reglab/statecodes huggingface dataset:
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 189 - Regulation Number 125-Insure Louisiana Incentive Program › Section XIII-18929 - Compliance

Current through Register Vol. 50, No. 6, June 20, 2024
A. The commissioner
				shall conduct an examination under
				R.S.
				22:1981, financial analysis under
				R.S.
				22:1984 and/or investigation annually, or
				more often as the commissioner deems necessary to determine the grantee's
				compliance with the requirements of the grant, as per
				R.S.
				22:2361 et seq., and Regulation 125. In
				addition to the requirements of
				R.S.
				22:2361 et seq., the department may require
				such reports and/or conduct such examinations, financial analysis or
				investigations as the commissioner deems necessary to verify compliance with
				the property insurance requirements set forth in the Incentive Program and
				Regulation 125.
B. The commissioner
				shall submit annual and quarterly reports on the Incentive Program to the House
				Committee on Appropriations, the Senate Committee on Finance, and the House and
				Senate Committees on Insurance containing information for the preceding year
				and quarter, respectively, detailing the following:
1. the amount of premium written by parish
				and by grantee under the Incentive Program;
2. the amount of premium by parish and by
				grantee associated with the property located in the parishes listed in
				§18917.B 3;
3. the amount of premium by parish and by
				grantee taken-out from the Louisiana Citizens Property Insurance Corporation;
				and
4. the total amount of premium
				for each grantee by parish, including the premium written under the Incentive
				Program.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 189 - Regulation Number 125-Insure Louisiana Incentive Program › Section XIII-18930 - Monitoring

Current through Register Vol. 50, No. 6, June 20, 2024
A. The commissioner
				shall expedite the approval of certificates of authority, rate filings, form
				filings, and other necessary regulatory approvals of qualified insurers to
				facilitate the underwriting of new policies pursuant to the Incentive
				Program.
B. The commissioner shall
				monitor the financial solvency of grantees by evaluating the adequacy of
				insurer reinsurance programs using catastrophe model stress tests of the
				grantee's book of business.
C. The
				commissioner shall take any action necessary to ensure that grantees remain
				financially solvent.
AUTHORITY NOTE:
				  Promulgated in accordance with Act No. 1 of the 2023 Extraordinary Session and
				  Act No. 2 of the 2023 Extraordinary Session,
				  R.S.
				  22:11,
				  22:2361 et seq., and the
				  Administrative Procedure Act,
				  R.S.
				  49:950 et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 189 - Regulation Number 125-Insure Louisiana Incentive Program › Section XIII-18931 - Earned Capital

Current through Register Vol. 50, No. 6, June 20, 2024
A. A grantee
				who has received a grant is entitled to earn the grant at the rate of 20
				percent per earning period for the last 12 months of that earning period in
				which the grantee is in compliance with the requirements of
				R.S.
				22:2361 et seq., and Regulation 125, such
				that the grantee may earn the entire grant after five years of full compliance
				with the requirements.
B. The
				grantee may begin to earn the grant from the reporting period in which the
				grantee first demonstrates that its net written premiums have reached
				compliance with all requirements of
				§18923.D.1 The
				grantee will earn 20 percent of the grant in each 12-month period thereafter in
				which the grantee demonstrates that it has maintained compliance with all
				requirements for net written premiums. Thus, if in compliance with
				§18923.D 1, the
				grantee may begin to earn the grant at the end of the first year.
C. Upon verification of the net written
				premium requirements during the preceding 12 months, the commissioner will
				issue written declaration that the grantee has earned 20 percent of the grant
				or a pro rata share thereof awarded to the grantee. No funds may be earned by
				the grantee until it receives official notification from the
				commissioner.
D. If the grantee
				does not meet the grant requirements during any year but shows promise of
				future compliance based on good cause having been demonstrated, the
				commissioner may extend the period of time from five years in order for the
				grantee to earn the entire grant. The extension may be granted for up to one
				year.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:11,
				  22:2361 et seq., and the
				  Administrative Procedure Act,
				  R.S.
				  49:950 et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 189 - Regulation Number 125-Insure Louisiana Incentive Program › Section XIII-18933 - Declaration of Default

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				commissioner may declare a grantee in default of the requirements for a grant
				should it be found that any of the following exists:
1. The grantee fails at any time to meet the
				specific minimum requirements of
				§18915.A 1-4. The
				commissioner may take into consideration the effects of the Incentive Program,
				including efforts demonstrated by the grantee, when monitoring compliance with
				this criteria.
2. The grantee fails
				to maintain a certificate of authority for the line or lines of insurance
				written pursuant to the grant program.
3. The grantee fails to meet the specific
				requirements of
				§18923
4. The grantee fails to comply with any other
				applicable provisions of
				R.S.
				22:2361 et seq., or Regulation 125.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 189 - Regulation Number 125-Insure Louisiana Incentive Program › Section XIII-18935 - Cooperative Endeavor Agreements

