R612-200-4. Insurance Carrier/Employer Liability

  A. This rule governs responsibility for payment of benefits for a work injury when:

  1. The claimant's entitlement to benefits is not in dispute; and

  2. There is a dispute between payors regarding their respective liability for such benefits because the claimant has suffered separate compensable injuries which are the liability of the different payors.

  B. In cases meeting the criteria of subsection A, the payor providing coverage for the most recent compensable injury shall advance benefits to the claimant. The benefits advanced shall be limited to medical benefits and temporary total disability compensation and shall be paid according to the entitlement in effect on the date of the earliest related injury.

  1. The payor advancing benefits shall notify the non-advancing payor within the time periods established by Subsection R612-200-1.B, that benefits are to be advanced pursuant to this rule.

  2. The payor not advancing benefits, upon notification from the advancing payor, shall notify the advancing payor within 10 working days of any potential defenses or limitations of the non-advancing payor's liability.

  C. Payors are encouraged to settle liabilities pursuant to this rule.However, any party may file a request for agency action with the Commission for determination of liability for the benefits at issue.

  D. The medical utilization decisions of the payor advancing benefits pursuant to this rule shall be presumed reasonable with respect to the issue of reimbursement.