Ariz. Admin. Code § 20-5-1510

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

Section R20-5-1510 - Processing of Workers' Compensation Claims; Authorization to Self-Administer

A. A Self-Insurer shall utilize a Third-Party Administrator to process workers' compensation claims unless the Division authorizes the Self-Insurer to Self-Administer.

B. A Self-Insurer seeking to Self-Administer shall file with the Division a completed Application to Self-Administer Form and all documentation and information required under subsection (C).

C. The Division, in consultation with the Claims Division of the Commission, shall authorize a Self-Insurer to Self-Administer if the Self-Insurer provides documentation and information establishing the following:

1. The Self-Insurer has facilities and equipment sufficient to manage, process, and store its own information pertaining to the SelfInsurer's workers' compensation claims;

2. The Self-Insurer's workers' compensation claims are processed by persons with experience, training, and knowledge regarding the processing of Arizona workers' compensation claims and the requirements of the Act and applicable administrative rules; and

3. The persons processing the Self-Insurer's claims have completed the Claims Division's workers' compensation training program within the prior two years.

D. The Division shall administratively review an application to Self-Administer within 20 days of receipt to determine if the application is complete. If the application is incomplete, the Division shall notify the Applicant in writing of the missing documentation or information necessary to comply with this section.

E. The Division shall deem an application to Self-Administer withdrawn if the Applicant fails to file a completed application within 10 days of being notified by the Division that the application is incomplete according to subsection (D).

F. Unless the substantive review time frame is extended under A.R.S. § 41-1075, the Division shall determine whether an application to Self-Administer meets the substantive criteria of subsection (C) within 30 days after the application to Self-Administer is deemed complete.

G. The overall timeframe for processing an application to Self-Administer is 50 days, unless extended under A.R.S. § 41-1072 et seq.

H. Upon approval of an application to Self-Administer, the Division shall serve a certificate of authorization on the Applicant no later than 30 days after approval.

I. The Division shall revoke a certificate of authorization to Self-Administer if the Self-Insurer no longer satisfies the requirements in subsection (C).

J. If the Division denies a request to Self-Administer or revokes a certificate of authorization, the Division shall issue and serve written findings and an order on the Applicant no later than 30 days after the denial or revocation.

K. Authorization to Self-Administer shall continue until any of the following occurs:

(1) self-insurance authority ceases;

(2) the SelfInsurer contracts with a Third-Party Administrator to process workers' compensation claims; or

(3) authority to Self-Administer is revoked by the Division.

Ariz. Admin. Code § R20-5-1510

New section made by final rulemaking at 28 A.A.R. 3435, effective 10/5/2022.