reglab/statecodes huggingface dataset:
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 05 - INDUSTRIAL COMMISSION OF ARIZONA › Article 12 - ARIZONA MINIMUM WAGE AND EARNED PAID SICK TIME PRACTICE AND PROCEDURE › Section R20-5-1213 - Findings and Order Issued by the Department

Current through Register Vol. 30, No. 28, July 12, 2024
A. Except as provided in
				R20-5-1219, after receipt of a
				complaint alleging a violation of the Act, the Department shall issue a
				Findings and Order of its determination. The Department shall serve its
				Findings and Order to both the employer and the complainant. Service may be
				made and is deemed complete by either depositing the document in regular or
				certified mail, addressed to the party served at the address shown in the
				records of the Department, by personal delivery upon the party, or with a
				party's consent, transmission by email to the email address shown in the
				records of the Department.
B. If
				the Department determines that an employer has violated the minimum wage,
				earned paid sick time, or equivalent paid time off requirements, the Department
				shall order the employer to pay the employee, and if applicable, affected
				employees, the balance of the wages, earned paid sick time, or equivalent paid
				time off owed, including interest at the legal rate and an additional amount
				equal to twice the underpaid wages, earned paid sick time, or equivalent paid
				time off owed.
C. If the Department
				determines that a retaliation, discrimination, confidentiality, or
				nondisclosure violation has occurred, the Department shall direct the employer
				or other person to cease and desist from the violation and may take action
				necessary to remedy the violation, including:
1. Rehiring or reinstatement,
2. Reimbursement of lost wages and
				interest,
3. Payment of penalty to
				employees or affected employees as provided for in the Act and this Article,
				and
4. Posting of notices to
				employees.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 05 - INDUSTRIAL COMMISSION OF ARIZONA › Article 12 - ARIZONA MINIMUM WAGE AND EARNED PAID SICK TIME PRACTICE AND PROCEDURE › Section R20-5-1214 - Review of Department Findings and Order; Hearings; Issuance of Decision upon Hearing

Current through Register Vol. 30, No. 28, July 12, 2024
A. Except as
				provided in
				R20-5-1213(D),
				a party aggrieved by a Findings and Order issued by the Department may request
				a hearing by filing a written request for hearing with the Department within 30
				days after the Findings and Order is served upon the party. Failure to timely
				file a request for hearing means that the Findings and Order issued by the
				Department is final and res judicata to all parties.
B. A request for hearing shall be in writing
				and contain:
1. The name and address of the
				party requesting the hearing,
2.
				The signature of the party or the party's authorized representative,
				and
3. A statement that a hearing
				is requested.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 05 - INDUSTRIAL COMMISSION OF ARIZONA › Article 12 - ARIZONA MINIMUM WAGE AND EARNED PAID SICK TIME PRACTICE AND PROCEDURE › Section R20-5-1215 - Request for Rehearing or Review of Decision upon Hearing

Current through Register Vol. 30, No. 28, July 12, 2024
A. A party may request rehearing or review of
				a decision issued under
				R20-5-1214
				by filing with the Administrative Law Judge a written request for rehearing or
				review no later than 15 days after the written decision is served personally or
				by regular first class mail upon the parties.
B. A request for rehearing or review shall be
				based upon any of the following causes that materially affected the rights of
				an aggrieved party:
1. Irregularities in the
				hearing proceeding or any order, or abuse of discretion that deprives a party
				seeking review of a fair hearing;
2. Accident or surprise that could not have
				been prevented by ordinary prudence;
3. Newly discovered material evidence that
				could not have been discovered with reasonable diligence and produced at the
				hearing;
4. Error in the admission
				or rejection of evidence, or errors of law occurring at the hearing;
5. Bias or prejudice of the Department or
				administrative law judge; and
6.
				The findings of fact or conclusions of law contained in the decision are not
				justified by the evidence or are contrary to law.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 05 - INDUSTRIAL COMMISSION OF ARIZONA › Article 12 - ARIZONA MINIMUM WAGE AND EARNED PAID SICK TIME PRACTICE AND PROCEDURE › Section R20-5-1216 - Judicial Review of Decision upon Hearing or Decision upon Review

Current through Register Vol. 30, No. 28, July 12, 2024
A. A party
				aggrieved by a decision upon hearing issued under
				R20-5-1214
				or a decision upon review issued under
				R20-5-1215
				may seek review by commencing an action in the Superior Court as provided in
				A.R.S. §
									12-901 et
				seq. within 35 days from the date a copy of the decision sought to be reviewed
				is served personally or by regular first class mail upon the party
				affected.
B. A decision upon
				hearing issued under R20-5-1214 or a decision upon review issued under
				R20-5-1215
				is final unless a party seeks judicial review as provided under A.R.S. §
									12-901 et
				seq.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 05 - INDUSTRIAL COMMISSION OF ARIZONA › Article 12 - ARIZONA MINIMUM WAGE AND EARNED PAID SICK TIME PRACTICE AND PROCEDURE › Section R20-5-1217 - Assessment of Civil Penalties under A.R.S. Section 23-364(F)

