reglab/statecodes huggingface dataset:
Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 19 - Future Medical Care and Related Benefits › Section III-1903 - Definitions

Current through Register Vol. 50, No. 6, June 20, 2024
Administrative Hearing
- hearing held in
				  response to a request or complaint by a patient in need of future medical care
				  or his/her representative, that the fund has failed or refused to pay for
				  medical care or related benefits. The hearing shall be conducted before at
				  least three board members.
Future Medical Care and Related Benefits
-
				  all reasonable medical, surgical, hospitalization, physical rehabilitation, and
				  custodial services, and includes drugs, prosthetic devices, and other similar
				  materials reasonably necessary in the provision of such services. The fund's
				  obligation to provide these benefits or to reimburse the claimant for those
				  benefits is limited to the lesser of the amount billed therefor or the maximum
				  amount allowed under the reimbursement schedule.
Reimbursement Schedule
-the most recent
				  reimbursement schedules promulgated by the Department of Labor, Office of
				  Workers' Compensation pursuant to
				  R.S.
				  23:1034.2.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  40:1299.44(D)(3).
Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 19 - Future Medical Care and Related Benefits › Section III-1905 - Obligation of the Fund

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				fund shall provide and/or fund the cost of all future medical care and related
				benefits in the amounts provided herein, after the date of the accident and
				continuing as long as medical or surgical attention is reasonably necessary,
				that are made necessary by the health care provider's malpractice, pursuant to
				a final judgment issued by a court of competent jurisdiction or as agreed to in
				a settlement reached between a patient and the fund, unless the patient refuses
				to allow the future medical care and related benefits to be
				furnished.
B. The fund acknowledges
				that a court is required neither to choose the best medical treatment nor the
				most cost-efficient treatment for a patient. The intent of Chapter 19 is to
				distinguish between those devices which are reasonably necessary to a patient's
				treatment and those which are devices of convenience or non-essential specialty
				items for a patient, and to provide for the maximum allowable reimbursement for
				those necessary future medical care and related benefits. However, the fund
				shall not pay for repairs for or replacement of durable medical equipment,
				vehicles or residential modifications or renovations.
C. Pursuant to the Act, the board has been,
				expressly and/or implicitly, vested with the responsibility and authority for
				the management, administration, operation, and defense of the fund and, as a
				prudent administrator, it must insure that all future medical care costs and
				related benefits are reasonable and commensurate with the usual and customary
				costs of such care in the patient's community. Therefore, the amount paid by
				the fund for future medical care and related benefits shall be the lesser of
				the amount billed for said care or benefit or the maximum amount allowed under
				the reimbursement schedule.
D.
				Payments for future medical care and related benefits shall be paid by the fund
				without regard to the $500,000 limitation imposed in
				R.S.
				40:1299.42.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  40:1299.44(D)(3).
Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 19 - Future Medical Care and Related Benefits › Section III-1907 - Claims for Future Medical Care and Related Benefits

Current through Register Vol. 50, No. 6, June 20, 2024
A. A patient, who is deemed to be in need of
				future medical care and related benefits pursuant to a final judgment issued by
				a court of competent jurisdiction or as agreed to in a settlement reached
				between the patient and the fund, may make a claim to the fund through the
				board for future medical care and related benefits as incurred by the patient
				and made necessary by the health care provider's malpractice.
B. If a patient's claim for future medical
				care and related benefits is disputed or payment of the amount thereof has been
				denied by the board, then the matter may be referred to the board for an
				administrative hearing.
C.
1. The following administrative hearing
				process shall be followed when such is requested by the claimant or the
				claimant's representative. The claimant desiring to institute a hearing shall
				prepare and file with the board a complaint setting forth:
a. the name and address of each
				respondent;
b. a statement, in
				ordinary and concise language, of the facts upon which the complaint is based,
				together with supporting evidentiary material, including but not limited to,
				whenever applicable, particular reference to the statute or statutes, or rules,
				regulations, and orders that the claimant alleges have been violated.
Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 19 - Future Medical Care and Related Benefits › Section III-1909 - Attorneys; Medical Experts ; Architects ; Adjusters

Current through Register Vol. 50, No. 6, June 20, 2024
A.
1. An
				attorney chosen to represent the fund pursuant to
				§1907 shall be an independent
				contractor, shall meet all applicable requirements for an outside contractor
				retained by the state of Louisiana, and shall be chosen by the executive
				director or his designee. The attorney shall be licensed to practice law in the
				state of Louisiana.
2. Once a
				matter involving future medical care and related benefits is referred to an
				attorney, then the attorney shall be responsible for the matter to the extent
				of the assignment. The attorney shall issue status reports to the claims
				adjuster at least every 90 days until the matter is concluded.
3. The attorney chosen to represent the fund
				may recommend any and all possible remedies to the fund and may hire or retain
				experts, subject to prior approval by the fund. The attorney shall utilize
				legal staff, including paralegals, nurse/paramedical personnel, clerks, and
				investigators, where necessary. With prior approval from the claims supervisor,
				the attorney may appoint a case manager in cases where no case manager has been
				appointed.
Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 19 - Future Medical Care and Related Benefits › Section III-1911 - Examinations; Notice Requirements

