reglab/statecodes huggingface dataset:
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 15 - Medical Services › Subchapter 11 - Medical Case Management › Section 810:15-11-5 - Renewal process

Current through Vol. 41, No. 20, July 1, 2024
(a) The
				Commission shall notify the independent medical case manager of the end of the
				case manager's two-year qualification period at least sixty (60) calendar days
				before the expiration of that period and shall apprise the case manager how to
				access the MCM Application form for reapplication as an independent medical
				case manager.
(b) Criteria for
				reapplication shall be governed by
				810:15-11-1 and
				810:15-11-2.
				If a resume has been previously submitted to the Court with a request for
				independent medical case manager status, the case manager does not have to
				resubmit the case manager's resume, unless there have been material changes
				that would have bearing upon the applicant's qualifications.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 15 - Medical Services › Subchapter 13 - Change of Treating Physician › Section 810:15-13-1 - Scope

Current through Vol. 41, No. 20, July 1, 2024
(a) This Subchapter applies to requests to the Commission for a change of treating physician or chiropractor made by a claimant who is not subject to a certified workplace medical plan. These requests are authorized in 85A O.S. § 56(B).
(b) Requests for a change of treating physician or chiropractor sought by an injured employee of an employer that previously contracted with a certified workplace medical plan are not subject to this Subchapter. Such requests must be made by utilizing the plan's dispute resolution process on file with the State Department of Health.
(c) Each certified workplace medical plan shall notify the Executive Director in writing of the plan's appropriate internet website address where its dispute resolution form(s) and current list of providers may be accessed electronically by the general public. A plan shall notify the Executive Director in writing upon a change of the website address where the required information may be accessed.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 15 - Medical Services › Subchapter 13 - Change of Treating Physician › Section 810:15-13-2 - Change of treating physician or chiropractor; no certified workplace medical plan

Current through Vol. 41, No. 20, July 1, 2024
(a) A claimant seeking a change of treating physician or chiropractor pursuant to 85A O.S. § 56(B) for a work-related injury occurring on and after February 1, 2014, shall file a Commission prescribed Application for Change of Treating Physician with the Commission. Upon such application, the Commission shall grant one (1) change of treating physician or chiropractor. At that time, the employer shall provide the claimant a list of three (3) licensed physicians, one of which may be a chiropractor, from which to select the replacement. Each physicianor chiropractor listed shall be qualified to treat the affected body part or condition for which a change of physician or chiropractor is sought.
(b) Nothing in this Section is intended to preclude the parties from agreeing upon a change of treating physicianor chiropractor without the necessity of complying with Subsection (a) of this Section, or from utilizing mediation to resolve a request for change of treating physicianor chiropractor.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 15 - Medical Services › Subchapter 15 - Medical Dispute Resolution › Section 810:15-15-1 - Definitions

Current through Vol. 41, No. 20, July 1, 2024
In addition to the terms defined in 85A O.S., § 2 and
				  810:15-1-2, the
				  following words and terms, when used in this Subchapter, shall have the
				  following meaning, unless the context clearly indicates otherwise:
"Medical fee dispute"
means a dispute that
				  involves an amount of payment for health or rehabilitation services, medicines
				  or supplies rendered to an injured employee. "Medical fee dispute" includes a
				  health care provider dispute of the denial or reduction by the insurance
				  carrier of a bill for services. "Medical fee dispute" does not include disputes
				  that involve an amount of payment for health care services rendered to an
				  injured employee by a certified workplace medical plan or pursuant to a written
				  contract between the insurance carrier and provider as provided in 85A O.S.,
				  § 55(B).
"Medical fee dispute resolution"
or
				  "MFDR"
means a process for resolution of a medical fee
				  dispute.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 15 - Medical Services › Subchapter 15 - Medical Dispute Resolution › Section 810:15-15-2 - Payment of charges

