCL 418.501 to
				  418.561.
(iv) The Christopher R. Slezak first
				  responder presumed coverage fund.
Michigan Administrative Code › Department - Labor and Economic Opportunity › Workers Compensation Agency › Workers' Compensation Health Care Services Rules › Part 1 - GENERAL PROVISIONS › Section R. 418.10111 - Advisory committee

Current through Vol. 24-12, July 15, 2024
Rule 111. The director of the workers' compensation agency
					 shall appoint an advisory committee from names solicited from provider,
					 carrier, and employee organizations. The advisory committee shall include 5
					 advocates for the concerns of providers, 5 advocates for the concerns of
					 employees, and 5 advocates for the concerns of carriers. The director of the
					 workers' compensation agency shall appoint a sixteenth member to act as chair
					 without a vote. The advisory committee shall meet not less than twice a year.
					 Additional meetings shall be scheduled if requested by the workers'
					 compensation agency, the chair, or a majority of the committee. Members may be
					 removed by the director of the workers' compensation agency for cause or for
					 missing more than one-half of the meetings in a year. The advisory committee
					 shall perform general program oversight and assist the workers' compensation
					 agency with the following:
(a) Annual
				  review of the rules and the fee schedule.
(b) Development of proposed amendments to the
				  rules and fee schedule, including payment methodologies.
(c) Review of data reports and data
				  analyses.
Michigan Administrative Code › Department - Labor and Economic Opportunity › Workers Compensation Agency › Workers' Compensation Health Care Services Rules › Part 1 - GENERAL PROVISIONS › Section R. 418.10112 - Missed appointment

Current through Vol. 24-12, July 15, 2024
Rule 112. A provider shall not receive payment for a missed
					 appointment unless the appointment was arranged by the carrier or the employer.
					 If the carrier or employer fails to cancel the appointment not less than 72
					 hours in advance and the provider is unable to arrange for a substitute
					 appointment for that time, then the provider may bill the carrier for the
					 missed appointment using procedure code 99199 with a maximum fee of
					 BR.
Michigan Administrative Code › Department - Labor and Economic Opportunity › Workers Compensation Agency › Workers' Compensation Health Care Services Rules › Part 1 - GENERAL PROVISIONS › Section R. 418.10113 - Initial evaluation and management service; medical report other than inpatient hospital care

Current through Vol. 24-12, July 15, 2024
Rule 113.
(1)
				  Except as provided in subrule (2) of this rule, and for other than inpatient
				  hospital care, a provider shall furnish the carrier, at no additional charge,
				  with a medical report for the initial visit, all information pertinent to the
				  covered injury or illness if requested at reasonable intervals, and a progress
				  report for every 60 days of continuous treatment for the same covered injury or
				  illness.
(2) If the provider
				  continues to treat an injured or ill employee for the same covered injury or
				  illness at intervals which exceed 60 days, then the provider shall provide a
				  progress report following each treatment that is at intervals exceeding 60
				  days.
(3) The medical report of the
				  initial visit and the progress report shall include all of the following
				  information:
(a) Subjective complaints and
				  objective findings, including interpretation of diagnostic tests.
(b) For the medical report of the initial
				  visit, the history of the injury, and for the progress report, significant
				  history since the last submission of a progress report.
(c) The diagnosis.
(d) As of the date of the medical report or
				  progress report, the projected treatment plan, including the type, frequency,
				  and estimated length of treatment.
(e) Physical limitations.
(f) Expected work restrictions and length of
				  time if applicable.
Michigan Administrative Code › Department - Labor and Economic Opportunity › Workers Compensation Agency › Workers' Compensation Health Care Services Rules › Part 1 - GENERAL PROVISIONS › Section R. 418.10114 - Requests for existing medical records and reports

Current through Vol. 24-12, July 15, 2024
Rule 114.
(1)
				  Nothing in these rules shall preclude a carrier, a carrier's agent, an
				  employee, or an employee's agent from requesting additional existing medical
				  records and reports related to a specific date of injury, in addition to those
				  specified in
				  R 418.10113, or those required for
				  proper submission of a bill from a provider.
(2) If a provider is requested by the carrier
				  to prepare and submit a special written report in addition to the medical
				  records required by
				  R 418.10113,
				  R 418.10203,
				  R 418.10204, and
				  R
				  418.10901, then the provider shall bill the special
				  report using procedure code 99199-32. For special reports up to 3 pages in
				  length, the carrier shall reimburse the provider at $25.00 PER PAGE.
(a) Complex reports greater than 3 pages in
				  length or record reviews shall be reimbursed on a contractual basis between the
				  carrier and the provider.
Michigan Administrative Code › Department - Labor and Economic Opportunity › Workers Compensation Agency › Workers' Compensation Health Care Services Rules › Part 1 - GENERAL PROVISIONS › Section R. 418.10115 - Responsibilities of insured employer or self-insurer