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				The fund shall be entitled to have a patient submit to a physical or mental
				examination, by a health care provider of the fund's choice, from time to time,
				to determine the patient's continued need of future medical care and related
				benefits, or the level of medical care needed, subject to the following
				requirements.
1. Notice, in writing, shall be
				delivered to or served upon the patient or the patient's counsel of record,
				specifying the time and place where the examination will be conducted. Delivery
				of the notice may be by certified mail or by hand delivery. Such notice shall
				be given at least 10 days prior to the time stated in the notice.
2. The place at which the examination is to
				be conducted shall not involve an unreasonable amount of travel for the
				patient, considering all of the circumstances.
3. It shall not be necessary for a patient
				who resides outside of Louisiana to come to this state for an examination,
				unless so ordered by the court.
4.
				The examination shall be conducted by a health care provider licensed by the
				state of Louisiana or by the state wherein the patient resides.
Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 19 - Future Medical Care and Related Benefits › Section III-1913 - Choice of Health Care Provider

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				A patient entitled to future medical care and related benefits, as determined
				under Chapter 19, shall be entitled to evaluation, diagnosis, and treatment by
				the health care providers of the patient's choice provided, however, that the
				health care provider rendering such evaluation, diagnosis, or treatment shall
				be licensed to practice medicine in Louisiana or by the state in which the
				patient resides. Notwithstanding the patient's right to choose his health care
				provider, the amount which the fund shall be required to pay or reimburse any
				healthcare provider shall be the lesser of the provider's billed amount or the
				reimbursement schedule.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  40:1299.44(D)(3).
Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 19 - Future Medical Care and Related Benefits › Section III-1915 - Psychological /Psychiatric Treatment and Counseling

Current through Register Vol. 50, No. 6, June 20, 2024
A. The fund will provide and/or fund, at the
				lesser of the billed amount or the maximum amount allowed under the
				reimbursement schedule, psychiatric/psychological testing, evaluation,
				diagnosis and treatment of a patient entitled to future medical care and
				related benefits, as determined under Chapter 19, where these medical services
				are reasonable and are made necessary by the health care provider's
				malpractice.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  40:1299.44(D)(3).
Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 19 - Future Medical Care and Related Benefits › Section III-1917 - Nursing Care; Sitter Care

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				fund will provide and/or fund, at the lesser of the billed amount or the
				maximum amount allowed under the reimbursement schedule, inpatient or
				outpatient nursing or sitter care when such care is required to provide
				reasonable medical, surgical, hospitalization, physical rehabilitation, or
				custodial services made necessary by the health care provider's malpractice,
				subject to the following limitations.
1. All
				nursing or sitter care shall be specifically prescribed or ordered by a
				patient's treating health care provider.
2. All nursing or sitter care shall be
				rendered by a licensed and/or qualified registered nurse or licensed practical
				nurse or by a sitter, a member of the patient's family or household, or other
				person as specifically approved by the fund.
3. There shall be a presumption that the
				person rendering nursing or sitter care is qualified if the treating health
				care provider issues a statement that that person is competent and qualified to
				render the nursing or sitter care required by the patient.
4. All claims for nursing or sitter care
				payments, including those for family members providing such care, must include
				a signed, detailed statement by the person rendering nursing or sitter care,
				setting forth the date, time, and type of care rendered to and for the
				patient.
Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 19 - Future Medical Care and Related Benefits › Section III-1919 - Treatment Protocol

Current through Register Vol. 50, No. 6, June 20, 2024
A. In
				cases where the future medical needs of the patient are so great that
				multi-disciplinary, long-term acute care is needed by the patient, and the
				patient and/or the patient's family, tutor, legal guardian or care givers are
				deemed to be incapable of determining what treatment is necessary, then the
				fund may retain a case manager to develop a treatment protocol for the patient.
				The patient, or the person legally responsible for the patient, will be
				provided with a copy of the written treatment protocol and will be asked to
				consent to the treatment or course of treatment proposed by the protocol prior
				to implementation of the protocol.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  40:1299.44(D)(3).
Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 19 - Future Medical Care and Related Benefits › Section III-1921 - Vehicles