Current through Register Vol. 30, No. 28, July 12, 2024
The Department may assess civil penalties for violations of
				  the Act and this Article, including the assessment of civil penalties for
				  engaging in conduct that hinders an investigation of the Department as
				  specified in
				  R20-5-1212.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 05 - INDUSTRIAL COMMISSION OF ARIZONA › Article 12 - ARIZONA MINIMUM WAGE AND EARNED PAID SICK TIME PRACTICE AND PROCEDURE › Section R20-5-1218 - Collection of Wages, Earned Paid Sick Time, Equivalent Paid Time Off, or Penalty Payments Owed

Current through Register Vol. 30, No. 28, July 12, 2024
A. Upon
				determination that wages, earned paid sick time, equivalent paid time off, or
				penalty payments are due and unpaid to any employee, the employee may, or the
				Department may on behalf of an employee, obtain judgment and execution,
				garnishment, attachment, or other available remedies for collection of unpaid
				wages and penalty payments established by a final Findings and Order of the
				Department.
B. If payment cannot be
				made to the employee, the Department shall receive monetary compensation or
				penalty payments on behalf of the employee and transmit monies it receives as
				payment in a special state fund as provided in A.R.S. §
									23-356(C).
C. The Department may amend a Findings and
				Order to conform to the legal name of the business or the person who is the
				defendant employer to a complaint under the Act, provided service of the
				Findings and Order was made on the defendant or the defendant's agent. If a
				judgment has been entered on the order, the Department may apply to the clerk
				of the superior court to amend a judgment that has been issued under a final
				order, provided service was made on the defendant or the defendant's
				agent.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 05 - INDUSTRIAL COMMISSION OF ARIZONA › Article 12 - ARIZONA MINIMUM WAGE AND EARNED PAID SICK TIME PRACTICE AND PROCEDURE › Section R20-5-1219 - Resolution of Disputes

Current through Register Vol. 30, No. 28, July 12, 2024
Notwithstanding any other provision of law, the Department
				  may mediate and conciliate a dispute between the parties.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 05 - INDUSTRIAL COMMISSION OF ARIZONA › Article 12 - ARIZONA MINIMUM WAGE AND EARNED PAID SICK TIME PRACTICE AND PROCEDURE › Section R20-5-1220 - Small Employer Request for Exception to Recordkeeping Requirements

Current through Register Vol. 30, No. 28, July 12, 2024
A. In this Section,
				unless context otherwise requires, "small employer" means a corporation,
				proprietorship, partnership, joint venture, limited liability company, trust,
				or association that has less than $500,000 in gross annual revenue.
B. A small employer, or any category of small
				employer that is unreasonably burdened by the recordkeeping requirements of the
				Act and this Article may file a written petition for exception with the
				Department requesting relief from certain recordkeeping requirements under this
				Article. The petition shall:
1. State the
				reasons for the request for relief;
2. State an alternate manner or method of
				making, keeping, and preserving records that will enable the Department to
				determine hours worked and wages paid; and
3. Include the signature of the employer or
				an authorized representative of the employer.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 05 - INDUSTRIAL COMMISSION OF ARIZONA › Article 13 - TREATMENT GUIDELINES › Section R20-5-1303 - Provider Request for Preauthorization

Current through Register Vol. 30, No. 28, July 12, 2024
A. No preauthorization is required under the
				Act to ensure payment for reasonably required medical treatment or services.
				While preau-thorization is not required under the Act, a provider may seek
				preauthorization as provided in this subsection.
B. A provider shall submit a request for
				preauthorization in writing using Section I (Provider Request for
				Preauthorization) of the Medical Treatment Preauthorization Form approved by
				the Commission under
				R20-5-106(A)(12).
				A provider shall attach documentation to a request for preauthorization that
				supports the medical necessity and appropriateness of the treatment or services
				requested, such as office notes and diagnostic reports.
C. A provider may submit the
				request for preauthorization by mail, electronically or by fax.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 05 - INDUSTRIAL COMMISSION OF ARIZONA › Article 13 - TREATMENT GUIDELINES › Section R20-5-1304 - Payer Denial of Request for Preauthorization

Current through Register Vol. 30, No. 28, July 12, 2024
A. A payer shall not deny a request for
				preauthorization solely because the guidelines do not address the requested
				treatment or services.
B. A payer
				shall not deny a request for preauthorization that is supported by the
				guidelines, unless the payer can rebut the presumption of reasonableness and
				correctness with a medical or psychological opinion establishing by a
				preponderance of the evidence that there is a contraindication or significant
				medical or psychological reason not to authorize the requested treatment or
				services. Upon request by the provider or injured employee, a denial of
				preauthorization in this situation shall be processed as an immediate referral
				to the Commission for administrative review as provided in R20-5-1311 unless
				the payer obtains an IME in support of its denial. If the payer obtains an IME
				which serves as the basis for the denial, then review of the payer's decision
				shall be processed as a request for investigation under A.R.S. §
									23-1061(J)
				 if filed by the injured employee.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 05 - INDUSTRIAL COMMISSION OF ARIZONA › Article 13 - TREATMENT GUIDELINES › Section R20-5-1305 - Payer Denial of Payment for Provided Treatment or Services