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				In furtherance of
				R.S.
				22:2361 et seq., and in accordance with
				R.S.
				22:2363.A, the grantee shall execute a
				cooperative endeavor agreement with and in a form prescribed by the
				commissioner subject to approval by the Office of State Procurement of the
				Division of Administration.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:11,
				  22:2361 et seq., and the
				  Administrative Procedure Act,
				  R.S.
				  49:950 et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 189 - Regulation Number 125-Insure Louisiana Incentive Program › Section XIII-18937 - Severability

Current through Register Vol. 50, No. 6, June 20, 2024
A. If any provision
				of Regulation 125 or its application to any person or circumstance is held
				invalid, such invalidity shall not affect other provisions or applications of
				Regulation 125 that can be given effect without the invalid provision or
				application, and to that end, the provisions of Regulation 125 are
				severable.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:11,
				  22:2361 et seq., and the
				  Administrative Procedure Act,
				  R.S.
				  49:950 et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 189 - Regulation Number 125-Insure Louisiana Incentive Program › Section XIII-18939 - Confidentiality

Current through Register Vol. 50, No. 6, June 20, 2024
A. Any and all
				records, documents and information associated with the Incentive Program that
				are deemed confidential or privileged pursuant to
				R.S.
				44:1 et seq.
,
Title 22 or
				any state or federal law will remain confidential or privileged.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:11,
				  22:2361 et seq., and the
				  Administrative Procedure Act,
				  R.S.
				  49:950 et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 189 - Regulation Number 125-Insure Louisiana Incentive Program › Section XIII-18941 - Effective Date

Current through Register Vol. 50, No. 6, June 20, 2024
A. This
				regulation shall become effective upon final publication in the
Louisiana Register
.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:11,
				  22:2361 et seq., and the
				  Administrative Procedure Act,
				  R.S.
				  49:950 et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 191 - Regulation 124-Catastrophe Claims Process Disclosure Form-Guide › Section XIII-19101 - Authority

Current through Register Vol. 50, No. 6, June 20, 2024
A. Regulation 124
				is promulgated on behalf of the Department by the Commissioner pursuant to the
				authority granted under the Louisiana Insurance Code,
				R.S.
				22:11, and as specifically required in
				accordance with
				R.S.
				22:1897.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:2,
				  22:11,
				  22:1897, and the Administrative
				  Procedure Act,
				  R.S.
				  49:950, et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 191 - Regulation 124-Catastrophe Claims Process Disclosure Form-Guide › Section XIII-19103 - Purpose

Current through Register Vol. 50, No. 6, June 20, 2024
A. The purpose of
				Regulation 124 is to implement the provisions of Acts 2022, No. 80 of the
				Regular Session of the Louisiana Legislature, which mandate that the Department
				promulgate rules and regulations for a catastrophe claims process disclosure
				form-guide that includes, but is not limited to, the particulars specified in
				R.S.
				22:1897(A)(1) -
				(12).
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:2,
				  22:11,
				  22:1897, and the Administrative
				  Procedure Act,
				  R.S.
				  49:950, et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 191 - Regulation 124-Catastrophe Claims Process Disclosure Form-Guide › Section XIII-19105 - Scope and Applicability

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				Regulation 124 applies to all property and casualty insurers settling a
				property insurance claim arising out of a state of emergency declared by the
				governor pursuant to
				R.S.
				29:724.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:2,
				  22:11,
				  22:1897, and the Administrative
				  Procedure Act,
				  R.S.
				  49:950, et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 191 - Regulation 124-Catastrophe Claims Process Disclosure Form-Guide › Section XIII-19107 - Definitions

Current through Register Vol. 50, No. 6, June 20, 2024
A. These terms when
				used in this Chapter shall have the following meanings:
Commissioner
- the Louisiana Commissioner
				  of
Insurance.
Department
- the Louisiana Department of
				  Insurance.
Disclosure Form-Guide
- the catastrophe
				  claims process disclosure form referenced in
				  R.S.
				  22:1897.
Governor
- the governor of the state of
				  Louisiana.
Insurer(s)
- property and casualty insurer(s)
				  licensed to conduct business in the state of Louisiana.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:2,
				  22:11,
				  22:1897, and the Administrative
				  Procedure Act,
				  R.S.
				  49:950, et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 191 - Regulation 124-Catastrophe Claims Process Disclosure Form-Guide › Section XIII-19109 - Disclosure Form-Guide