Current through Register Vol. 50, No. 6, June 20, 2024
A. The fund will
				provide and/or fund the cost of standard modified vehicles or specialized
				modified vehicles to patients entitled to receive future medical care and
				related benefits under §1921, when ownership and use of such vehicles are
				reasonably necessary in providing reasonable medical, surgical,
				hospitalization, physical rehabilitation, or custodial services made necessary
				by the health care provider's malpractice. The vehicles described herein are
				standard model, modified passenger vehicles of domestic manufacture or standard
				model, modified vans of domestic manufacture. Alternatively, and at the fund's
				option, the fund will provide and/or fund modifications to the patient's
				vehicle when such modifications are reasonably necessary in the provision of
				such services.
B. The choice of
				vehicle, vendor of the vehicle, modifications thereto, and inclusion or
				exclusion of option items on these vehicles will be at the sole discretion of
				the fund.
C. The fund will not
				provide nor fund the cost of any type of insurance for any such vehicle and
				will not provide nor fund the maintenance or operating costs on any vehicle
				modified by the fund or provided by the fund. The fund will fund repairs to the
				handicap modifications to the vehicle, unless such damage was
				intentional.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  40:1299.44(D)(3).
Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 19 - Future Medical Care and Related Benefits › Section III-1923 - Ancillary Cost; Mileage

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				fund will reimburse a patient (or the patient's family or care givers) entitled
				to future medical care and related benefits under
				§1923 for actual out-of-pocket ancillary
				costs of medical treatment and/or care to the patient including, but not
				limited to, the actual costs of over-the-counter medicines and patient aids,
				the reasonable costs of hotel/motel accommodations and meals associated with
				physician appointments or treatment, when such costs are made necessary by the
				health care provider's malpractice.
B.
1.
				Vehicle Not Provided by the Fund. The fund will reimburse a patient (or the
				patient's family or care givers) entitled to future medical care and related
				benefits under
				§1923 for actual mileage to and from
				physician appointments or treatment at a rate not to exceed $0.24 per mile or
				the current mileage rate allowance under applicable state guidelines.
2. Vehicle Provided by the Fund
a. Fund Reimbursement. Notwithstanding
				Paragraph B.1 or §1921 C, above, when the fund has furnished the vehicle to a
				patient, the fund will reimburse that patient (or that patient's family or care
				givers) who is entitled to future medical care and related benefits under
				§1923, for actual mileage to and from physician appointments or other testing
				or treatment, at a rate equal to 50 percent of the then applicable mileage
				rate.
b. Fund Credit for
				Non-Covered Usage. When the vehicle has been provided by the fund and the fund
				is required to reimburse for medically-related usage, the fund shall, however,
				be entitled to a credit, at the same mileage rate, for any use of the vehicle
				which is not eligible for reimbursement.
Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 19 - Future Medical Care and Related Benefits › Section III-1925 - Modifications/Renovations to Patient's Residence

Current through Register Vol. 50, No. 6, June 20, 2024
A. The fund will provide and/or fund the cost
				of modifications to a patient's residence which are reasonably necessary in
				providing reasonable medical, physical rehabilitation, and custodial services
				for the patient and which are made necessary by the health care provider's
				malpractice. The fund will not provide nor fund the cost of devices of
				convenience.
B. Upon request by the
				patient and/or the patient's family or care givers for modifications, there
				will be a meeting with the claims manager to determine specifically what
				modifications should be made to the home. The claims manager and the architect
				chosen by the fund will then review the medical report(s), and then meet to
				determine what action will be taken as to the modifications of the home, within
				the specific guidelines listed below.
1. The
				fund will provide and/or fund the cost of modifications or renovations to the
				patient's existing home including, but not limited to, modifications of
				lavatories, including handicap accessible toilets, showers, ramps for ingress
				and egress, expanded doorways, and expansion of rooms to accommodate medical
				devices required by the patient, which are reasonably necessary for the care
				and rehabilitation of the patient and in accordance with the American with
				Disabilities Act and other applicable handicap accessibility
				standards.
2. All renovations
				and/or modifications will be designed and built with builders spec or similar
				grade materials from plans drawn and/or approved by an architect obtained by
				the fund. The fund will determine the amount to be paid by the fund based on
				the architect's recommendations and proposals obtained from reputable
				contractors. Any deviations from this amount must be preapproved by the fund or
				borne by the patient or claimant, as applicable.
3. When the fund has provided and/or funded
				modifications or renovations to the home where the patient resides, the fund
				shall retain no interest in that residence. Where the home is owned by the
				patient's parents, relatives, care givers, or guardian, the fund reserves the
				right to require the owners of the home to execute a promissory note, mortgage,
				or other instrument of security in favor of the patient in an amount equal to
				the increased value of the home, as determined by a qualified appraiser
				retained by the fund.
Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 19 - Future Medical Care and Related Benefits › Section III-1927 - Testimony; Communications