Current through Register Vol. 30, No. 28, July 12, 2024
A. A payer shall not deny payment for
				provided treatment or services solely because the guidelines do not address the
				requested treatment or services.
B.
				A payer shall not deny payment for provided treatment or services supported by
				the guidelines, unless the payer can rebut the presumption of reasonableness
				and correctness with a medical or psychological opinion establishing by a
				preponderance of the evidence that there is a medical contraindication or
				significant medical or psychological reason not to pay for the treatment or
				services.
C. A dispute related to a
				payer's failure to pay for provided treatment or services may be processed as a
				request for investigation under A.R.S. §
									23-1061(J)
				 if filed by an injured employee.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 05 - INDUSTRIAL COMMISSION OF ARIZONA › Article 13 - TREATMENT GUIDELINES › Section R20-5-1306 - Payer Reversal of Decision to Deny Treatment or Services

Current through Register Vol. 30, No. 28, July 12, 2024
A payer may reverse its decision to deny treatment or
				  services at any time throughout the process described in this Article. In this
				  situation, the payer's subsequent authorization or agreement to pay for the
				  treatment or services at issue shall end this process.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 05 - INDUSTRIAL COMMISSION OF ARIZONA › Article 13 - TREATMENT GUIDELINES › Section R20-5-1307 - Payer Decision, In Whole or In Part

Current through Register Vol. 30, No. 28, July 12, 2024
A payer may issue a decision approving or denying a request
				  for preauthorization in whole, or in part.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 05 - INDUSTRIAL COMMISSION OF ARIZONA › Article 13 - TREATMENT GUIDELINES › Section R20-5-1308 - Failure to Comply with Required Time Limits

Current through Register Vol. 30, No. 28, July 12, 2024
A payer's failure to comply with the required time limits of
				  this process may be considered unreasonable delay under
				  R20-5-163.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 05 - INDUSTRIAL COMMISSION OF ARIZONA › Article 13 - TREATMENT GUIDELINES › Section R20-5-1309 - Payer Decision on Request for Preauthorization

Current through Register Vol. 30, No. 28, July 12, 2024
A. Except as provided in subsections (C) or
				(D), a payer shall communicate to the provider its decision on a request for
				preau-thorization no later than 7 business days after the request is received.
				The decision shall be issued in writing using Section II (Payer Decision on
				Request for Preauthorization) of the Medical Treatment Preauthorization Form
				approved by the Commission under
				R20-5-106(A)(12).
				A payer shall attach to the decision a statement of what has been authorized,
				including, if applicable, a partial authorization, and, if the request for
				preauthorization is denied, in whole or in part, a statement of explanation
				that includes the medical reason supporting the payer's decision. For purposes
				of this Section, the 7 business days begin to run the day after the payer
				receives the request.
B. If a payer
				fails to communicate to a provider its decision on request for preauthorization
				within 7 business days, then the payer's failure to take action is deemed a "no
				response" and the provider or injured employee may submit a request for
				administrative review directly to the Commission as provided in
				R20-5-1311.
C. If a payer receives a request for
				preauthorization not submitted on Section I (Provider Request for
				Preauthorization) of the Medical Treatment Preauthorization Form approved by
				the Commission under
				R20-5-106(A)(12)
				or an incomplete request for preauthorization using Section I (Provider Request
				for Preauthorization) of the Medical Treatment Preauthorization Form approved
				by the Commission under
				R20-5-106(A)(12),
				the payer shall:
1. No later than 7 business
				days after the request is received and identified, act on the request for
				preauthorization pursuant to subsection (A); or
2. No later than 7 business days after the
				request is received and identified, notify the provider in writing that the
				request for pre-authorization is incomplete or, if applicable, that a request
				for preauthorization must be submitted on Section I (Provider Request for
				Preauthorization) of the Medical Treatment Preauthorization Form approved by
				the Commission under R20-5-106(A)(12).
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 05 - INDUSTRIAL COMMISSION OF ARIZONA › Article 13 - TREATMENT GUIDELINES › Section R20-5-1310 - Payer Reconsideration on Request for Preauthorization

