Arkansas Administrative Code
Agency 099 - Arkansas Workman's Compensation
Rule 099.00.05-004 - Rule 099.38: Third-Party Administrators
Universal Citation: AR Admin Rules 099.00.05-004
Current through Register Vol. 49, No. 9, September, 2024
Part I. General
A. For purposes of this rule, "third party
administrator" (hereafter TPA) means any person, firm, or partnership which
collects or charges premiums or fees, or receives remuneration in any form in
exchange for adjusting or settling claims, or otherwise providing
administrative services concerning workers' compensation coverage in this
State. The term does not include:
1.
companies which are licensed workers' compensation carriers, except to the
extent that they engage in claims and administrative activities for which they
or companies, including self-insurers, in their corporate family do not bear a
direct risk.
2. self-insurers which
self administer their claims and administrative activities, except to the
extent that they engage in claims and administrative activities for which they
or companies, including licensed workers' compensation carriers, in their
corporate family do not bear a direct risk.
3. attorneys engaged in the representation of
claimants or respondents in cases of controverted workers' compensation
claims.
B. Any TPA, that
has applied for or received authorization from the Commission, shall at all
times meet the following conditions:
1. The
owners, partners, members, or officers of the TPA, shall be persons of good
moral character with reputations for honesty and fair dealings.
2. The TPA must have a sufficient number of
experienced and qualified claims personnel. In order to represent a group
self-insurer client, the TPA must maintain an Arkansas claims office and have
at least one resident adjuster with check authority.
3. The TPA shall provide, at the Commission's
request, written proof of compliance with the conditions set forth in items 1
and 2 above. When received by the Commission, such documentation shall be
considered of a confidential nature.
4. The TPA shall continuously maintain with
the Commission a current listing of all claim office locations handling
Arkansas workers' compensation claims as well as a contact person/information
for such locations.
5. The TPA
shall, at the request of the Commission, provide a list of clients for which
Arkansas claims handling is offered. When received by the Commission, such
documentation shall be considered as being of a confidential nature.
Part II Applications
A. Any firm desiring authorization to act as
a TPA for workers' compensation purposes shall:
1. Make application to the Commission on such
forms as may be prescribed.
2.
Remit an application fee of one hundred dollars ($100) payable to the Arkansas
Workers Compensation Commission. This fee will not be refunded, regardless of
the disposition of the application.
3. Receive authorization from the Commission
prior to contracting with any client to provide claims handling services for
Arkansas workers' compensation claims.
Part III Renewals
A. Certificates of Authority to act as a TPA
for workers' compensation purposes shall expire annually on September 30. Any
firm desiring to continue its authorization to act as a TPA from the Commission
shall annually renew such authority. Such renewal shall consist of:
1. Remittance of a renewal fee in the amount
of one hundred dollars ($100) payable to the Arkansas Workers' Compensation
Commission. Any TPA having made application and receiving approval from the
Commission with an effective date from August 1 to September 30, may at the
Commission's discretion, have the first renewal fee waived.
2. Submission of a certified listing of all
locations, location contact persons, location contact information, company's
renewal contact person and contact information.
3. Submission of the above items and any
additional documentation required by the Commission shall be submitted no later
than September 1 of the year in question.
Part IV Termination or Revocation of Authority
A. Termination by the TPA - Any TPA
may surrender it's authority by notifying the Commission in writing of the
effective date of such termination.
B. Revocation by the Commission - Failure to
comply with any of the foregoing rules or any order of the Commission within
the time prescribed shall be considered good cause for revocation of the TPA
authority. The Commission shall give prior written notice of such revocation.
The TPA shall have fifteen (15) days from the date of mailing to request a
hearing. Failure to request a hearing within the time prescribed shall result
in the revocation becoming effective thirty (30) days from the date of mailing
of the original notice. In no event shall the revocation of the certificate of
authority 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.
(Approved August 29, 2001; effective September 20, 2001. revised effective January 1, 2006)
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