Current through Register Vol. 50, No. 6, June 20, 2024
A. Any
				health care provider selected and paid by the fund who shall make or be present
				at an examination of the patient conducted pursuant to
				§1911 may be required to testify as to
				the conduct thereof and the findings so made.
B. Communications made by the patient during
				the examination conducted pursuant to
				§1911 by the health care provider shall
				not be considered privileged.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  40:1299.44(D)(3).
Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 19 - Future Medical Care and Related Benefits › Section III-1929 - Fees and Costs

Current through Register Vol. 50, No. 6, June 20, 2024
A. The fund
				shall pay all reasonable fees and costs of examinations, including the costs
				and fees of expert witnesses in any proceeding, where termination of medical
				care and related benefits is sought.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  40:1299.44(D)(3).
Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 19 - Future Medical Care and Related Benefits › Section III-1931 - Attorney Fees

Current through Register Vol. 50, No. 6, June 20, 2024
A. Following
				the completion of the administrative hearing process hereunder, pursuant to its
				continuing jurisdiction, the district court, from which a final judgment has
				been issued in cases where future medical care and related benefits have been
				determined to be needed by a patient, shall award reasonable attorney fees to
				the patient's attorney if the court finds that the fund unreasonably failed to
				pay for medical care and related benefits within 30 days after submission of a
				claim for payment of such benefits.
B. A patient and/or the patient's attorney
				shall not be entitled to attorney fees in any action to enforce rights pursuant
				to §1931. A if the patient fails or refuses to submit to examination in
				accordance with a notice and if the requirements of
				§1911 have been satisfied.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  40:1299.44(D)(3).
Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 21 - Rulemaking Petitions › Section III-2101 - Submission of a Rulemaking Petition

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				In accordance with
				R.S.
				49:953(C)(1), any interested
				person may petition an agency to adopt a new rule, or to amend or repeal an
				existing rule.
B. To petition the
				board for changes to the boards current rules, or for the adoption of new rules
				within the boards purview, an interested person shall submit a written petition
				to the board. The petition shall include:
1.
				the petitioners name and address;
2. the name of the promulgating agency for
				the rule in question;
3. specific
				text or a description of the proposed language desired for the adoption or
				amendment of a rule, or the specific rule and language identified for
				repeal;
4. justification for the
				proposed action; and
5. the
				petitioners signature.
Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 21 - Rulemaking Petitions › Section III-2103 - Consideration of a Rulemaking Petition

Current through Register Vol. 50, No. 6, June 20, 2024
A. Upon receipt, a rulemaking petition shall
				be forwarded to the board for review.
B. Within 90 days of receipt of the
				rulemaking petition, the board shall either:
1. initiate rulemaking procedures to adopt a
				new rule, or to amend or repeal an existing rule; or
2. notify the petitioner in writing of the
				denial to proceed with rulemaking, stating the reason(s) therefor.
Louisiana Administrative Code › Title 37 - INSURANCE › Part VII - Motor Vehicles › Chapter 1 - Insurance › Subchapter A - Self Insurance › Section VII-101 - Certificates of Self Insurance

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Place of Application. Applications for certificates of self-insurance shall be
				  made at the Driver Management Bureau, 109 South Foster Drive, Baton Rouge,
				  Louisiana, or through the mail by writing to Department of Public Safety,
				  Record Management Section, Self-Insurance Unit, Box 64886, Baton Rouge, LA
				  70896.
B. Applications
1. All applications for certificates of
				  self-insurance shall be made on Form LC-75 or revisions thereof. In cases where
				  the applicant has more than 25 vehicles registered in his name, the application
				  shall be accompanied by the following items:
a. a list of all vehicles registered in the
				  name of the applicant including the make, model, year, vehicle identification
				  number, and current license plate number;
b. a financial statement of assets,
				  liabilities, and net worth in sufficient detail to show that the applicant is
				  possessed and will continue to be possessed of the ability to pay
				  judgments.
Louisiana Administrative Code › Title 37 - INSURANCE › Part IX - Agricultural Commodities › Chapter 1 - Self-Insurance Fund › Section IX-101 - Definitions