Current through Register Vol. 30, No. 28, July 12, 2024
A. Except as
				provided in subsection (C), a payer shall communicate to the provider its
				decision on a request for reconsideration no later than 7 business days after
				the request is received. This decision shall be issued in writing using Section
				IV (Payer Decision on Request for Reconsideration) of the Medical Treatment
				Preauthorization Form approved by the Commission under
				R20-5-106(A)(12).
				A payer shall attach to the decision a statement of what has been authorized,
				including, if applicable, a partial authorization, and, if the request for
				preauthorization is denied, in whole or in part, a statement of explanation
				that includes the medical reason supporting the payer's decision. For purposes
				of this subsection, the 7 business days begin to run the day after the payer
				receives the request for reconsideration.
B. If a payer fails to respond to a request
				for reconsideration within 7 business days, the provider or injured employee
				may submit a request for administrative review directly to the Commission as
				provided in
				R20-5-1311.
C. If, no later than 7 business days after a
				request for reconsideration has been received, a payer provides written notice
				to the provider that an IME has been requested under
				R20-5-114
				using Section IV (Payer Decision on Request for Reconsideration) of the Medical
				Treatment Preauthorization Form approved by the Commission under
				R20-5-106(A)(12),
				then the payer's decision on a request for reconsideration shall be issued no
				later than 7 business days after the final IME report has been received by the
				payer. The payer shall provide a copy of the final IME report to the provider
				upon receipt of the report.
D.
				Commission Review of Payer Reconsideration Decision:
1. An injured employee or provider may seek
				review of a payer reconsideration decision by requesting an administrative
				review by the Commission as provided in
				R20-5-1311
				unless the payer decision was supported by an IME.
2. An injured employee may seek review of a
				payer reconsideration decision that is supported by an IME by requesting an
				investigation under A.R.S. §;
				23-1061(J).
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 05 - INDUSTRIAL COMMISSION OF ARIZONA › Article 13 - TREATMENT GUIDELINES › Section R20-5-1311 - Administrative Review by Commission

Current through Register Vol. 30, No. 28, July 12, 2024
A.
				Absent further action of the Commission under
				R20-5-1301(C),
				administrative review under this Article is available for requests for medical
				treatment or services related to all body parts and conditions.
B. A request for administrative review shall
				be in writing using Section V (Provider or Employee Request for Administrative
				Peer Review) of the Medical Treatment Preauthorization Form approved by the
				Commission under
				R20-5-106(A)(12).
				A request for administrative review must attach copies of relevant medical
				information or records and copies of all documentation related to the payer's
				decision or non-response. A request for administrative review must be submitted
				to the Commission by mail, electronically or by fax.
C. Upon
				receipt of a request for administrative review, the Commission shall determine
				whether the administrative review is available under this Article.
1. If administrative review is not available,
				then no later than three business days after receiving a request for
				administrative review, the Commission shall send notice to the injured employee
				and payer that administrative review is not available.
2. If administrative review is available,
				then no later than three business days after receiving the request, the
				Commission shall send notice to the payer that a request for administrative
				review has been received and provide information on how to participate in the
				process.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 05 - INDUSTRIAL COMMISSION OF ARIZONA › Article 13 - TREATMENT GUIDELINES › Section R20-5-1312 - Hearing Process

Current through Register Vol. 30, No. 28, July 12, 2024
A. A
				referral of a request for hearing under R20-5-1311(L) shall be processed as
				provided for in the Act unless all parties agree to participate in the fast
				track process.
B. The following
				applies only to the Fast Track ALJ Dispute Resolution Program:
1. Parties must agree to participate in the
				Fast Track ALJ Dispute Resolution Program with the understanding that a short
				form decision will be issued.
2.
				Review by the presiding ALJ shall be limited to the treatment or service
				dispute considered at the administrative review under R20-5-1311.
3. The presiding ALJ shall issue a notice of
				hearing within 10 business days of the receipt of the fully executed agreement
				to participate and certificate of readiness.
4. The hearing shall be held within 30
				calendar days from the day that the notice of hearing is issued to the extent
				practicable.
5. Discovery is
				limited to five interrogatories and no depositions are permitted.
6. The presiding ALJ shall take all lay
				witness testimony at the time of the hearing and will not hold any further
				hearings.
7. The presiding ALJ
				shall consider documentary medical evidence only; no medical testimony shall be
				taken.
8. Medical file review
				opinions shall be deemed to constitute substantial evidence to support the
				requested treatment or service.
9.
				All documentary evidence shall be submitted no later than 10 business days
				before the scheduled hearing.
10.
				The hearing shall be recorded, but not transcribed, unless one or more of the
				parties files a request for review under A.R.S. §
										23-942
				and A.R.S. §
										23-943.
11. The presiding ALJ shall issue a short
				form decision within five business days after the matter is deemed
				submitted.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 05 - INDUSTRIAL COMMISSION OF ARIZONA › Article 14 - MUNICIPAL FIREFIGHTER CANCER REIMBURSEMENT FUND AND FIREFIGHTER AND FIRE INVESTIGATOR CANCER CLAIM REPORTING › Section R20-5-1401 - Application of the Article and Definitions