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				Whenever a state of emergency is declared by the governor in accordance with
				R.S.
				29:724, an insurer must provide a disclosure
				form-guide to all policyholders asserting a claim for damages occasioned by the
				disaster or catastrophic event made the subject of the governor's emergency
				declaration.
B. The disclosure
				form-guide was created by the department in accordance with the particulars set
				forth in R.S.
				22:1897(A)(1)-(12) and
				thereafter issued by bulletin to all property and casualty insurers licensed in
				this state.
C. The disclosure
				form-guide has been uploaded to the department's website, at
www.ldi.la.gov
, and insurers are authorized
				to access and download it as needed to comply with Regulation 124 and with the
				statutory requirements set forth in
				R.S.
				22:1897.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:2,
				  22:11,
				  22:1897, and the Administrative
				  Procedure Act,
				  R.S.
				  49:950, et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 191 - Regulation 124-Catastrophe Claims Process Disclosure Form-Guide › Section XIII-19111 - Date and Method of Delivery

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				The insurer shall send the disclosure form-guide to the policyholder on the
				date that the adjuster commences an initial investigation of the
				claim.
B. The insurer may deliver
				the disclosure form-guide to the policyholder by United States mail, electronic
				delivery, or hand-delivery.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:2,
				  22:11,
				  22:1897, and the Administrative
				  Procedure Act,
				  R.S.
				  49:950, et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 191 - Regulation 124-Catastrophe Claims Process Disclosure Form-Guide › Section XIII-19113 - Proof of Timely Delivery

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				Delivery by Mail. If the disclosure form-guide is sent to a policyholder via
				United States mail, proof of such mailing shall be sufficient evidence to
				establish delivery of the disclosure form-guide, provided it reflects the date
				of the mailing and the policyholder.
B. Electronic Delivery. If the disclosure
				form-guide is sent to a policyholder via email, the email delivery receipt or,
				if none, a copy of the as-sent email, shall be sufficient evidence to establish
				delivery of the disclosure form-guide, provided the delivery receipt or email
				reflects the date of the electronic mailing and the policyholder.
C. Hand-Delivery. If the disclosure
				form-guide is hand-delivered to a policyholder, the representative of the
				insurer perfecting delivery must complete and sign a Certificate of
				Hand-Delivery, verifying pertinent details related to the delivery of the
				disclosure form-guide, including the date and location of the delivery, the
				name of the person accepting the delivery, and the name of the policyholder.
				Appendix A sets forth the Certificate of Hand-Delivery form insurers must use
				when opting to hand-deliver the disclosure form-guide to a
				policyholder.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:2,
				  22:11,
				  22:1897, and the Administrative
				  Procedure Act,
				  R.S.
				  49:950, et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 191 - Regulation 124-Catastrophe Claims Process Disclosure Form-Guide › Section XIII-19115 - Severability Clause

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				provisions of this Subpart are severable. If any provision or item of this
				Subpart, or application thereof, is held invalid, such invalidity shall not
				affect other provisions, items, or applications of this Subpart, which are to
				be given effect without the invalid provision, item, or application of the
				Subpart.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:2,
				  22:11,
				  22:1897, and the Administrative
				  Procedure Act,
				  R.S.
				  49:950, et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 191 - Regulation 124-Catastrophe Claims Process Disclosure Form-Guide › Section XIII-19117 - Effective Date

Current through Register Vol. 50, No. 6, June 20, 2024
A. Regulation
				124 shall become effective upon publication.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:2,
				  22:11,
				  22:1897, and the Administrative
				  Procedure Act,
				  R.S.
				  49:950, et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 191 - Regulation 124-Catastrophe Claims Process Disclosure Form-Guide › Section XIII-19119 - Appendix A-Certificate Of Hand-Delivery

Current through Register Vol. 50, No. 6, June 20, 2024
CATASTROPHE CLAIMS PROCESS DISCLOSURE
				  FORM-GUIDE
I hereby certify, under penalty of perjury, that on the _____
				  day of _____________, 20____, I appeared at:
(Physical address): _____________________________
_____________________________________________
_____________________________________________,
and personally hand-delivered a true and complete copy of the
				  Catastrophe Claims Process Disclosure Form-Guide to:
(Name of recipient): _____________________________
Delivery of this disclosure form-guide was made in connection
				  with the following policy of insurance:
(Policy number): ______________________________
(Policyholder): ______________________________
(Printed Name): ______________________________
(Signature): __________________________________
(Date signed): ________________________________
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:2,
				  22:11,
				  22:1897, and the Administrative
				  Procedure Act,
				  R.S.
				  49:950, et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 193 - Regulation Number 128-Louisiana Timber and Agriculture Transportation Group Self-Insurance Funds › Section XIII-19301 - Definitions