Current through Register Vol. 50, No. 6, June 20, 2024
A. As used in this
				Part:
Applicant
- any person, firm, corporation, or
				  other legal entity seeking the issuance of a warehouse license, cotton
				  merchant, or grain dealer license from the commission or a renewal
				  thereof.
Claim
- a written notice and/or proof of loss
				  which is filed with the Agricultural Commodity Commission Self-Insurance
				  Program.
Claimant
- any person or entity who, in
				  writing, alleges a loss covered under the Agricultural Commodity Commission
				  Self-Insurance Program.
Fee
- with respect to the self-insurance
				  fund, means the charge imposed by the Louisiana Agricultural Commodities
				  Commission for participation in the self-insurance program, as contemplated in
				  R.S.
				  3:3410.1.C.
Insurance
- with respect to the
				  self-insurance fund, means the amount of annual coverage the self-insurance
				  program will provide to each warehouse and grain dealer licensee participating
				  in the program.
Licensee
- any person holding or required to
				  hold a license as warehouse or grain dealer issued by the commission.
Loss
- a licensee's failure to perform one or
				  more legal obligations directly related to licensee's business, which failure
				  results in damages to one or more producers, one or more holders of warehouse
				  receipts, or the Commodities Credit Corporation.
Self-Insurance Fund
- that special fund
				  created in the state treasury for the Agricultural Commodity Commission's fees
				  or assessments collected by the commission for participation in the
				  self-insurance fund.
B. All other
				definitions given in
				R.S. 3:3402 and in
				the regulations are applicable.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  3:3410.1.
Louisiana Administrative Code › Title 37 - INSURANCE › Part IX - Agricultural Commodities › Chapter 1 - Self-Insurance Fund › Section IX-103 - The Fund

Current through Register Vol. 50, No. 6, June 20, 2024
A. There is
				hereby created, pursuant to the authority granted in
				R.S.
				3:3410.1, a fund to be used for the purposes
				described in the following Subsection hereof, and said fund shall be known as
				the Agricultural Commodities Commission Self-Insurance Fund.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  3:3410.1.
Louisiana Administrative Code › Title 37 - INSURANCE › Part IX - Agricultural Commodities › Chapter 1 - Self-Insurance Fund › Section IX-105 - Purpose

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				self-insurance fund is established to guarantee the faithful performance of all
				duties and obligations of licensed grain dealers, cotton merchants, and
				licensed warehouses to agricultural producers and holders of state warehouse
				receipts for agricultural commodities and previous holders of state warehouse
				receipts released in trust in order to have commodity shipped (open storage),
				included but not limited to Commodity Credit Corporation, banks and lien
				holders, provided however that this fund does not apply to federal warehouses
				with regard to the requirements for federal warehouse license and
				bond.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  3:3410.1.
Louisiana Administrative Code › Title 37 - INSURANCE › Part IX - Agricultural Commodities › Chapter 1 - Self-Insurance Fund › Section IX-107 - Fees

Current through Register Vol. 50, No. 6, June 20, 2024
A. Fees for
				participation in said fund may be determined and announced annually by the
				commission, and the commission, in doing so, shall consider the self-insurance
				fund's experience and current market conditions affecting the financial status
				of licenses.
B. Each applicant for
				a warehouse license and/or cotton merchant and/or a grain dealer license who
				participates in the self-insurance fund shall be assessed an annual fee for
				participation in the self-insurance program. Said fee must accompany the
				application for a license, and is not refundable unless the license application
				or renewal is denied and, in that event, the fee will be refunded on a pro rata
				basis with the commission retaining a proportionate amount for any period
				during which coverage was provided to the applicant.
C. An applicant who does not pay said fee on
				or before April 30 of the new license year shall pay an additional sum equal to
				10 percent of the annual fee.
D.
				The amount of the annual fee shall be $500 for a grain dealer or cotton
				merchant licensee. The annual fee for a warehouse licensee shall be determined
				first by calculating the amount of bond required of a license under R.S.
				3:34010.C and D. If the required bond is $25,000, then the fee shall be $135.
				If the required bond is over $25,000, then the fee shall be $135 plus $4 per
				each additional $1,000 of coverage required.
E. Whenever the licensed warehouse capacity
				increases, the amount of the fee shall be amended to conform with the current
				licensed capacity of the facility or facilities covered by the fee.
F. For licensees entering the self-insurance
				fund during the license year, the fee shall be based on a pro-rata basis for
				each month of coverage provided.
G.
				The commission may require applicants who are participating in the
				self-insurance fund for the first time to pay two times the normal fee
				assessment.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  3:3410.1.
Louisiana Administrative Code › Title 37 - INSURANCE › Part IX - Agricultural Commodities › Chapter 1 - Self-Insurance Fund › Section IX-109 - Insurance Coverage

