Title 34, Chapter 9, Section 360
( 34-9-360)
(a) If an employee who has a permanent impairment incurs a
subsequent injury or disease arising out of and in the course of
employment, which subsequent injury results in liability for the
disability arising from merger of the subsequent injury with the
preexisting permanent impairment, the employer or insurer shall in
the first instance pay all compensation provided by this chapter.
The employer or insurer shall be reimbursed from the Subsequent
Injury Trust Fund for all weekly income benefits payments payable
after 104 weeks of payment. (b) An employer or insurer who has paid medical and rehabilitation
expenses on behalf of the employee who comes under this article
shall be entitled to reimbursement from the fund on the following
basis: (1) Fifty percent reimbursement of all medical and rehabilitation
expenses which exceed $5,000.00 but do not exceed $10,000.00; (2) One hundred percent reimbursement of all medical and
rehabilitation expenses paid which exceed $10,000.00. (c) As a prerequisite to reimbursement from the fund, the insurer
shall be required to certify that the medical and indemnity reserves
have been reduced to the threshold limits of reimbursement. (d) When the same employer in a claim accepted by the fund for
reimbursement returns the injured worker to work with the same
employer, the employer shall not be subject to further indemnity or
medical deductibles in the event the employee suffers a new accident
that merges with the same prior impairment that previously resulted
in fund acceptance of the prior reimbursement claim. This provision
does not apply if the employee returns to work for a different
employer or there has been a break in service by the employee. (e) As a prerequisite to reimbursement from the fund, there must be evidence of payment of workers' compensation benefits in accordance with Code Section 34-9-221 or an award of the State Board of Workers' Compensation directing the employer to pay weekly income benefits as a result of the subsequent injury. (f) The fund shall reimburse only those indemnity, medical, and
rehabilitation expenses that the employer or insurer was legally
obligated to pay to the employee or claimant. The fund shall
reimburse such expenses at a rate not exceeding the usual and
customary charges. The administrator of the fund may refer any
medical or rehabilitation expense to the State Board of Workers'
Compensation for review and recommendation and, in the event of a
dispute between the fund and the employer or insurer, the questioned
medical and rehabilitation expense shall be referred to the State
Board of Workers' Compensation for approval. This subsection shall
apply to any claim filed against the fund on and after July 1, 1987. |