Current through Register Vol. 50, No. 6, June 20, 2024
A. When used in
				this regulation, the following words or terms shall have the following meaning.
Contingent Liability
-the amount that a group
				  self-insurance fund may be obligated to pay in excess of a given fund year's
				  normal premium collected or on hand.
Department
-the Louisiana Department of
				  Insurance.
Group Self-Insurance Fund or Fund
-employers
				  who enter into agreements to pool their automobile liabilities for timber
				  transportation vehicles, agriculture transportation vehicles, or a combination
				  of both types of vehicles in accordance with Louisiana Revised Statutes
				  3:4351.2.
Members Distribution Payable/Surplus
-assets
				  of a group self-insurance fund in excess of loss reserves, actual and
				  contingent liabilities and loss development reserves in all fund years.
Surplus
-assets of a group self-insurance
				  fund in excess of loss reserves, actual and contingent liabilities and loss
				  development reserves in all fund years.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  3:4351.9(D).
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 193 - Regulation Number 128-Louisiana Timber and Agriculture Transportation Group Self-Insurance Funds › Section XIII-19303 - Excess Insurance or Reinsurance

Current through Register Vol. 50, No. 6, June 20, 2024
A. All funds shall maintain specific excess
				insurance or reinsurance in the amount of at least $2,000,000 per occurrence
				and aggregate excess insurance or reinsurance of at least $2,000,000.
B. The maximum retention allowed for a fund's
				specific excess policy shall be approved by the department.
1. A fund shall submit a feasibility study
				prepared by a qualified actuary which analyzes the impact the specific
				retention on the fund.
2. No fund
				shall secure a retention which in the commissioner's opinion is not actuarially
				sound.
3. The commissioner shall
				deny the use of a retention if he finds that the higher retention will have a
				significant adverse effect on the financial condition of the fund.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 193 - Regulation Number 128-Louisiana Timber and Agriculture Transportation Group Self-Insurance Funds › Section XIII-19305 - Financial and Actuarial Reports

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				At inception, each fund shall either:
1.
				Provide evidence satisfactory to the commissioner that it possesses surplus in
				excess of $1,000,000, or
2. Submit
				a current audited financial statement, audited by an independent certified
				public accountant, of at least two members showing, at the inception of the
				fund, a combined net worth of a minimum of $1,000,000, current financial
				statements of all other members, a combined ratio of current assets to current
				liabilities of more than one to one, a combined working capital of an amount
				establishing financial strength and liquidity of the members to pay normal
				compensation claims promptly, and showing evidence of the financial ability of
				the group to meet its obligations. An audited or a financial statement properly
				certified by an officer, owner, or partner for all members joining the fund
				after the inception date shall be submitted to the commissioner until such time
				as an audited financial statement is available for the fund as a whole.
				Thereafter, the filing of member financial statements with the department is no
				longer required. In no event shall the cumulative net worth or ratio of the
				current assets to current liabilities of all members be less than that required
				in this Subsection.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 193 - Regulation Number 128-Louisiana Timber and Agriculture Transportation Group Self-Insurance Funds › Section XIII-19307 - Insolvencies

Current through Register Vol. 50, No. 6, June 20, 2024
A. Pursuant to
				R.S.
				3:4351.9(D)(1), a fund
				subject to delinquency proceedings shall be governed by the applicable
				provisions of
				R.S.
				22:731, et seq., pertaining to administrative
				supervisions, or the applicable provisions of R. S. 22:2001, et seq.,
				pertaining to receivership, that are not inconsistent with the provisions of R.
				S. 3:4351.1, et seq.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  3:4351.9.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 193 - Regulation Number 128-Louisiana Timber and Agriculture Transportation Group Self-Insurance Funds › Section XIII-19309 - Cease and Desist Orders and Other Penalties

Current through Register Vol. 50, No. 6, June 20, 2024
A.
1. After
				notice and opportunity for a hearing, the commissioner may issue an order
				requiring a person or group to cease and desist from engaging in an act or
				practice found to be not in compliance with
				R.S.
				3:4351, et seq. or with any rule promulgated
				by the department pursuant to the Administrative Procedure Act or order or
				directive issued by the department. Any cease and desist order issued under
				this Section may include a prohibition against the fund writing any new or
				renewal business.
2. After notice
				and opportunity for a hearing, the commissioner may suspend or revoke the
				certificate of authority of the fund found to be not in compliance with
				R.S.
				3:4351, et seq. or with any rule promulgated
				by the department pursuant to the Administrative Procedure Act or order or
				directive issued by the department.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 193 - Regulation Number 128-Louisiana Timber and Agriculture Transportation Group Self-Insurance Funds › Section XIII-19311 - Examinations