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				Compliance with all other applicable statutes, rules and regulations is a
				mandatory requirement for all permit holders.
A. Insurance coverage available to the user
				of a licensed operation shall be limited to the amount of the bond required by
				R.S.
				3:3410 and/or
				R.S.
				3:3411 and shall be accepted in lieu of said
				bond as follows.
1. Each licensed grain
				dealer or cotton merchant shall be insured in the total aggregate amount of
				$50,000 for all claims in each licensed year.
2. Each licensed warehouse shall be insured
				in an amount not less than $25,000 and not more than $500,000 in the total
				aggregate amount in each licensed year as follows:
a. $0.20 per bushel for the first million
				bushels of licensed capacity;
b.
				$0.15 per bushel for the second million bushels of licensed capacity;
c. $0.10 per bushel for all bushels over two
				million.
3. For purposes
				of §109, one CWT shall equal 2.22 bushels, and one barrel shall equal 3.6
				bushels.
Louisiana Administrative Code › Title 37 - INSURANCE › Part IX - Agricultural Commodities › Chapter 1 - Self-Insurance Fund › Section IX-111 - Claim Provisions

Current through Register Vol. 50, No. 6, June 20, 2024
Any person, firm or corporation who has made application for
				  a permit to enter the liquefied petroleum gas business and whose request for
				  permit has been denied, may resubmit a permit application 90 days after the
				  date of denial, with the exception of a Class I-E permit application. Any
				  person, firm or corporation who has made application for a Class I-E permit to
				  enter the liquefied petroleum gas business and whose request for permit has
				  been denied, may resubmit a permit application any time during the same
				  disaster and/or emergency that the initial permit application was submitted to
				  the commission.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  40:1846.
Louisiana Administrative Code › Title 37 - INSURANCE › Part IX - Agricultural Commodities › Chapter 1 - Self-Insurance Fund › Section IX-113 - Appeal Procedure

Current through Register Vol. 50, No. 6, June 20, 2024
A. Any
				decision of the commission to deny or grant a claim for payment from the fund
				may be appealed to the commission by the licensee or claimant by seeking an
				adjudicatory hearing to have said decision reconsidered by the commission in
				accordance with Chapter 13 of Title 49 of the Louisiana Revised Statutes, as
				well as all subsequent appeals therefrom, provided said appellant files with
				the commission a written notice of appeal within 30 days of the mailing of the
				decision of the commission to the affected party.
2. Class I-E. Holders of these permits may
				enter any phase of the liquefied petroleum gas business. These permits shall
				only be granted during an emergency and/or disaster. These permits are valid
				for 90 days from the date of issuance. Permits may be renewed prior to the
				expiration date of the permit during the course of the emergency and/or
				disaster that it was initially applied for.
a.
				Holders of these permits shall furnish evidence of general liability insurance
				in the minimum sum of $1,000,000 coverage per:
i. products;
ii. manufacturers and contractors;
				and
iii. automobile
				liability.
Louisiana Administrative Code › Title 37 - INSURANCE › Part IX - Agricultural Commodities › Chapter 1 - Self-Insurance Fund › Section IX-115 - Subrogation

Current through Register Vol. 50, No. 6, June 20, 2024
A. Whenever a claim
				is paid by the commission from the self-insurance fund, the claimant, by
				accepting said payment, subrogates his rights to the commission up to the full
				amount of payment, and the commission shall have the right to recover such
				payments from any responsible person or entity as it shall determine.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  3:3410.1 and
				  R.S.
				  3:3405.
Louisiana Administrative Code › Title 37 - INSURANCE › Part IX - Agricultural Commodities › Chapter 1 - Self-Insurance Fund › Section IX-117 - Limit of Self-Insurance Fund

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				The maximum amount necessary to sustain the self-insurance fund is $10,000,000.
				When the self-insurance fund has $10,000,000 available for payment of claims,
				no further fees or assessment will be collected until said fund is reduced by
				payment of claims or as otherwise provided for herein, provided that every
				participant in the fund shall have paid fees into the fund for a minimum of 15
				years before any such suspension of fees are applicable to said
				participant.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  3:3410.1 and
				  R.S.
				  3:3405.
Louisiana Administrative Code › Title 37 - INSURANCE › Part IX - Agricultural Commodities › Chapter 1 - Self-Insurance Fund › Section IX-121 - Participation in the Self-Insurance Fund

Current through Register Vol. 50, No. 6, June 20, 2024
A. Participation in the agricultural
				commodity commission self-insurance fund shall be voluntary; however, for good
				cause shown, the commission may require a licensee to provide other security,
				in accordance with
				R.S.
				3:3410(A) and /or
				R.S.
				3:3411(F), in lieu of or in
				addition to participation in the self-insurance fund.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  3:3410.1 and
				  R.S.
				  3:3405.
Louisiana Administrative Code › Title 37 - INSURANCE › Part IX - Agricultural Commodities › Chapter 1 - Self-Insurance Fund › Section IX-123 - Prohibited Acts: Criminal Penalties