Current through Register Vol. 30, No. 28, July 12, 2024
A. This Article applies to reimbursement
				claims submitted to the Municipal Firefighter Cancer Reimbursement Fund under
				Arizona Revised Statutes ("A.R.S."), Title 23, Chapter 11, and firefighter and
				fire investigator cancer claim reporting under A.R.S. §
									23-971.
B. The definitions in A.R.S. §
									§
									23-1701
				and
				23-901.09
				apply in this Article.
C.
				"Cancer-related claims" as used in A.R.S. §
									23-971
				and this Article shall mean Arizona workers' compensation claims involving any
				disease, infirmity, or impairment of health that is caused by cancer.
D. "Fiscal year"
				or "reporting period" shall mean the 12-month cycle that begins on July 1 and
				ends on June 30.
E. "Loss valuation
				date" shall mean the last day of the reporting period and the date on which
				firefighter and fire investigator cancer claim data shall be determined for
				reporting purposes.
F. An "open"
				claim shall mean a workers' compensation claim that is eligible for temporary
				compensation and/or active medical treatment. A "closed" claim shall mean a
				workers' compensation claim in which temporary compensation and active medical
				treatment have been terminated.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 05 - INDUSTRIAL COMMISSION OF ARIZONA › Article 14 - MUNICIPAL FIREFIGHTER CANCER REIMBURSEMENT FUND AND FIREFIGHTER AND FIRE INVESTIGATOR CANCER CLAIM REPORTING › Section R20-5-1402 - Reimbursement Claims

Current through Register Vol. 30, No. 28, July 12, 2024
A. A Municipal
				Payor seeking reimbursement from the Fund shall submit a reimbursement claim in
				writing on the Municipal Firefighter Cancer Reimbursement Form approved by the
				Commission.
B. The Municipal
				Firefighter Cancer Reimbursement Form shall include the following attestations,
				which shall be made by an autho- rized representative of a Municipal Payor
				seeking reimbursement from the Fund:
1. The
				reimbursement request includes only eligible compensation and benefits paid
				under A.R.S. §
										23-1702(A)
				 on municipal fire- fighter or municipal fire
				investigator workers' compensation claims accepted under A.R.S. §
										23-901.09.
2. The reimbursement request only
				includes amounts actually paid by th e Municipal Payor for comp ensation and
				benefits under A.R.S. §
										23-1702(A)
				 during the immediately preceding fiscal
				year.
3. The reimbursement request
				does not include amounts paid for expenses relating to case management,
				vocational rehabilitation, or similar nonmedical costs.
4. The information included in, or submitted
				with, the Municipal Firefighter Cancer Reimbursement Form is true and
				correct.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 05 - INDUSTRIAL COMMISSION OF ARIZONA › Article 14 - MUNICIPAL FIREFIGHTER CANCER REIMBURSEMENT FUND AND FIREFIGHTER AND FIRE INVESTIGATOR CANCER CLAIM REPORTING › Section R20-5-1403 - Recordkeeping and Record Inspections

Current through Register Vol. 30, No. 28, July 12, 2024
A. Municipal Payors seeking reimbursement
				from the Fund shall maintain all records suppor ting amounts included in a
				reimbursement claim for at least ten years after the reimbursement claim is
				filed.
B. Municipal Payor records
				supporting amounts included in a reimbursement claim shall always be open for
				inspection by the Commis- sion or representatives of the Commission to
				ascertain information necessary for its administration of A.R.S. §§
									23-1701
				through 23- 1703. Upon request, a Municipal Payor shall make such records
				available to the Commission within 30 days.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 05 - INDUSTRIAL COMMISSION OF ARIZONA › Article 14 - MUNICIPAL FIREFIGHTER CANCER REIMBURSEMENT FUND AND FIREFIGHTER AND FIRE INVESTIGATOR CANCER CLAIM REPORTING › Section R20-5-1404 - Fund Overpayments

Current through Register Vol. 30, No. 28, July 12, 2024
A. A
				Municipal Payor that discovers an error in a reimbursement claim which may
				result or has resulted in an overpayment from the Fund shall notify the
				Commission of the error within three business days of discovery of the
				error.
B. Overpayments made by the
				Fund to Municipal Payors that are di scovered through inspection of records, or
				otherwise, shall be returned to the Fund by the applicable Municipal Payor
				within 30 days of notification by the Commission.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 05 - INDUSTRIAL COMMISSION OF ARIZONA › Article 14 - MUNICIPAL FIREFIGHTER CANCER REIMBURSEMENT FUND AND FIREFIGHTER AND FIRE INVESTIGATOR CANCER CLAIM REPORTING › Section R20-5-1406 - Cancer Reporting; Required General Data Elements