Current through Vol. 41, No. 20, July 1, 2024
(a) As
				provided in 85A O.S., § 50(H), payment for medical care required by the
				AWCA is due within forty-five (45) days of receipt by the employer or insurance
				carrier of a complete and accurate invoice. The late payment of medical
				charges, absent good cause, may subject the employer or insurance carrier to a
				Commission ordered penalty of up to twenty-five percent (25%) of any amount due
				under the Oklahoma workers' compensation fee schedule that remains unpaid. The
				Commission also may assess a civil penalty of up to Five Thousand Dollars
				($5,000.00) per occurrence if the Commission finds a pattern of an employer or
				insurance carrier willfully and knowingly delaying payments for medical care.
				Any such fines and penalties assessed under the AWCA, upon collection, shall be
				deposited to the Workers' Compensation Fund created in 85A O.S., §
				28.
(b) Medical care provided as
				recommended by the ODG is presumed reasonable, and also is presumed to be
				health care reasonably required. In order for the insurance carrier to deny
				payment for medical services that are recommended by the ODG, the denial must
				be supported by clear and convincing medical evidence. A medical provider whose
				services exceed, are not recommended, or are not addressed by the ODG, must
				support the deviation from the ODG by clear and convincing medical evidence, in
				writing to the insurance carrier, as a condition of payment for services
				rendered. Resolution of medical fee disputes involving deviation from the ODG
				are governed by
				810:15-15-4.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 15 - Medical Services › Subchapter 15 - Medical Dispute Resolution › Section 810:15-15-4 - Other medical disputes

Current through Vol. 41, No. 20, July 1, 2024
Medical disputes not otherwise addressed by this Subchapter,
				  including, but not limited to, matters of medical necessity or appropriateness,
				  requests by an injured employee for a refund or reimbursement for health care
				  paid by the employee, and requests initiated by the employer or insurance
				  carrier pursuant to 85A O.S., § 55 for a determination of the
				  reasonableness of charges for appropriate and necessary medical services and
				  supplies rendered to an injured employee with a compensable work-related
				  injury, may be addressed by filing a request for hearing before an
				  administrative law judge of the Commission as provided in
				  810:10-5-16,
				  by mediation, or by agreement of the parties, as appropriate.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 20 - Vocational Rehabilitation Services › Section 810:20-1-1 - Purpose

Current through Vol. 41, No. 20, July 1, 2024
This Chapter implements provisions of the Administrative
				Workers' Compensation Act, 85A O.S., §§ 1, et seq., which relate to
				vocational rehabilitation services.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 20 - Vocational Rehabilitation Services › Section 810:20-1-2 - Definitions

Current through Vol. 41, No. 20, July 1, 2024
In addition to the terms defined in 85A O.S., § 2, the
				following words and terms, when used in this Chapter, shall have the following
				meaning, unless the context clearly indicates otherwise:
"AWCA"
means the Administrative Workers'
				Compensation Act, 85A O.S., §§ 1, et seq.
"Claimant"
means a person who claims benefits for
				an alleged work injury, occupational disease or illness, or death pursuant to
				the provisions of the AWCA, 85A O.S., §§ 1, et seq.
"Commission"
means the Oklahoma Workers'
				Compensation Commission, a designee, or an administrative law judge to whom the
				Commission has delegated responsibility as authorized by 85A O.S., §
				21(D).
"Disabled"
means rendered unable, as the result of
				a work-related injury, to perform work for which the person has previous
				training or experience.
"Gainful employment"
means the capacity to perform
				employment for wages for a period of time that is not part-time, occasional or
				sporadic.
"Insurance carrier"
means any stock company,
				mutual company, or reciprocal or interinsurance exchange authorized to write or
				carry on the business of workers' compensation insurance in this state, and
				includes an individual own risk employer or group self-insurance association
				duly authorized by the Commission to self fund its workers' compensation
				obligations.
"Pre-injury or equivalent job"
means the job that
				the claimant was working for the employer at the time the injury occurred or
				any other employment offered by the claimant's employer that pays at least one
				hundred percent (100%) of the employee's average weekly wage.
"Vocational rehabilitation"
means the process of
				restoring the vocational functioning of a worker who experiences a work-related
				injury.
"Vocational rehabilitation services"
means
				professional services reasonably necessary during or after, or both during and
				after, medical treatment to enable a disabled injured employee to return to
				gainful employment as soon as practical. "Vocational rehabilitation services"
				includes vocational evaluation, retraining and job placement.
"Work-related injury"
means a single event injury,
				cumulative trauma injury, or occupational injury or illness that arises out of
				and in the course of employment as provided in the AWCA.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 20 - Vocational Rehabilitation Services › Section 810:20-1-3 - Contested vocational rehabilitation cases