Current through Register Vol. 50, No. 6, June 20, 2024
A. The commissioner
				shall examine, not less frequently than once every five years, and at any other
				time when an examination is necessary in the opinion of the commissioner, all
				group self-insurance funds established pursuant to
				R.S.
				3:4351 et seq. The reasonable expenses of
				such examinations shall be paid by the fund being examined.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  3:4351.5.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 195 - Regulation 127-The Hurricane Property Insurance Claim Alternate Dispute Resolution Program › Section XIII-19501 - Authority

Current through Register Vol. 50, No. 6, June 20, 2024
A. Regulation 127
				is promulgated on behalf of the Department of Insurance by the Commissioner of
				Insurance pursuant to the authority granted under the Louisiana Insurance Code,
				R.S.
				22:11, and as specifically instructed in
				accordance with
				R.S.
				22:2657.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:2,
				  22:11,
				  22:2651, et seq., and the
				  Administrative Procedure Act,
				  R.S.
				  49:950, et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 195 - Regulation 127-The Hurricane Property Insurance Claim Alternate Dispute Resolution Program › Section XIII-19503 - Purpose

Current through Register Vol. 50, No. 6, June 20, 2024
A. The purpose of
				Regulation 127 is to establish rules and regulations pertaining to the
				hurricane mediation program, codified at
				R.S.
				22:2651, et seq., in accordance with Act 591
				of the 2022 Regular Session of the Louisiana Legislature.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:2,
				  22:11,
				  22:2651, et seq., and the
				  Administrative Procedure Act,
				  R.S.
				  49:950, et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 195 - Regulation 127-The Hurricane Property Insurance Claim Alternate Dispute Resolution Program › Section XIII-19505 - Scope and Applicability

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				Regulation 127 applies to all property and casualty insurers of residential
				property situated in a geographical area that is included in a state of
				emergency declaration issued by the governor of Louisiana in response to a
				hurricane, named storm, or named windstorm event.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:2,
				  22:11,
				  22:2651, et seq., and the
				  Administrative Procedure Act,
				  R.S.
				  49:950, et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 195 - Regulation 127-The Hurricane Property Insurance Claim Alternate Dispute Resolution Program › Section XIII-19507 - Definitions

Current through Register Vol. 50, No. 6, June 20, 2024
A. These terms when
				used in this Chapter shall have the following meanings.
Commissioner
-the Louisiana Commissioner of
				  Insurance.
Department
-the Louisiana Department of
				  Insurance.
Disclosure Notice
-a written notification
				  issued by insurers to insureds disclosing the existence of the hurricane
				  mediation program as required in
				  R.S.
				  22:2656.
Governor
-the governor of the state of
				  Louisiana.
Hurricane Mediation Program
-the "Hurricane
				  Property Insurance Claim Alternate Dispute Resolution Program" set forth in
				  Chapter 22 of Title 22 of the Louisiana Revised Statutes of 1950, at
				  R.S.
				  22:2651, et seq.
Mediation Firm
-an entity or person that has
				  elected to participate in the hurricane mediation program, complies with all
				  requirements set forth in
				  R.S.
				  22:2654, meets the qualifications set forth
				  in R.S.
				  9:4106, and is listed as an approved
				  mediation firm on the department's website.
Parties
-the insured and insurer,
				  collectively.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:2,
				  22:11,
				  22:2651, et seq., and the
				  Administrative Procedure Act,
				  R.S.
				  49:950, et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 195 - Regulation 127-The Hurricane Property Insurance Claim Alternate Dispute Resolution Program › Section XIII-19509 - Nature and Purpose of the Hurricane Mediation Program

Current through Register Vol. 50, No. 6, June 20, 2024
A. The hurricane mediation program was
				enacted in response to a demonstrated need for effective, fair, and timely
				handling of residential property insurance claims for residential properties
				damaged by a hurricane, named storm, or named windstorm event.
B. The hurricane mediation program is
				voluntary and provides for a non-adversarial alternative dispute resolution
				procedure designed to give insurers and insureds a way to resolve disputed
				residential property insurance claims in a timely and low-cost
				manner.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:2,
				  22:11,
				  22:2651, et seq., and the
				  Administrative Procedure Act,
				  R.S.
				  49:950, et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 195 - Regulation 127-The Hurricane Property Insurance Claim Alternate Dispute Resolution Program › Section XIII-19511 - Participation in the Hurricane Mediation Program

