Ariz. Admin. Code § 20-5-1405

Current through Register Vol. 30, No. 49, December 6, 2024

Section R20-5-1405 - Cancer Claim Reporting Method; Frequency; Deadlines; Duration

A. Cancer-related claim reporting under A.R.S. § 23-971 and this Article shall be performed electronically through the commission's electronic claims portal. Insurance carriers, self-insured employers, self-insurance pools, or a designee (including third-party administrators or an adjuster) are authorized to complete required claim reporting. Duplicate reporting of the same claim information is prohibited.

B. Subject to the claim reporting durations specified in subsection D of this section, insurance carriers, self-insured employers, and self-insurance pools subject to A.R.S. § 23-971 shall annually report the data elements specified in R20-5-1407 and R20-5-1408 for cancer-related claims filed by or on behalf of firefighters and fire investigators.

C. Claim data reported pursuant to subsection B of this section shall be determined as of the loss valuation date for the applicable reporting period.

D. Claim reporting shall be completed within 31 days after each applicable reporting period, i.e. , no later than July 31 of each year.

E. Claim reporting under A.R.S. § 23-971 is subject to the following claim reporting durations:

1. Denied Claims: Reported one time following the reporting period during which the claim is denied by a notice of claim status. Reporting is not required for claims denied prior to July 1, 2021.

2. Claims Accepted on or after July 1, 2021: Reported for the longer of:

(a) the duration the claim remains open plus two additional annual reports after the claim is closed; or

(b) ten annual reports after acceptance of the claim.

3. Claims Accepted before July 1, 2021: If the claim was open on July 1, 2021, the claim shall be reported for the duration the claim remains open plus two additional annual reports after the claim is closed. If the claim was closed as of July 1, 2021, and was accepted on or after July 1, 2011, the claim shall be reported for two annual reports. If the claim was closed as of July 1, 2021, and was accepted prior to July 1, 2011, reporting is not required.

4. Reopened Claims: Reported for the longer of:

(1) the duration the claim remains open (following acceptance of the petition to reopen), plus two additional annual reports after the claim is closed; or

(2) ten annual reports after acceptance of the petition to reopen.

5. Claims that Develop into Cancer-Related Claims: If a claim develops into a cancer-related claim, reporting should begin following the reporting period in which the claim developed into a cancer-related claim. In these circumstances, the claim shall be reported for the longer of:

(1) the duration the claim remains open plus two additional annual reports after the claim is closed; or

(2) ten annual reports.

6. Non-Cancer-Related Claims: If a cancer-related claim develops into a claim that no longer meets the definition of a cancer-related claim, no further annual reporting is required.

7. Informational Claims: Claims that have been filed but have not been accepted or denied as of the applicable loss valuation date shall not be reported.

Ariz. Admin. Code § R20-5-1405

New section made by final rulemaking at 28 A.A.R. 1481, effective 6/10/2022.