34A-2-703 - Payments from Employers' Reinsurance Fund.
34A-2-703. Payments from Employers' Reinsurance Fund.
If an employee, who has at least a 10% whole person permanent impairment from anycause or origin, subsequently incurs an additional impairment by an accident arising out of and inthe course of the employee's employment during the period of July 1, 1988, to June 30, 1994,inclusive, and if the additional impairment results in permanent total disability, the employer or itsinsurance carrier and the Employers' Reinsurance Fund are liable for the payment of benefits asfollows:
(1) The employer or its insurance carrier is liable for the first $20,000 of medical benefitsand the initial 156 weeks of permanent total disability compensation as provided in this chapter orChapter 3, Utah Occupational Disease Act.
(2) Reasonable medical benefits in excess of the first $20,000 shall be paid in the firstinstance by the employer or its insurance carrier. Then, as provided in Subsection (5), theEmployers' Reinsurance Fund shall reimburse the employer or its insurance carrier for 50% ofthose expenses.
(3) After the initial 156-week period under Subsection (1), permanent total disabilitycompensation payable to an employee under this chapter or Chapter 3, Utah OccupationalDisease Act, becomes the liability of and shall be paid by the Employers' Reinsurance Fund.
(4) If it is determined that the employee is permanently and totally disabled, the employeror its insurance carrier shall be given credit for all prior payments of temporary total, temporarypartial, and permanent partial disability compensation made as a result of the industrial accident. Any overpayment by the employer or its insurance carrier shall be reimbursed by the Employers'Reinsurance Fund under Subsection (5).
(5) (a) Upon receipt of a duly verified petition, the Employers' Reinsurance Fund shallreimburse the employer or its insurance carrier for the Employers' Reinsurance Fund's share ofmedical benefits and compensation paid to or on behalf of an employee. A request forEmployers' Reinsurance Fund reimbursements shall be accompanied by satisfactory evidence ofpayment of the medical or disability compensation for which the reimbursement is requested. Each request is subject to review as to reasonableness by the administrator. The administratormay determine the manner of reimbursement.
(b) A decision of the administrator under Subsection (5)(a) may be appealed inaccordance with Part 8, Adjudication.
(6) If, at the time an employee is determined to be permanently and totally disabled, theemployee has other actionable workers' compensation claims, the employer or insurance carrierthat is liable for the last industrial accident resulting in permanent total disability shall be liable forthe benefits payable by the employer as provided in this section and Section 34A-2-413. Theemployee's entitlement to benefits for prior actionable claims shall then be determined separatelyon the facts of those claims. Any previous permanent partial disability arising out of those claimsshall then be considered to be impairments that may give rise to Employers' Reinsurance Fundliability under this section.
Renumbered and Amended by Chapter 375, 1997 General Session