Current through Register Vol. 50, No. 6, June 20, 2024
A. Every insured may request mediation
				involving a residential property insurance claim, provided such claim:
1. arises from a hurricane, named storm, or
				named windstorm event that results in the governor declaring a state of
				emergency in accordance with
				R.S.
				29:724,
2. is for damages to residential property
				that is situated within a geographical area included in the governor's state of
				emergency declaration, and
3.
				involves disputed amounts of up to $150,000. Parties may agree to mediate and
				be subject to the provisions of
				R.S.
				22:2651, et seq. for disputed amounts that
				exceed $150,000.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 195 - Regulation 127-The Hurricane Property Insurance Claim Alternate Dispute Resolution Program › Section XIII-19513 - Mediation Firm Requirements for Participating in the Hurricane Mediation Program

Current through Register Vol. 50, No. 6, June 20, 2024
A. Every
				mediation firm that elects to participate in the hurricane mediation program
				shall:
1. contact the department within ten
				calendar days regarding any change involving its official name, contact
				information, municipal address, electronic mail address, telephone number, and
				mediation qualification status,
2.
				give written notice to the parties within five business days after receiving
				the mediation assignment,
3. set
				the matter for mediation to occur within 30 days from the date the mediation
				assignment is received,
4. conduct
				the mediation in accordance with the standards of professional conduct for
				mediation adopted by the American Bar Association pursuant to
				R.S.
				9:4107,
5. establish and describe the mediation
				procedures to be followed,
6.
				conduct in-person mediations statewide in a metropolitan statistical area and
				at an office or business location to be selected by the mediation firm,
				and
7. provide advanced
				notification as needed to accommodate a party's request to participate in the
				mediation remotely via telephone, video conference, or other similar electronic
				means.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 195 - Regulation 127-The Hurricane Property Insurance Claim Alternate Dispute Resolution Program › Section XIII-19515 - Costs Associated With the Hurricane Mediation Program

Current through Register Vol. 50, No. 6, June 20, 2024
A. Once an insured
				has contacted a participating mediation firm that is listed on the department's
				website, the mediation firm shall submit its proposed mediation rate for
				approval to the department's Property and Casualty Division, which will examine
				the proposed rate to confirm that it is reasonable in accordance with the
				prevailing mediation rates for the location where the residential property
				insurance claim arises.
B.
				Mediation costs shall be the responsibility of the insurer in accordance with
				R.S.
				22:2655.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:2,
				  22:11,
				  22:2651, et seq., and the
				  Administrative Procedure Act,
				  R.S.
				  49:950, et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 195 - Regulation 127-The Hurricane Property Insurance Claim Alternate Dispute Resolution Program › Section XIII-19517 - Notification of the Hurricane Mediation Program

Current through Register Vol. 50, No. 6, June 20, 2024
A. Whenever a hurricane, named storm, or
				named windstorm event results in the governor declaring a state of emergency in
				accordance with
				R.S.
				29:724, an insurer shall prepare and deliver
				a disclosure notice to all insureds who have filed a covered residential
				property insurance claim for property situated within the geographical area
				included in the state of emergency declaration.
B. The insurer must deliver a disclosure
				notice to the insured prior to conducting an initial investigation of the
				insured's residential property insurance claim.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:2,
				  22:11,
				  22:2651, et seq., and the
				  Administrative Procedure Act,
				  R.S.
				  49:950, et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 195 - Regulation 127-The Hurricane Property Insurance Claim Alternate Dispute Resolution Program › Section XIII-19519 - Authorized Methods of Delivering a Disclosure Notice

Current through Register Vol. 50, No. 6, June 20, 2024
A. A disclosure notice shall be delivered to
				the insured in a manner specified in
				R.S.
				22:2656.A, which specifically authorizes
				delivery via United States mail, electronic mail, or by
				hand-delivery.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:2,
				  22:11,
				  22:2651, et seq., and the
				  Administrative Procedure Act,
				  R.S.
				  49:950, et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 195 - Regulation 127-The Hurricane Property Insurance Claim Alternate Dispute Resolution Program › Section XIII-19521 - Proof That Disclosure Notice Was Timely Delivered

Current through Register Vol. 50, No. 6, June 20, 2024
A. Delivery by Mail. If a disclosure notice
				is sent to the insured via United States mail, proof of such mailing shall be
				sufficient evidence to establish delivery of the disclosure notice, provided it
				reflects the date of the mailing and the name of the insured.
B. Electronic Delivery. If a disclosure
				notice is sent to the insured via email, the email delivery receipt or, if
				none, a copy of the as-sent email, shall be sufficient evidence to establish
				delivery of the disclosure notice, provided the delivery receipt or email
				reflects the date of the electronic mailing and the name of the
				insured.
C. Hand-Delivery. If a
				disclosure notice is hand-delivered to the insured, the representative of the
				insurer perfecting delivery must complete and sign a certificate of
				hand-delivery, verifying pertinent details related to the delivery of the
				disclosure notice, including the date and location of the delivery, the name of
				the person accepting the delivery, and the name of the insured. Insurers may
				use the "Certificate of Hand-Delivery" form set forth in Appendix A of this
				Regulation, or insurers may create and use a substantially similar form to
				verify delivery details provided it complies with all requirements of this
				Section.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:2,
				  22:11,
				  22:2651, et seq., and the
				  Administrative Procedure Act,
				  R.S.
				  49:950, et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 195 - Regulation 127-The Hurricane Property Insurance Claim Alternate Dispute Resolution Program › Section XIII-19523 - Severability Clause