Current through Register Vol. 30, No. 28, July 12, 2024
A. Name of Data Provider
				(
i.e.
, What entity is reporting the data?): The name of the
				insurance carrier, self-insured employer, self-insurance pool, or designee
				submitting the cancer-related claim data.
B. Data Provider Type Code: Insurance
				Carrier; Self-Insured Employer; Self-Insurance Pool; Third-Party Administrator;
				or Other Designee.
C. Name of
				Person Submitting Data: The name of the individual submitting the
				cancer-related claim data.
D. Name
				of Data Provider Primary Contact: The name of the individual designated by the
				Data Provider who can be contacted regarding the data submission. (May be the
				same as the "Name of Person Submitting the Data.")
E. Data Provider Primary Contact Phone
				Number: The phone number of the Data Provider Primary Contact.
F. Data Provider Primary Contact Email
				Address: The email address of the Data Provider Primary Contact.
G. Loss valuation date: The last day of the
				12-month reporting period.
H. Total
				Number of New Cancer-Related Claims: Total number of cancer-related claims
				filed by or on behalf of firefighters and fire investigators during the
				applicable reporting period (whether or not the claims are included in the
				detailed reporting).
1. Accepted: Total
				number of new cancer-related claims accepted during the applicable reporting
				period.
2. Denied: Total number of
				cancer-related claims denied during the applicable reporting period.
3. Pending: Total number of cancer-related
				claims pending decision on the applicable loss valuation date.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 05 - INDUSTRIAL COMMISSION OF ARIZONA › Article 15 - WORKERS' COMPENSATION SELF-INSURANCE › Section R20-5-1502 - Computation of Time; Extension of Time Limits

Current through Register Vol. 30, No. 28, July 12, 2024
A. In computing any time period prescribed or
				allowed by this Article, the day of the event from which the time period begins
				to run shall not be included, but the last day of the period computed shall be
				included unless it is a Saturday, Sunday, or legal holiday, in which event the
				period shall run until the end of the next day that is not a Saturday, Sunday,
				or legal holiday. When the time period prescribed or allowed is less than 11
				days, intermediate Saturdays, Sundays, and legal holidays shall not be included
				in the computation of time.
B.
				Except as otherwise precluded by law, the Division may extend time limits
				prescribed by this Article for good cause. A request for an extension of a time
				limit shall be filed with the Division in writing and shall state the reasons
				for the request.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 05 - INDUSTRIAL COMMISSION OF ARIZONA › Article 15 - WORKERS' COMPENSATION SELF-INSURANCE › Section R20-5-1503 - Forms and Reports

Current through Register Vol. 30, No. 28, July 12, 2024
The following forms, available at
http://www.azica.gov
and upon request
				  from the Division, shall be used when applicable:
1. Initial Application for Authority to
				Self-Insure Form,
2. Self-Insurance
				Renewal Application Form,
3. New
				Pool Member Application Form,
4.
				Workers' Compensation Liability Form,
5. Application to Self-Administer
				Form,
6. Self-Provider of Medical
				Benefits Form,
7. Parent Guaranty
				Form,
8. Workers' Compensation
				Guaranty Bond Form,
9. Statutory
				Deposit Agreement Form,
10. Custody
				Agreement Form,
11. Request for
				Waiver of Security Form,
12. Notice
				of Termination of Self-Insurance Form,
13. Annual Payroll Report Form,
14. Annual Medical Report Form,
15. Annual Injury Report Form,
16. Annual Hospital Report Form,
17. Quarterly Tax Payment Form.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 05 - INDUSTRIAL COMMISSION OF ARIZONA › Article 15 - WORKERS' COMPENSATION SELF-INSURANCE › Section R20-5-1504 - Self-Insurance Criteria

Current through Register Vol. 30, No. 28, July 12, 2024
A. A
				Public Entity may file an application for authority to self-insure if:
1. The Public Entity's annual payroll is at
				least $2 million; and
2. The Public
				Entity's total assets are at least $25 million.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 05 - INDUSTRIAL COMMISSION OF ARIZONA › Article 15 - WORKERS' COMPENSATION SELF-INSURANCE › Section R20-5-1507 - New Member Application Requirements for Self-Insurance Pools

Current through Register Vol. 30, No. 28, July 12, 2024
A. Except as
				authorized in subsection (C), a previously authorized Self-Insurance Pool
				seeking to add a new member shall file with the Division a completed New Pool
				Member Application Form and the documentation and information required in
				subsection (B).
B. For a new member
				application to be deemed complete, the following documentation and information
				shall be provided by the Applicant:
1. A
				resolution of the Self-Insurance Pool Board authorizing the filing of the New
				Pool Member Application Form.
2.
				The documentation and information listed in R20-5-1505(B)(2), (B)(5), (B)(7),
				(B)(13)(c) through (e), and (B)(13)(j) through (l) specifically pertaining to
				the employer seeking to join the Self-Insurance Pool.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 05 - INDUSTRIAL COMMISSION OF ARIZONA › Article 15 - WORKERS' COMPENSATION SELF-INSURANCE › Section R20-5-1508 - Processing of Initial, Renewal, and New Member Applications

