19 Del. Admin. Code §§ 1401-19.0

Current through Register Vol. 27, No. 12, June 1, 2024

Section 1401-19.0 - Powers of the Division

19.1 Forms. The Division shall create forms, including a form for a complaint, that may be filed with the Division for a claim of non-compliance with the Act. The forms will be on the Division's website. All forms shall be produced and be made available on the Division's online portal and website in both English and Spanish. The website itself shall be available in both languages, as well. If additional languages achieve a level of common usage where it is primarily spoken by 5.0% of the state's population (as established by the U.S. Census Bureau), those languages shall also be used in all forms and communications, in addition to English and Spanish. All material released by the Division shall be formatted so that it can machine read for purposes of improved accessibility for people with disabilities.

19.2 Audit. In addition to those powers stated in the Act, the Division may audit employers for compliance with the Act, as the Division determines. The Division reserves the right to examine any adjudicated claims application, whether they have been approved or denied, on a random basis. Admitted private insurers with approved PFML coverage plans shall provide the Division access to their records systems, along with the training and assistance necessary to understand the materials therein, so that the Division may audit claims adjudicated by those insurers. The records and systems of self-insured private plans shall likewise be made available to and intelligible by the Division for auditing purposes.

19.3 Division audit and investigative authority. The Division may enter and inspect an employer's premises or place of business or employment. In so far as possible, the Division will attempt to arrange a mutually acceptable time for this inspection, providing at least 24 hours' notice to the employer.

19.3.1 All employers shall keep and preserve any or all books, registers, payrolls, and other records, including those required by the Act, for at least 3 calendar years. Items preserved or archived in electronic form (rather than in physical form for 3 years shall be considered to satisfy this requirement.

19.3.2 The Division may deem it necessary or appropriate to prescribe or approve forms, which may be used by an employer for statements, sworn statements, or other information the Division determines.

19.4 Division initial determination. If, after submissions from the parties, the Division initially determines an employer violated 1 or more provisions of the Act, or a covered individual received overpayment or violated the Act, the Division shall notify the appropriate party in writing within 5 days of its initial determination. The notice shall provide, at a minimum:

19.4.1 The date of the notice;

19.4.2 Amounts owed;

19.4.3 Civil penalties accessed, if any;

19.4.4 Notification of the ability to appeal the Division's initial determination to the Board.

19.5 Appeal to the Board. A covered individual or employer must file an appeal, if any, to the Board within 30 days from the date of the Division's claim review determination. Within 5 days of receipt of the appeal, the Board shall provide the parties with a hearing date.

19.6 Nothing in these regulations limits the Department of Insurance's jurisdiction over an insurer issuing an approved private plan and the Division shall have authority to pursue any issues in its jurisdiction that the Department of Insurance declines to pursue.

19 Del. Admin. Code §§ 1401-19.0

27 DE Reg. 52 (7/1/2023)
27 DE Reg. 287 (11/1/2023) (Errata)