La. Admin. Code tit. 40 § I-1715

Current through Register Vol. 50, No. 11, November 20, 2024

Section I-1715 - Servicing for Self-Insurer; Qualifications for Service Companies

A. Each individual self-insurer, as a condition of approval to self-insure, shall be required to provide proof of compliance with the provisions of this Section as follows.

1. It shall be the sole responsibility of each individual self-insurer to provide for qualified persons to service its program in the areas of claims adjusting, underwriting, safety engineering and loss control. Should the individual self-insurer be unable or unwilling to provide any or all of these services through the use of its own employees, then it shall contract with outside agencies with established qualifications, as evidenced by their official certificates of approval issued by this office, to provide these services.

2. In the case where an individual self-insurer elects to contract with an approved service company, the Office of Workers' Compensation may, at its discretion, choose to use the service company as an intermediary in its dealings with the employer. In the case where no service company is used, the office will deal with the employer only.

B. Any firm desiring to become qualified as a service company for individual self-insurers shall make application to the office on such forms as may be prescribed and the application must be approved before any contract for servicing shall be recognized as fulfilling §1715. A

C. Any firm making application to qualify as a service company shall provide proof that it meets the following conditions before approval may be granted.

1. The owners of the firm, including members of a co-partnership, and the officers of the corporation, shall be persons of good moral character with reputations for honesty and fair dealings.

2. The firm has a sufficient number of experienced and qualified claims personnel, including at least one resident adjuster with check or draft authority.

3. The firm has a sufficient number of experienced and qualified personnel in the areas of loss control and safety engineering.

4. The firm has a sufficient number of experienced and qualified personnel in the area of underwriting. In this context, underwriting includes, but is not limited to, the overall planning and coordinating of a self-insurer program, the ability to advise or assist in the procurement of bonds and excess insurance, the ability to provide summary data regarding the self-insurer's costs of accidents, including the frequency and distribution by type and cause, and the skill to make recommendations to the self-insurer regarding the correction of any deficiencies that arise in the self-insurer program.

5. The application for the privilege of being a service company, as defined herein, shall be accompanied by a remittance in the amount of $200, payable to the Office of Workers' Compensation. This fee will not be refunded, regardless of the disposition of the application.

D. In support of its application the firm shall submit summary information concerning its organization and rÉsumÉs on all employees with administrative or professional capacity sufficient to establish compliance with §1715. C

E. Upon compliance to the satisfaction of the office with the above provisions, a certificate of approval as a recognized and authorized service organization shall be issued to the applicant. Failure to comply with any of the foregoing rules or any order of the office within the time prescribed shall be considered good cause for withdrawal of the certificate of approval. The office shall give prior written notice of such withdrawal. The service company shall have 15 days from the date of mailing to request a hearing. Failure to request a hearing within the time prescribed shall result in the withdrawal becoming effective 30 days from the date of mailing of the original notice. In no event shall the withdrawal of the certificate of approval be effective prior to the date that the hearing on the question is scheduled. Such notice shall be served personally or by certified or registered mail upon all interested parties.

F. Each service company shall file immediately upon entering into a contract or agreement for servicing, notice of this contract or agreement with the Office of Workers' Compensation Administration. It shall be the responsibility of the individual self-insurer to obtain the written permission of the Office of Workers' Compensation Administration before changing its method of fulfilling its servicing requirements from those which were previously approved by the office.

La. Admin. Code tit. 40, § I-1715

Promulgated by the Department of Employment and Training, Office of Workers' Compensation, LR 17:962 (October 1991).

AUTHORITY NOTE: Promulgated in accordance with R.S. 23:1168 of Act 938 of 1988 Regular Session.