Current through Vol. 24-12, July 15, 2024
Rule 115.
(1) An
				  insured employer shall do all of the following:
(a) Promptly file form 100, employer's basic
				  report of injury, to report an injury that results in 7 or more days of
				  disability, specific loss, or death, with the workers' compensation agency and
				  its insurer.
(b) Promptly notify
				  its insurer of the cases that do not result in 7 or more days of disability,
				  specific loss, or death.
(c)
				  Promptly inform the provider of the name and address of its insurer or the
				  designated agent of the insurer to whom health care bills should be
				  sent.
(d) If an insured employer
				  receives a bill, then the insured employer shall promptly transmit the
				  provider's bill and documentation to the insurer or the designated agent of the
				  insurer regarding a related injury or illness.
Michigan Administrative Code › Department - Labor and Economic Opportunity › Workers Compensation Agency › Workers' Compensation Health Care Services Rules › Part 1 - GENERAL PROVISIONS › Section R. 418.10116 - Provider responsibilities

Current through Vol. 24-12, July 15, 2024
Rule 116.
(1) When
				  a licensed facility or practitioner licensed in this state treats an injured
				  worker for a compensable work-related injury or illness and bills the workers'
				  compensation carrier, the carrier shall reimburse the licensed provider or
				  facility the maximum allowable payment, or the providers' usual and customary
				  charge, whichever is less, pursuant to these rules. A provider shall do both of
				  the following:
(a) Promptly bill the carrier
				  or the carrier's designated agent after the date of service.
(b) Submit the bill for the medical services
				  provided to treat an injured worker on the proper claim form, to the workers'
				  compensation carrier or the carrier's designated agent and attach the
				  documentation required in part 9 of these rules.
Michigan Administrative Code › Department - Labor and Economic Opportunity › Workers Compensation Agency › Workers' Compensation Health Care Services Rules › Part 1 - GENERAL PROVISIONS › Section R. 418.10117 - Carrier responsibilities

Current through Vol. 24-12, July 15, 2024
Rule 117.
(1) The
				  carrier or its designated agent shall assure that a billing form is completed
				  properly before making payment to the licensed provider or licensed
				  facility.
(2) A carrier may
				  designate a third party to receive provider bills on its behalf. If a carrier
				  instructs the provider to send the medical bills directly to the third party,
				  then the 30-day limit of this rule begins when the third party receives the
				  bill. The carrier is responsible for forwarding bills and medical documentation
				  when there is a third party reviewing medical bills for the carrier.
(3) A carrier or designated agent shall make
				  payment of an unadjusted and properly submitted bill within 30 days of receipt
				  of a properly submitted bill or shall add a self- assessed 3% late penalty to
				  the maximum allowable payment or the provider's charge, whichever is less, as
				  required by these rules.
(4) A
				  carrier or designated agent shall record payment decisions on a form entitled
				  "Carrier's Explanation of Benefits" using a format approved by the workers'
				  compensation agency. The carrier or designated agent shall keep a copy of the
				  explanation of benefits and shall send a copy to the provider and to the
				  injured worker. The carrier's explanation of benefits shall list a clear reason
				  for the payment adjustment or amount disputed and shall notify the provider
				  what information is required for additional payment.
(5) A carrier or designated agent shall make
				  payment of an adjusted bill or portion of an adjusted bill within 30 days of
				  receipt of the properly submitted bill. If a carrier or designated agent
				  rejects a bill in its entirety, then the carrier or designated agent shall
				  notify the provider of the rejection within 30 days after receipt of a properly
				  submitted bill.
(6) If a carrier
				  requests the provider to send duplicated copies of the documentation required
				  in part 9 or additional medical records not required by these rules, then the
				  carrier shall reimburse the provider for the copying charges in accord with
				  R 418.10118.
(7) When the carrier has disputed a case and
				  has not issued a copy of the formal notice of dispute to the medical provider,
				  then the carrier's explanation of benefits shall be sent in response to the
				  provider's initial bill. The carriers' explanation of benefits shall serve as
				  notice to the provider that nonpayment of the bill is due to the
				  dispute.