Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-190 - RULES FOR SELF-INSURERS UNDER THE WORKERS' COMPENSATION ACT › Section 69O-190.063 - Annual Review and Examination - Self-Insurers Funds

Current through Reg. 50, No. 138; July 16, 2024
(1) All bonds or securities issued by the
				State of Florida or the United States Government which are posted as security
				deposits shall be reviewed annually by the Office to determine market value. In
				the event market value is less than the deposit requirement, the Office may
				require that additional securities be posted by the self-insurer. In making
				such a determination, the Office shall consider the self-insurer's financial
				condition, the amount that market value is less than the deposit requirement
				and the likelihood that such securities will be needed to provide
				benefits.
(2) All self-insurers
				funds shall maintain at a central location within the State of Florida such
				records as are necessary to verify the accuracy and completeness of all reports
				submitted to the Office pursuant to these rules as well as all reports
				necessary to establish the financial solvency of the self-insurers fund.
				Furthermore, the central location shall be the office of the administrator or
				fiscal agent of the self-insurers fund. However, the self-insurers fund shall
				be authorized to transfer its financial records to the offices of the Certified
				Public Accountant for the self-insurers fund upon the written permission of the
				Office. In addition, if the self-insurers fund has contracted with a service
				company for claims handling, then the claims files and related records may be
				located at the offices of the service company as long as they are within the
				State of Florida.
(3) All records
				as herein required shall be open to inspection by authorized representatives of
				the Office during regular business hours. Records shall be retained for a
				period of time sufficient to ensure their availability for audit purposes. In
				the absence of other guidelines, the records shall be retained according to the
				schedule adopted by the Office for similar records. The location of these
				records shall be made known to the Office upon the application for
				self-insurance and at such times thereafter sufficient to keep the Office
				informed of their location.
(4) The
				fund, in any agreement or contract with the administrator or fiscal agent,
				shall require that the records of the administrator or fiscal agent which
				pertain to fund operations, assets or liabilities under Chapter 440, F.S.,
				shall be open to inspection by authorized representatives of the Office during
				regular business hours.
(5) Each
				self-insurers fund's records shall be examined in accordance with Section
				624.316, F.S., by
				representatives of the Office at such time as may be determined by the Office.
				Prior notice of the audit shall not be required. This audit is in addition to
				any audit performed in preparation of the financial reports required by these
				rules.
(6) Each self-insurers fund
				shall comply with the guidelines regarding questionable claims handling
				techniques, questionable patterns of claims, repeated unreasonably controverted
				claims or poor payment practices established pursuant to Section
				440.20(16),
				Florida Statutes.
(7) After each
				audit, a written report shall be prepared with a copy to the self-insurers
				fund; such report to be a part of the annual review for compliance with these
				rules. Any deficiencies cited by this report shall be considered on their merit
				in determining if there are grounds for revocation of the self-insurance
				privilege or the imposition of penalties pursuant to subsection (9). Within 45
				days after the receipt of an audit report which contains findings that the fund
				violated a rule contained in rule Chapter 69O-190, F.A.C., the trustees shall
				convene a meeting to discuss the report. The discussion of the report shall be
				noted in the minutes of the meeting.
(8) As part of its annual review and audit,
				the Office shall determine if the self-insurers fund has a contingent
				liability. In the event the fund is found to have a contingent liability, the
				Office shall inform the fund and order that this liability be funded in
				accordance with subsections
				69O-190.060(2)
				and 69O-190.065(5),
				F.A.C.
(9) In addition to the
				penalties prescribed in Rule 69O-190.038, F.A.C., the Office may impose civil
				penalties not to exceed $100 for each violation of the Law or these rules.
				Penalties shall be imposed pursuant to Section
				440.021,
				F.S.
Rulemaking Authority 440.38(2)(b), (3), 624.4621 FS. Law
					 Implemented 440.38(2)(b), 624.4621 FS.
New 10-1-82, Amended 12-25-84, Formerly 38F-5.63, Amended
					 3-11-87, 12-19-93, Formerly 38F-5.063,
					 4-190.063.