Current through Vol. 41, No. 20, July 1, 2024
(a) If vocational rehabilitation services are
			 not voluntarily offered by the employer or the insurance carrier, and accepted
			 by the injured employee entitled to such services, the Commission, upon request
			 or on its own motion, may refer the employee to a vocational rehabilitation
			 evaluator for evaluation of the practicability of, need for, and kind of
			 service or training necessary and appropriate to restore the employee to
			 gainful employment.
(b) If, upon
			 receipt of the evaluator's written report, the parties dispute the report or
			 are unable to agree on a vocational rehabilitation plan recommended by the
			 evaluator and commence the vocational rehabilitation services, they may attempt
			 to resolve the dispute through mediation or forego mediation and proceed
			 directly to a contested case hearing before the assigned administrative law
			 judge. The administrative law judge, after notice and affording the parties an
			 opportunity to be heard and offer evidence, may order that the services
			 recommended by the evaluator, or such other vocational rehabilitation services
			 as deemed appropriate by the administrative law judge, be provided at the
			 expense of the employer or insurance carrier.
(c) Contested hearings before the
			 administrative law judge shall be conducted as provided in Subchapter 5 of
			 Chapter 10 of this Title.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 20 - Vocational Rehabilitation Services › Section 810:20-1-4 - Vocational Rehabilitation Director

Current through Vol. 41, No. 20, July 1, 2024
To carry out the vocational rehabilitation provisions of AWCA and this Chapter, the Commission may hire or contract for a Vocational Rehabilitation Director to oversee the vocational rehabilitation program of the Commission and focus on helping injured workers return to the work force. The Commission may hire such additional personnel, within budgetary constraints, as may be deemed necessary to assist the Vocational Rehabilitation Director.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 20 - Vocational Rehabilitation Services › Section 810:20-1-5 - Registry of private providers of vocational rehabilitation services

Current through Vol. 41, No. 20, July 1, 2024
(a) The Commission
			 shall maintain a registry of private providers of vocational rehabilitation
			 services.
(b) To request to be
			 included in the registry, a private provider of vocational rehabilitation
			 services shall submit a signed and completed Commission prescribed VRS Registry
			 form to the following address: Oklahoma Workers' Compensation Commission,
			 Attention: HEALTH SERVICES DIVISION, 1915 North Stiles Avenue, Oklahoma City,
			 Oklahoma 73105. Illegible, incomplete or unsigned registry forms will not be
			 considered by the Commission and shall be returned. A copy of the VRS Registry
			 form may be obtained from the Commission at the address set forth in this
			 Subsection, or from the Commission's website at
http://www.wcc.ok.gov
.
(c) The registrant shall provide the
			 following information, and such other additional information as may be required
			 on the VRS Registry form:
(1) the private
			 provider's name, business name (if applicable), business address, telephone
			 number, and e-mail address;
(2)
			 information describing the evaluation, assessment, assistance, placement or
			 support services available from the private provider;
(3) the locations where the private provider
			 renders services;
(4) a statement
			 showing the private provider's education, training, or experience in vocational
			 rehabilitation;
(5) information
			 regarding any experience or education concerning workers' compensation
			 principles of the Oklahoma workers' compensation system; and
(6) the private provider's professional
			 credentials [e.g. Certified Rehabilitation Counselor (CRC), Certified
			 Vocational Evaluator (CVE), Certified Disability Management Specialist
			 (CDMS)].
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 1 - General Provisions › Section 810:25-1-1 - Purpose

Current through Vol. 41, No. 20, July 1, 2024
This Chapter establishes procedures and standards for proof
				  of coverage (85A O.S., § 42); filing of Affidavits of Exempt Status and
				  Cancellations of Affidavit of Exempt Status (85A O.S., § 36); regulation
				  of individual own risk employers, group self-insurance associations and
				  third-party administrators for workers' compensation purposes (85A O.S.,
				  §§ 22, 29, 38, 102 and 103); and enforcement of workers' compensation
				  insurance requirements (85A O.S., § 40), as authorized in the
				  Administrative Workers' Compensation Act, 85A O.S., §§ 1, et seq.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 1 - General Provisions › Section 810:25-1-3 - Proceedings related to permit actions

Current through Vol. 41, No. 20, July 1, 2024
(a) The Permitting Services Division may
				revoke a Certificate of Noncoverage (Subchapter 5 of this Chapter), or refuse
				to issue or renew, or revoke a permit for Individual Own Risk Employer
				(Subchapter 9 of this Chapter), Group Self-Insurance Association (Subchapter 11
				of this Chapter) or Third-Party Administrator (Subchapter 13 of this Chapter)
				as provided in this Chapter.
(b) An
				applicant or permit holder may seek review of a decision rendered by the
				Permitting Services Division by filing with the Commission a request for
				hearing within ten (10) days of the date the decision was mailed to the
				applicant or permit holder. Proceedings related to permit actions shall be
				governed by this Section and the contested hearings rules set forth in
				Subchapter 5 of Chapter 10 of this Title.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 3 - Proof of Coverage › Section 810:25-3-1 - Proof of coverage requirements