Current through Register Vol. 50, No. 6, June 20, 2024
A. Any claimant who provides the commission
				with false information regarding an alleged loss may be denied payment of the
				claim on the basis alone.
B. Any
				warehouse, cotton merchant or grain dealer licensee who intentionally provides
				the commission with false information regarding a claim, or regarding any other
				matters pertaining to the self-insurance program, shall be subject, upon
				conviction, to penalties for perjury established under
				R.S.
				14:123.
C. Any warehouse, cotton merchant, or grain
				dealer licensee who intentionally provides the commission with false
				information regarding a claim, or regarding any other matters pertaining to the
				self-insurance fund, shall be subject to a fine of up to $10,000, imprisonment
				for not more than 10 years, or both, for each occurrence proven at a hearing
				conducted in accordance with Chapter 13 of Title 49 of the Revised
				Statutes.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  3:3410.1.
Louisiana Administrative Code › Title 37 - INSURANCE › Part IX - Agricultural Commodities › Chapter 1 - Self-Insurance Fund › Section IX-125 - Validity of Rules

Current through Register Vol. 50, No. 6, June 20, 2024
A. If any part
				of this regulation is declared to be invalid for any reason by any court of
				competent jurisdiction, said declaration shall not affect the validity of any
				other part not so declared.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  3:3410.1 and
				  R.S.
				  3:3405.
Louisiana Administrative Code › Title 37 - INSURANCE › Part IX - Agricultural Commodities › Chapter 1 - Self-Insurance Fund › Section IX-127 - Pending Litigation; Stay of Claims

Current through Register Vol. 50, No. 6, June 20, 2024
A. Where the commission finds that litigation
				is pending which could determine whether payment of a claim is due or to whom
				payment of a claim is due, the claim in question may be stayed until the
				judgment in said litigation has become final and definitive. The commission
				shall give notice of the stay to any claimants whose claims have been
				stayed.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  3:3405 and
				  3:3410.1.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XI - Rules › Chapter 1 - Rule Number 3A-Advertisement of Medicare Supplement Insurance › Section XI-103 - Applicability

Current through Register Vol. 50, No. 6, June 20, 2024
A. This rule shall
				apply to any advertisement of Medicare supplement insurance as that term is
				defined herein, unless otherwise specified in these rules, which the insurer
				knows, or reasonably should know, is intended for presentation, distribution,
				or dissemination in this state when such presentation, distribution, or
				dissemination is made either directly or indirectly by or on behalf of an
				insurer, agent, broker, producer, or solicitor, as these terms are defined in
				the
Insurance Code
of this state.
B. Every insurer shall establish, and at all
				times maintain, a system of control over the content, form, and method of
				dissemination of all of its Medicare supplement insurance advertisements. All
				such advertisements, regardless of by whom written, created, designed, or
				presented shall be the responsibility of the insurers benefiting directly or
				indirectly from their dissemination.
C. Advertising materials which are reproduced
				in quantity shall be identified by form numbers or other identifying means.
				Such identification shall be sufficient to distinguish an advertisement from
				any other advertising materials, policies, applications, or other materials
				used by the insurer.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:2 and
				  22:224.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XI - Rules › Chapter 1 - Rule Number 3A-Advertisement of Medicare Supplement Insurance › Section XI-107 - Method of Disclosure of Required Information

Current through Register Vol. 50, No. 6, June 20, 2024
A. All information required to be disclosed
				by this rule shall be set out conspicuously and in close conjunction with the
				statements to which such information relates or under appropriate captions of
				such prominence that it shall not be minimized, rendered obscure, or presented
				in an ambiguous manner or fashion or intermingled with the context of the
				advertisement so as to be confusing or misleading.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:2 and
				  22:224.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XI - Rules › Chapter 1 - Rule Number 3A-Advertisement of Medicare Supplement Insurance › Section XI-109 - Form and Content of Advertisements