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				provisions of this Subpart are severable. If any provision or item of this
				Subpart, or application thereof, is held invalid, such invalidity shall not
				affect other provisions, items, or applications of this Subpart, which are to
				be given effect without the invalid provision, item, or application of the
				Subpart.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:2,
				  22:11,
				  22:2651, et seq., and the
				  Administrative Procedure Act,
				  R.S.
				  49:950, et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 195 - Regulation 127-The Hurricane Property Insurance Claim Alternate Dispute Resolution Program › Section XIII-19525 - Effective Date

Current through Register Vol. 50, No. 6, June 20, 2024
A. Regulation
				127 shall become effective upon publication.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:2,
				  22:11,
				  22:2651, et seq., and the
				  Administrative Procedure Act,
				  R.S.
				  49:950, et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 195 - Regulation 127-The Hurricane Property Insurance Claim Alternate Dispute Resolution Program › Section XIII-19527 - Appendix A

Current through Register Vol. 50, No. 6, June 20, 2024
CERTIFICATE OF HAND-DELIVERY
HURRICANE MEDIATION PROGRAM
DISCLOSURE NOTICE
I hereby certify that on the ____ day of __________,   20____,
I appeared at:
(Physical address):
___________________________________
___________________________________
___________________________________ ,
and personally hand-delivered a true and complete copy of the
				  hurricane mediation program disclosure notice to:
(Name of recipient):
_____________________________________
Delivery of this disclosure notice was made in connection
				  with the following policy of insurance:
(Policy number):
_____________________________________
(Insured):
_____________________________________
(Printed name):
_____________________________________
(Signature):
_____________________________________
(Date signed):
_____________________________________
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:2,
				  22:11,
				  22:2651, et seq., and the
				  Administrative Procedure Act,
				  R.S.
				  49:950, et
				  seq.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 1 - General Administration › Chapter 1 - General Provisions › Section I-101 - Purpose

Current through Register Vol. 50, No. 6, June 20, 2024
A. The purpose of
				  the rules and regulations is to define the responsibilities and rights of the
				  employee, employer and the carrier in the administration of workers'
				  compensation in Louisiana.
B. The
				  rules are intended to expedite the receipt of benefits by the injured worker;
				  to insure that the proper rate of compensation is paid; to aid in the
				  rehabilitation of the injured worker; to provide for collection of statistical
				  data; to provide for review of safety plans; and, where necessary, to
				  facilitate the resolution of disputes regarding benefits.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 23:1021.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 1 - General Administration › Chapter 1 - General Provisions › Section I-103 - Definitions

Current through Register Vol. 50, No. 6, June 20, 2024
A. For the purposes
				  of these rules, the following definitions apply.
Act
- the Louisiana Workers' Compensation
					 Law, Chapter 10, R.S. 23.
Carrier
- unless otherwise indicated,
					 insurance companies, self-insured employers and group self-insured
					 employers.
Certificate
- the notice the office is
					 required to give after its recommendation is rejected.
Clerk
- the clerks of the district courts
					 in Louisiana.
Commissioner
- the commissioner of
					 insurance for the state of Louisiana.
Date of Filing
- the
date of
					 filing
, reporting receipt in the office shall be the date the document
					 is received in the office.
Days
(when used to determine a period
					 allowed for filing)- the number of calendar
days
. If the final
					 day of a time period falls on a Saturday, Sunday, holiday, or other day that
					 the office is officially closed, then the period of filing shall be extended to
					 the next day that the office is officially opened.
Directors
- the assistant secretary of the
					 Department of Labor responsible for workers' compensation
					 administration.
Document Size
- all filings not on forms
					 approved by the office shall be submitted on 8 1/2" by 11" paper.
Employee Notice
- the notice the employer
					 is required to keep posted in the workplace.
Form
- the forms required for notification
					 to the office required by the Act.
Medical Examiner
- any medical
					 practitioner selected by the director for settling disputes.
Office
- the Office of Workers'
					 Compensation Administration in the Department of Labor.
Penalty
- the percentages of additional
					 payment required by section 1201 B of Act 1, 1983 Extraordinary Session.
Rehabilitation
- the program designed to
					 help an injured worker reenter the workplace.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 23:1021.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 1 - General Administration › Chapter 1 - General Provisions › Section I-109 - Compliance Penalty