Current through Vol. 41, No. 20, July 1, 2024
(a) Any insurer issuing a policy to provide
				benefits pursuant to the AWCA, or group self-insurance association approved by
				the Commission, must report its statutorily required notices of insurance
				coverage and cancellation electronically with the Commission using the NCCI
				Proof of Coverage (POC) system. To do so, the insurer must elect with the NCCI
				to use the NCCI POC system, authorize the NCCI to make the required filings on
				behalf of the insurer, and report its policy information, including, but not
				limited to, new and renewal policies, binders, cancellations, reinstatements,
				and endorsements, with the NCCI in accordance with NCCI reporting requirements
				for the State of Oklahoma.
(b)
				Compliance with 85A O.S., § 42(B) is required to effect cancellation of a
				workers' compensation insurance policy. Notice of intent to cancel provided to
				NCCI or to the Commission pursuant to 85A O.S., § 42(B) does not
				constitute service upon the insured employer of notice of intent to
				cancel.
(c) An insurer shall
				electronically file its cancellations with the NCCI, in lieu of mailing to the
				Commission. The date the cancellation is electronically received by the NCCI
				will constitute the beginning date for the ten and thirty day waiting periods
				referenced in 85A O.S., § 42(B)(2) for the cancellation to become
				effective.
(d) A policy must be
				reported to the NCCI no later than thirty (30) days after the effective date of
				the policy. Every named insured and covered location in the State of Oklahoma
				must be reported as well. The date the policy is first received by the NCCI
				will count as the received date for purposes of this deadline. For purposes of
				mid-year endorsements or jurisdictional additions to policies, the date the
				original policy was received by the NCCI will count as the received date for
				purposes of this deadline. Any insurer who fails to timely and accurately file
				a policy with the NCCI shall be subject to a fine by the Commission of not more
				than One Thousand Dollars ($1,000.00) per policy as determined by the
				Commission.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 5 - Documentation of Exempt Status › Section 810:25-5-1 - Affidavit of exempt status requirements

Current through Vol. 41, No. 20, July 1, 2024
(a) As authorized by 85A O.S. §36,any
				individual or business entity that is not required to secure compensation under
				the AWCA, upon payment to the Commission of a nonrefundable filing fee of Fifty
				Dollars ($50.00), may execute and file an Affidavit of Exempt Status
				electronically at
www.ok.gov/wcc
or file an
				original and one (1) copy at the following address: Oklahoma Workers'
				Compensation Commission, 1915 North Stiles Avenue, Oklahoma City, Oklahoma
				73105. The affidavit shall be signed by the affiant under penalty of perjury. A
				copy of the Affidavit of Exempt Status form may be obtained from the Commission
				at the address set forth in this Subsection or the Commission's
				website.
(b) An Affidavit of Exempt
				Status executed and filed as provided in this Rule shall expire at midnight two
				(2) years from the date of filing, unless earlier cancelled by the filing, in
				accordance with 85A O.S., § 36(D)(1)(b), of a Cancellation of Affidavit of
				Exempt Status (CC-Form-36C) upon changed circumstances that make securing
				compensation pursuant to the AWCA necessary.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 5 - Documentation of Exempt Status › Section 810:25-5-2 - Revocation of certificate of noncoverage

Current through Vol. 41, No. 20, July 1, 2024
The Commission may revoke a CNC for cause, including, but
				  not limited to, material misrepresentation on the CNC application, or refusal
				  or substantial failure of the CNC holder to notify the Commission of any change
				  affecting the holder's qualifications as provided in
				  810:25-5-1.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 5 - Documentation of Exempt Status › Section 810:25-5-3 - Affidavit of exempt status renewal process

Current through Vol. 41, No. 20, July 1, 2024
An unexpired Affidavit of Exempt Status may be renewed by
				  filing a new Affidavit of Exempt Status before expiration. The criteria for
				  renewal shall be the same as that for a new Affidavit of Exempt Status, as
				  provided in
				  810:25-5-1(a).
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 7 - Enforcement of Workers' Compensation Insurance Requirements › Section 810:25-7-1 - Proof of insurance

