North Dakota Administrative Code › Title 92 - Workforce Safety and Insurance › Article 92-01 - General Administration › Chapter 92-01-02 - Rules of Procedure - North Dakota Workers' Compensation Act › Section 92-01-02-54 - Deductible programs

Current through Supplement No. 393, July, 2024
The organization and an employer may contract for a
				  deductible program. When a deductible program contract is entered, the employer
				  shall reimburse the organization for benefits payable on individual claims up
				  to the agreed deductible amount. The organization shall provide a reduced
				  premium to participating employers based on an actuarial analysis of the
				  contracted deductible and the rate classification of the employer. For purposes
				  of calculating premiums, the experience rate utilized will exclude actual and
				  expected primary losses.
For an additional premium, the organization may provide
				  aggregate excess coverage limiting the maximum liability for losses of the
				  employer during a policy period. Premiums will be derived from actuarial
				  analysis and a selected aggregate limit. The aggregate limit will be agreed
				  upon by the employer and the organization.
1.
Eligibility.
Eligibility for
				participation in a deductible program is based on the financial stability and
				resources of the employer. Participating employers must be in good standing
				with the organization.
The organization may require participating employers to
				  submit to a financial audit to ensure financial stability. The audit may
				  include a credit check and review of company financial reports.
The organization shall analyze each proposed contract based
				  on risk analysis and sound business practices. The organization may refuse any
				  deductible program if it determines that the proposed contract does not
				  represent a sound business practice or decision. Past participation in a
				  deductible program does not guarantee continued eligibility. The organization
				  may decline renewal of any deductible program.
2.
Claim payment.
The
				organization shall process and pay claims in accordance with North Dakota
				Century Code title 65. The employer shall reimburse the organization for all
				costs paid by the organization on individual claims up to the amount of the
				contractually agreed deductible.
If a third-party recovery on a claim is made, the recovery
				  will be allocated according to the terms of the contractual agreement between
				  the organization and the employer, subject to North Dakota Century Code section
				  65-04-19.3.
The organization shall deduct any delinquent deductible
				  reimbursements from any subrogation amounts recovered on any claim.
3.
Premium payment.
Premium is due at policy inception pursuant to the terms of the
				contractual agreement between the organization and the employer.
4.
Financial security.
The
				organization may require an employer to provide a bond, letter of credit, or
				other security approved by the organization to guarantee payment of future
				employer obligations incurred by a deductible contract.
General Authority: NDCC 65-02-08
Law Implemented: NDCC
					 65-04-19.3