California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 8 - Office of the Director › Subchapter 2 - Administration of Self-Insurance Plans › Article 13 - Group Self-Insurance › Section 15475.1 - Separation Among Service Providers

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) No claims administrator or employee,
					 officer, or director of a claims administrator shall be an employee, officer or
					 director of, or have a direct or indirect management or financial interest in
					 either the Group Administrator or an affiliate member of the private group self
					 insurer, nor shall any owner or employee of the Group Administrator or
					 affiliate member of the private group self insurer be an owner, employee,
					 officer or director of, or have a direct or indirect management or financial
					 interest in the claims administrator.
(b) No Group Administrator, claims
					 administrator, or insurance broker or employee, officer, or director thereof,
					 shall serve as the certified public accountant for any group self insurer for
					 which it provides services as a Group Administrator, claims administrator or
					 insurance broker, respectively, nor shall any owner or employee of an affiliate
					 group member of group self insurer serve as the certified public accountant for
					 the group self insurer.
(c) No
					 insurance broker of a group self insurer, or employee, officer, or director of
					 such insurance broker with a direct or indirect management or financial
					 interest in the group self insurer's claims administrator shall be an employee,
					 officer or director of, or have a direct or indirect management or financial
					 interest in the Group Administrator of the same group self insurer unless the
					 Group Administrator notifies the group self insurer in writing of its
					 relationship, and in no event shall the group self insurer be required by the
					 Group Administrator to utilize the Group Administrator as broker.
(d) No actuary of a private self insured
					 group preparing a written actuarial report pursuant to Section
					 15475(d)(7) shall
					 be an employee, officer or director of, or have a direct or indirect management
					 or financial interest in the Group Administrator of the same private self
					 insured group unless the Group Administrator notifies the group self insurer
					 and the Manager in writing of its relationship; notwithstanding this
					 subsection, the Manager at his or her discretion may require that a written
					 actuarial report pursuant to Section
					 15475(d)(7) be
					 prepared at the expense of the group self insurer by an independent actuary
					 with no relationship to the group administrator.
(e) No claims bill reviewer of a group self
					 insurer shall be an employee, officer, or director of, or have a direct or
					 indirect management or financial interest in, the Group Administrator of the
					 group self insurer unless the Group Administrator notifies the group self
					 insurer and the Manager in writing of its relationship. In no event shall the
					 group self insurer be required by the Group Administrator to utilize services
					 of the claims bill reviewer in which the Group Administrator has a direct or
					 indirect interest.
1. New
						section filed 3-2-2009; operative 3-2-2009 pursuant to Government Code section
						11343.4
						(Register 2009, No. 10).
Note: Authority cited: Sections
						  54,
						  55 and
						  3702.10, Labor
						  Code. Reference: Sections
						  3700,
						  3700.1,
						  3701,
						  3701.5,
						  3702.1,
						  3702.2 and
						  3702.10, Labor
						  Code.