Current through Register Vol. 30, No. 28, July 12, 2024
A. The Division shall administratively review
				an initial, renewal, or new member application within 20 days of receipt of the
				application 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 Article.
B. The Division shall deem an initial,
				renewal, or new member application withdrawn if the Applicant fails to file a
				complete application within 30 days of being notified by the Division that the
				application is incomplete according to subsection (A) or fails to submit
				requested information or documentation within 30 days of receiving a request
				under subsection (F).
C. Unless the
				substantive review time frame is extended under A.R.S. § 41-1075, the
				Commission shall determine whether an initial, renewal, or new member
				application meets the substantive criteria of A.R.S. §§ 11-952.01,
				15-382, 23-961, 23-961.01, and 41621.01, and this Article, as applicable,
				within 60 days after the initial, renewal, or new member application is deemed
				complete.
D. The overall timeframe
				for processing initial, renewal, and new member applications is 80 days, unless
				extended under A.R.S. § 411072 et seq.
E. Upon the filing of a complete initial,
				renewal, or new member application, the Division shall review the submitted
				documentation and information and:
1.
				Evaluate and determine whether the Applicant meets the requirements of A.R.S.
				§§ 11-952.01, 15-382, 23-961, 23-961.01, and 41-621.01 and this
				Article, as applicable;
2. Evaluate
				and determine whether the Applicant has the financial ability to process and
				pay benefits required under the Act;
3. Evaluate and determine whether a waiver of
				security is appropriate under R20-5-1525 or, if security is required, the
				appropriate amount of security; and
4. If the Division recommends approval of an
				initial or renewal application, evaluate and determine a recommended term of
				selfinsurance, which may not be less than one year or more than two years from
				the date of Commission approval under R20-5-1509.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 05 - INDUSTRIAL COMMISSION OF ARIZONA › Article 15 - WORKERS' COMPENSATION SELF-INSURANCE › Section R20-5-1509 - Commission Review of Initial, Renewal, and New Member Applications

Current through Register Vol. 30, No. 28, July 12, 2024
A. The Commission
				shall consider the following before approving or denying an initial, renewal,
				or new member application:
1. The
				documentation and information submitted by Applicant according to R20-5-1505,
				R20-5-1506, R20-5-1507, or R20-5-1508(F);
2. The evaluation, findings, and
				recommendations of the Division according to R20-5-1508; and
3. The requirements of A.R.S. §§
				11-952.01, 15-382, 23-961, 23-961.01, and 41-621.01 and this Article, as
				applicable.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 05 - INDUSTRIAL COMMISSION OF ARIZONA › Article 15 - WORKERS' COMPENSATION SELF-INSURANCE › Section R20-5-1510 - Processing of Workers' Compensation Claims; Authorization to Self-Administer

Current through Register Vol. 30, No. 28, July 12, 2024
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.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 05 - INDUSTRIAL COMMISSION OF ARIZONA › Article 15 - WORKERS' COMPENSATION SELF-INSURANCE › Section R20-5-1511 - Location of Claims Files

Current through Register Vol. 30, No. 28, July 12, 2024
A Self-Insurer shall provide written notice to the Division
				  regarding the location of the Self-Insurer's open and closed claims files
				  within 90 days of the Authorization Date. If a Self-Insurer or Third-Party
				  Administrator intends to change the location of its claims files, the
				  SelfInsurer shall provide written notice to the Division of the change in
				  location at least 30 days before the files are moved.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 05 - INDUSTRIAL COMMISSION OF ARIZONA › Article 15 - WORKERS' COMPENSATION SELF-INSURANCE › Section R20-5-1512 - Reports, Books, Records, and Data Review by the Commission; Audit

Current through Register Vol. 30, No. 28, July 12, 2024
A. All reports,
				books, records, minutes, and data of a Self-Insurer relating to matters
				governed by the Act and this Article are subject to review by the Commission or
				its authorized representative upon request. A Self-Insurer shall ensure that
				reports, books, records, minutes, and data relating to matters governed by the
				Act and this Article are accurate and maintained in a legible and
				understandable manner.
B. The
				Commission may, upon notice of three days, perform or have performed for its
				benefit an audit of the reports, books, records, minutes, and data of a
				Self-Insurer relating to matters governed by the Act and this Article. The
				Commission shall be responsible for the cost of an audit.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 05 - INDUSTRIAL COMMISSION OF ARIZONA › Article 15 - WORKERS' COMPENSATION SELF-INSURANCE › Section R20-5-1513 - Financial Statements and Actuarial Reports

Current through Register Vol. 30, No. 28, July 12, 2024
A. A Self-Insurer shall ensure that audited
				financial statements are prepared annually at the end of the Self-Insurer's
				fiscal year by a certified public accountant experienced in auditing financial
				statements.
B. Actuarial reports
				and studies required in this Article must be completed by an actuary that is a
				member of the American Academy of Actuaries (MAAA) or a fellow of the Casualty
				Actuarial Society (FCAS). At a minimum, actuarial reports must address claim
				reserves, supplemental reserves, and actuarial liabilities using an expected
				confidence level and a discount rate consistent with Actuarial Standard of
				Practice No. 20 (or a successor standard).
C. Upon request, a Self-Insurer shall file
				its most-recent annual audited financial statements or actuarial report with
				the Division.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 05 - INDUSTRIAL COMMISSION OF ARIZONA › Article 15 - WORKERS' COMPENSATION SELF-INSURANCE › Section R20-5-1514 - Claim Processing and Reserving