Current through Register Vol. 50, No. 6, June 20, 2024
A. The format and content of a Medicare
				supplement insurance advertisement shall be sufficiently complete and clear to
				avoid deception or the capacity or tendency to mislead or deceive. Whether an
				advertisement has a capacity or tendency to mislead or deceive shall be
				determined by the department from the overall impression that the advertisement
				may be reasonably expected to create upon a person of average education or
				intelligence, within the segment of the public to which it is
				directed.
B. Advertisements shall
				be truthful and not misleading in fact or in implication. Words or phrases
				whose meanings are clear only by implication or by the consumer's familiarity
				with insurance terminology shall not be used.
C. An insurer must clearly identify its
				Medicare supplement insurance policy as an insurance policy. A policy trade
				name must be followed by the words, "...Insurance Policy," or similar words
				clearly identifying the fact that an insurance or health benefits product (in
				the case of health maintenance organizations, prepaid health plans, and other
				direct service organizations) is being offered.
D. No insurer, agent, broker, producer,
				solicitor, or other person shall solicit a resident of this state for the
				purchase of Medicare supplement insurance in connection with, or as the result
				of the use of any advertisement by such person or any other person, where the
				advertisement:
1. contains any misleading
				representation or misrepresentations, or is otherwise untrue, deceptive, or
				misleading with regard to the information imparted, the status, character, or
				representative capacity of such person or the true purpose of the
				advertisement; or
2. otherwise
				violates the provisions of these rules.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XI - Rules › Chapter 1 - Rule Number 3A-Advertisement of Medicare Supplement Insurance › Section XI-111 - Advertisements of Benefits, Losses Covered, or Premiums Payable

Current through Register Vol. 50, No. 6, June 20, 2024
A. Deceptive Words,
				Phrases or Illustrations Prohibited
1. No
				advertisement shall omit information or use words, phrases, statements,
				references, or illustrations if the omission of such information or use of such
				words, phrases, statements, references, or illustrations has the capacity,
				tendency, or effect of misleading or deceiving purchasers or prospective
				purchasers as to the nature or extent of any policy benefit payable, loss
				covered, or premium payable. The fact that the policy offered is made available
				to a prospective insured for inspection prior to consummation of the sale or an
				offer is made to refund the premium if the purchaser is not satisfied does not
				remedy misleading statements.
2. No
				advertisements shall contain or use words or phrases such as "all," "full,"
				"complete," "comprehensive," "unlimited," "up to," "as high as," "this policy
				will help fill some of the gaps that Medicare and your present insurance leave
				out," "this policy pays all that Medicare doesn't," or similar words and
				phrases, in a manner which exaggerates any benefit beyond the terms of the
				policy.
3. An advertisement which
				also is an invitation to join an association, trust, or discretionary group
				must solicit insurance coverage on a separate and distinct application which
				requires separate signature for each application. The insurance program must be
				presented so as not to mislead or deceive the prospective members that they are
				purchasing insurance as well as applying for membership, if that is the
				case.
4. An advertisement shall not
				contain descriptions of policy limitations, exceptions, or reductions worded in
				a positive manner to imply that it is a benefit, such as describing a waiting
				period as a benefit builder or stating, "even pre-existing conditions are
				covered after six months." Words and phrases used in an advertisement to
				describe such policy limitations, exceptions, and reductions shall fairly and
				accurately describe the negative features of such limitations, exceptions, and
				reductions of the policy offered.
5. An advertisement of Medicare supplement
				insurance sold by direct response shall not state or imply that "because no
				insurance agent will call and no commissions will be paid to 'agents' that it
				is a low cost plan" or use other similar words or phrases because the cost of
				advertising and servicing such policies is a substantial cost in marketing by
				direct response.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XI - Rules › Chapter 1 - Rule Number 3A-Advertisement of Medicare Supplement Insurance › Section XI-113 - Necessity for Disclosing Policy Provisions Relating to Renewability, Cancellability, and Termination

Current through Register Vol. 50, No. 6, June 20, 2024
A. An
				advertisement which is an invitation to contract shall disclose the provisions
				relating to renewability, cancellability, and termination and any modification
				of benefits, losses covered, or premium because of age or for other reasons, in
				manner which shall not minimize or render obscure the qualifying
				conditions.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:2 and
				  22:224.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XI - Rules › Chapter 1 - Rule Number 3A-Advertisement of Medicare Supplement Insurance › Section XI-115 - Testimonials or Endorsements by Third Parties

Current through Register Vol. 50, No. 6, June 20, 2024
A. Testimonials and endorsements used in
				advertisements must be genuine, represent the current opinion of the author, be
				applicable to the policy advertised, and be accurately reproduced. The insurer,
				in using a testimonial or endorsement, makes as its own all of the statements
				contained therein, and the advertisement, including such statement, is subject
				to all the provisions of these rules. When a testimonial or endorsement is used
				more than one year after it was originally given, a confirmation must be
				obtained.
B. A person shall be
				deemed a spokesperson if the person making the testimonial or endorsement:
1. has a financial interest in the insurer or
				a related entity as a stockholder, director, officer, employee, or otherwise;
				or
2. has been formed by the
				insurer, is owned or controlled by the insurer, its employees, or the person or
				persons who own or control the insurer; or
3. has any person in a policy-making position
				who is affiliated with the insurer in any of the above described capacities;
				or
4. is in any way directly or
				indirectly compensated for making a testimonial or endorsement.