1. (1) The department will:

   1. (a) Follow these reimbursement limitations when determining reimbursement amounts for the licensed caregiver third party liability program claims:

      1. (i) The total amount the department will pay as the result of one occurrence must not exceed:

         1. (A) $25,000 for all property damages and personal injury;
         2. (B) $5,000 for emergency medical expenses; or
         3. (C) $3,000 for claims related to the ownership or operation of a motor vehicle;
      2. (ii) The total reimbursement cost is assessed for each occurrence separately and includes the costs for each item in the occurrence;
      3. (iii) The limitations for each occurrence must apply regardless of whether there are multiple claims from the same occurrence;

      4. (iv) The total reimbursement cost for property damages, personal injuries, and emergency medical expenses are limited to the costs:

         1. (A) Not covered in any insurance policies, up to the maximum occurrence costs in (a)(i) of this subsection; and
         2. (B) Of the insurance policy deductible and any out-of-pocket expenses, up to the maximum occurrence costs in (a)(i) of this subsection; and
      5. (v) Dental or vision appliances are limited to comparable replacements up to the maximum occurrence costs in (a)(i) of this subsection;
   2. (b) Consider damages from the same occurrence claimed by one or more licensed caregivers in the same household as a single occurrence;

   3. (c) Pay comparable replacement costs only if the:

      1. (i) Item cannot be cleaned or repaired; or
      2. (ii) The comparable replacement cost of the item is less than the cleaning or repair cost;
   4. (d) Reimburse for labor expenses for the amount payable to a licensed business;

   5. (e) Not reimburse claims if the licensed caregivers are not liable to the third party or the child's or youth's birth or adoptive parents or guardians because of:

      1. (i) Immunities;
      2. (ii) Limitations; or
      3. (iii) Exclusions provided by law; and
   6. (f) Not require licensed caregivers to use their insurance policy but will only consider reimbursement for the insurance deductible, coinsurance amounts, and any out-of-pocket expenses up to the limit of the occurrence as outlined in (a)(i) of this subsection.

2. (2) Licensed caregivers must:

   1. (a) Notify the department if their property damages or losses were paid, will be paid, or are covered by a homeowner's, motor vehicle, or other public, personal, or business insurance policy; and
   2. (b) Provide detailed medical bills and insurance statements or explanation of benefits showing the amount covered for emergency medical expenses.

[Statutory Authority: RCW 74.13.031 and 74.14B.080. WSR 26-09-128, s 110-50-0960, filed 4/21/26, effective 5/22/26. WSR 18-14-078, recodified as § 110-50-0960, filed 6/29/18, effective 7/1/18. Statutory Authority: RCW 74.13.031. WSR 01-08-047, § 388-25-0330, filed 3/30/01, effective 4/30/01.]