Current through Register Vol. 50, No. 6, June 20, 2024
A. Unless
				  otherwise provided for in the rules of the Office of Workers' Compensation, a
				  person or entity that fails to comply with any rule or regulation adopted under
				  the provisions of the Workers' Compensation Act may be penalized with a fine
				  not to exceed $500.
B. A person or
				  entity may appeal any penalty imposed pursuant to this rule by filing a
				  Disputed Claim Form, LDOL-WC-1008, in the district where the person or entity
				  is located or in Baton Rouge, LA. All such appeals shall be de novo. Any
				  penalty imposed pursuant to this rule becomes final and may be pursued for
				  collection unless such an appeal is filed within 30 days of the notice of the
				  penalty.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 23:1291(B)(13).
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 1 - General Administration › Chapter 1 - General Provisions › Section I-111 - Restricted Work Notification

Current through Register Vol. 50, No. 6, June 20, 2024
A. Every
				  employer of more than 10 employees who is subject to record keeping under the
				  provisions of U.S.C. Section 655 shall, within 90 days of any occupational
				  death of an employee, any nonfatal occupational illness, or any nonfatal
				  occupational injury involving either loss of consciousness, restriction of work
				  or motion, transfer to another job, or medical treatment other than first aid,
				  report to the statistical data section of the office on Form
				  OSHA-200.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 23:1292.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 1 - General Administration › Chapter 3 - Electronic Billing › Section I-301 - Purpose

Current through Register Vol. 50, No. 6, June 20, 2024
A. The purpose of
				  this Rule is to provide a legal framework for electronic billing, processing,
				  and payment of medical services and products provided to an injured employee
				  and data reporting subject to
				  R.S.
				  23:1203.2. It is the goal of the OWCA that
				  electronic billing in Louisiana will follow formats that adhere to national
				  standards and industry practices so as to minimize any customization specific
				  to Louisiana. However, electronic billing in the workers compensation
				  environment requires additional consideration for the required medical records
				  (electronic attachments). At the time of promulgation, electronic attachments
				  are not commonly used outside of the workers compensation environment. While
				  the purpose of
				  R.S.
				  23:1203.2 and these accompanying rules are to
				  implement electronic billing in Louisiana, it is recognized that not all
				  healthcare providers will immediately have the systems and processes to
				  accommodate electronic billing and electronic attachments; therefore,
				  participation in electronic medical billing as established in these rules is
				  consistent with
				  R.S.
				  23:1203.2 and is voluntary for healthcare
				  providers.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 23:1203.2.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 1 - General Administration › Chapter 3 - Electronic Billing › Section I-305 - Formats for Electronic Medical Bill Processing

Current through Register Vol. 50, No. 6, June 20, 2024
A. Where mandated for insurance carriers,
				  beginning July 1, 2013 for electronic transmissions, the following electronic
				  medical bill processing standards shall be used.
1. Billing
a. Professional Billing-the ASC X12 Standards
				  for Electronic Data Interchange Technical Report Type 3, Health Care Claim:
				  Professional (837), May 2006, ASC X12, 005010X222 and Type 3 Errata to Health
				  Care Claim: Professional (837), June 2010, ASC X12, 005010X222A1.
b. Institutional/Hospital Billing-the ASC X12
				  Standards for Electronic Data Interchange Technical Report Type 3, Health Care
				  Claim: Institutional (837), May 2006, ASC X12N/005010X223, Type 1 Errata to
				  Health Care Claim: Institutional (837), ASC X12 Standards for Electronic Data
				  Interchange Technical Report Type 3, October 2007, ASC X12N/005010X223A1, and
				  Type 3 Errata to Health Care Claim: Institutional (837), June 2010, ASC X12,
				  005010X223A2.
c. Dental Billing-the
				  ASC X12 Standards for Electronic Data Interchange Technical Report Type 3,
				  Health Care Claim: Dental (837), May 2006, ASC X12N/005010X224, Type 1 Errata
				  to Health Care Claim: Dental (837), ASC X12 Standards for Electronic Data
				  Interchange Technical Report Type 3, October 2007, ASC X12N/005010X224A1, and
				  Type 3 Errata to Health Care Claim: Dental (837), June 2010, ASC X12,
				  005010X224A2.
d. Retail Pharmacy
				  Billing-the Telecommunication Standard Implementation Guide, Version D, Release
				  0 (Version D.0), August 2007, National Council for Prescription Drug Programs
				  and the Batch Standard Batch Implementation Guide, Version 1, Release 2
				  (Version 1.2), January 2006, National Council for Prescription Drug
				  Programs.