Current through Register Vol. 30, No. 28, July 12, 2024
A. Self-Insurers and Third-Party
				Administrators shall ensure that claims are processed and benefits are paid in
				compliance with the Act and applicable administrative rules.
B. Self-Insurers and Third-Party
				Administrators shall adopt and adhere to industry-standard reserving practices
				and maintain claim reserves at the full undiscounted value of each claim,
				including related claim expenses.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 05 - INDUSTRIAL COMMISSION OF ARIZONA › Article 15 - WORKERS' COMPENSATION SELF-INSURANCE › Section R20-5-1515 - Notice of Adverse Condition, Bankruptcy, Change in Ownership Status, or Change in Business Address

Current through Register Vol. 30, No. 28, July 12, 2024
A. A
				Self-Insurer shall notify the Division in writing within 10 days of any adverse
				condition or material change that impacts or could impact the Self-Insurer's
				ability to process and pay benefits required under the Act. When a Self-Insurer
				provides notice to the Commission under this subsection, the Self-Insurer shall
				provide a written proposal to correct the actual or potential adverse condition
				or material change.
B. A Public
				Entity Pool shall notify the Division within 30 days of receipt of any
				notification from the Director of the Department of Insurance and Financial
				Institutions according to A.R.S. §§ 11-952.01(N) and
				41-621.01(L).
C. A Self-Insurer
				shall notify the Division in writing within 10 days of any bankruptcy filing
				under federal law or insolvency proceeding under any state's laws.
D. A Self-Insurer shall notify the Division
				in writing within 30 days of any change in the ownership status or business
				address of the Self-Insurer.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 05 - INDUSTRIAL COMMISSION OF ARIZONA › Article 15 - WORKERS' COMPENSATION SELF-INSURANCE › Section R20-5-1516 - Revocation of Self-Insurance Authorization

Current through Register Vol. 30, No. 28, July 12, 2024
A. The Commission may revoke authorization to
				self-insure for good cause. Good cause for revocation includes, but is not
				limited to, any of the following:
1.
				Impairment of the solvency of the Self-Insurer;
2. An inability or failure to process and pay
				benefits required under the Act, including the failure to pay or comply with
				any award of the Commission;
3. The
				failure of the Self-Insurer to respond within 10 days to a demand by the
				Commission to substitute security when the posted security is unsatisfactory or
				insufficient in amount or character;
4. The failure of the Self-Insurer to pay tax
				assessments levied by the Commission within 30 days of the due dates prescribed
				by A.R.S. §§ 23-961 and 23-1065;
5. The failure of the Self-Insurer to
				promptly provide the Commission with notices or information required under this
				Article;
6. The failure of the
				Self-Insurer to comply with the Act or administrative rules contained in Title
				20, Chapter 5, Articles 1, 13, 14 and this Article;
7. The willful misstating of material fact in
				any documentation or information provided to the Commission;
8. The failure of a Public Entity Pool to
				comply with the recommendations of the Director of the Department of Insurance
				and Financial Institutions within 60 days of the date of notice issued under
				A.R.S. §§ 11-952.01(N) and 41-621.01(L); or
9. Except for a Self-Insurer approved to
				Self-Administer, the failure to contract with or adequately fund a Third-Party
				Administrator for claim processing and payment.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 05 - INDUSTRIAL COMMISSION OF ARIZONA › Article 15 - WORKERS' COMPENSATION SELF-INSURANCE › Section R20-5-1517 - Retaining Authorization to Self-Insure Through Insolvency or Bankruptcy

Current through Register Vol. 30, No. 28, July 12, 2024
A. If a
				Self-Insurer becomes insolvent or files for protection under the United States
				Bankruptcy Code seeking to reorganize, and desires to remain self-insured, it
				shall file with the Division a written statement regarding its intent to
				reorganize under the applicable provisions of the United States Bankruptcy
				Code. The statement shall discuss in detail the Self-Insurer's financial
				ability to continue selfinsurance.
B. A Self-Insurer shall file the statement
				described in subsection (A) with the Division within 10 days of the insolvency
				or bankruptcy filing. The letter shall be signed by an authorized
				representative of the Self-Insurer.
C. A Self-Insurer seeking to retain
				authorization to self-insure through bankruptcy shall ensure that a provision
				addressing the SelfInsurer's obligations to workers' compensation claimants and
				the Commission is included in the plan of reorganization filed with the United
				States Bankruptcy Court.
D. During
				the period between the initial bankruptcy filing and a final bankruptcy court
				determination, the Self-Insurer may continue its self-insurance status only
				after demonstrating to the Commission ongoing ability to process and pay
				benefits required under the Act. The Commission may require the Self-Insurer to
				post additional security in an amount the Commission deems appropriate to fully
				protect the Special Fund in the event of an assignment under A.R.S. §
				23-966, which amount may exceed the amount specified in
				R20-5-1520(A).
E. A Self-Insurer
				shall file with the Division a copy of any proposed plan of reorganization or
				liquidation, including amendments, within 10 days of filing.