Michigan Administrative Code › Department - Labor and Economic Opportunity › Workers Compensation Agency › Workers' Compensation Agency - General Rules › Part 2 - RECORDS › Section R. 408.33 - Disputed claims; late payment penalty

Current through Vol. 24-12, July 15, 2024
Rule 3.
(1) On or
				  before the fourteenth day after the employer has notice or knowledge of an
				  alleged injury or death, the carrier, PEGSISF, and self-insurers' security fund
				  shall notify the agency on form WC
-
107, or its electronic
				  equivalent, if the right of the injured or dependent to compensation is
				  disputed. A copy of the form WC
-
107, notice of dispute, must be
				  provided to the injured employee.
(2) The following subdivisions govern the
				  administration and enforcement of the penalty provisions under section 801 of
				  the act, MCL 418.801:
(a) Under section 801(1)
				  of the act, MCL 418.801, compensation must be paid promptly and directly to the
				  person entitled to compensation. Weekly benefits become due and payable on the
				  fourteenth day after the employer has notice or knowledge of the disability or
				  death. On that date, all compensation that has accrued must be paid. If
				  benefits are not paid within 30 days of becoming due and payable, then the
				  carrier shall pay to the employee $50.00 per day for each day after 30 days
				  that the benefits remain unpaid, not to exceed $1,500.00.
(b) If a case is in litigation and the
				  defendant agrees to pay benefits on a voluntary basis, then the magistrate
				  shall specify the weekly compensation rate, the period of time for which
				  accrued benefits have become due, and which medical bills shall be paid by the
				  carrier as a result of the injury or disability. If the benefits agreed to are
				  not paid within 30 days of the date the agreement is formalized by the
				  magistrate, then the carrier shall pay to the employee $50.00 per day for each
				  day after 30 days that the benefits remain unpaid, not to exceed
				  $1,500.00.
(c) A medical bill
				  becomes due and payable when the carrier or employer has received reasonable
				  proof and the itemized bill. If there is a dispute resulting in a delay in
				  paying the medical bills, then the carrier shall advise the employee and doctor
				  of the reasons for the delay in writing. If there is no dispute and the bill
				  remains unpaid 30 days after the carrier has received notice of nonpayment by
				  certified mail, then the carrier shall pay to the employee $50.00 for each day
				  after 30 days that the bill remains unpaid, not to exceed $1,500.00.
(d) The travel allowance for medical
				  examination, treatment, or rehabilitation is provided in
				  R
				  408.45. The employee shall be notified by the carrier,
				  in writing, of any dispute resulting in a delay in paying travel allowance
				  payments. If the expenses are not paid within 30 days of the date of the
				  carrier's receipt of notification of non-payment by certified mail, and if the
				  expenses are not disputed, then the carrier shall pay the employee $50.00 for
				  each day after 30 days that the expenses remain unpaid, not to exceed
				  $1,500.00.
(e) Under section 801(4)
				  of the act, an employer may be liable for all or a portion of the penalty
				  provided in section 801(2) of the act, MCL 418.801. If there is a dispute
				  between an employer and insurance carrier as to who is liable for the payment
				  of the penalty, the carrier shall be liable for paying the penalties, but may
				  be entitled to reimbursement from the employer.
(f) Any employee who may be entitled to
				  penalty payments under section 801 of the act, MCL 418.801, and who has not
				  received the payments may apply by notifying the agency in writing. A copy of
				  the request must be forwarded to the carrier. In all cases, the agency shall
				  respond within a reasonable period of time and shall act, as it deems
				  appropriate, to resolve any disputes involving the penalty provisions of
				  section 801 of the act, MCL 418.801. If a dispute continues beyond a
				  determination by the agency or if the director believes there is a question of
				  compliance with the act, then the dispute may be set for a hearing under
				  R
				  408.35. A party to a dispute may request a formal
				  hearing before a magistrate.
(g) A
				  carrier shall pay any penalty amounts due an injured employee as a result of
				  the penalty provisions specified in section 801 of the act, MCL 418.801, in a
				  separate check. Penalty amounts are not a part of the basic benefits to which
				  an employee is entitled for the purpose of loss or assessment.
(h) Benefits, allowances, or bills are
				  presumed paid within 30 days if a check is mailed within 27 days of becoming
				  due and payable under these rules.