Current through Vol. 41, No. 20, July 1, 2024
(a)
				Whenever the Commission has reason to believe that an employer is required to
				secure the payment of compensation under the AWCA and has failed to do so, the
				Commission may make reasonable inquiry of the employer, issue subpoenas and
				demand proof of current workers' compensation insurance coverage compliant with
				85A O.S. § 38 or documentation substantiating the employer's exemption
				from coverage requirements. Subpoenas issued under this Section shall be
				governed by
				810:10-5-31.
(b) As authorized in 85A O.S. § 40, if
				no proof of insurance or exemption is provided; or the documentation offered
				does not substantiate a claimed exemption or is not current, valid proof of
				insurance in accordance with 85A O.S. § 38; or the employer fails to
				respond in a timely manner, the Commission shall serve on the employer a
				proposed judgment declaring the employer to be in violation of the workers'
				compensation insurance coverage requirements mandated by law and may assess a
				monetary fine against the employer, if any, in an amount not to exceed One
				Thousand Dollars ($1,000.00) per day of violation, and not to exceed a total of
				Fifty Thousand Dollars ($50,000.00) for the first violation.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 7 - Enforcement of Workers' Compensation Insurance Requirements › Section 810:25-7-2 - Hearing process and consent agreements

Current through Vol. 41, No. 20, July 1, 2024
(a) A proposed judgment issued under
				810:25-7-1 may
				be contested by the employer as provided in 85A O.S. § 40, and is subject
				to a hearing process conducted pursuant to 85A O.S. § 70 through
				78.
(b) An employer served with a
				proposed judgment, may waive its right to a contested hearing and execute a
				consent agreement with the Commission for a reduced penalty. The employer shall
				secure the payment of compensation within the meaning of 85A O.S. § 38 as
				a condition to executing a consent agreement.
(c) The consent agreement may become void if
				the employer defaults on payment under the agreement or if the agreement was
				obtained by fraud or misrepresentation of a material fact.
(d) The Commission may institute collection
				proceedings independently or in District Court, including, but not limited to,
				an asset hearing, garnishment of income and wages, judgment lien against
				personal and/or business properties, or an intercept of an income tax refund
				consistent with Section
				205.2
				of Title 68 of the Oklahoma Statutes upon any penalties becoming final under
				the provisions of 85A O.S. § 40.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 7 - Enforcement of Workers' Compensation Insurance Requirements › Section 810:25-7-3 - Interference of duty

Current through Vol. 41, No. 20, July 1, 2024
No person shall interfere with, obstruct or hinder by force
				  or otherwise, the Commission or its personnel while in the performance of their
				  duties, or refuse to properly answer questions asked by the Commission or its
				  personnel, pertaining to the Commission's enforcement of the workers'
				  compensation insurance coverage requirements mandated by the
				  AWCA.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 7 - Enforcement of Workers' Compensation Insurance Requirements › Section 810:25-7-4 - Injunctive relief against a noncompliant employer

Current through Vol. 41, No. 20, July 1, 2024
As authorized in 85A O.S., § 40, if an employer fails to
				  comply with workers' compensation insurance coverage requirements or pay any
				  civil penalty assessed against it after a judgment issued under
				  810:25-7-1
				  becomes final, the Commission may pursue relief in district court to enjoin the
				  employer from engaging in further employment during the period of
				  noncompliance.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 9 - Individual Own Risk Employer Permit › Section 810:25-9-1 - Application for Individual Own Risk Employer Permit

Current through Vol. 41, No. 20, July 1, 2024
(a) To request a permit to self fund its
				workers' compensation obligations as authorized in 85A O.S., § 38(A)(3),
				an employer shall:
(1) Submit a signed and
				completed Application for Individual Own Risk Employer Permit in the manner
				prescribed by the Commission, together with all required supporting
				documentation and attachments completed in their entirety, at least sixty (60)
				days before the desired effective date of the permit. The application shall be
				submitted under penalty of perjury by an authorized representative of the
				employer. Incomplete applications will not be considered and shall be rejected.
				The application may be accessed from the Commission's website;
(2) Pay to the Commission a nonrefundable
				application fee of One Thousand Dollars ($1,000.00) for the Application for
				Individual Own Risk Employer Permit;
(3) Submit its current audited financial
				statement for the two (2) previous years, including balance sheet, statement of
				income, statement of cash flows and notes. If audited financial statements are
				unavailable, submit its financial statement for the two previous fiscal years
				signed by two (2) company executives, including balance sheet, statement of
				income, statement of cash flows and notes;
(4) Submit the employer's most recent
				available interim financial statements, including balance sheet and statement
				of income; and
(5) Provide such
				additional records and information germane to the application as may be
				required by the Commission.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 9 - Individual Own Risk Employer Permit › Section 810:25-9-2 - Minimum eligibility requirements

Current through Vol. 41, No. 20, July 1, 2024
(a) Unless waived as provided in Subsection
				(b) of this Section and except for governmental entities subject to
				810:25-9-11,
				to be eligible for an Individual Own Risk Employer Permit, the applicant must:
(1) have been continuously engaged in
				business for not less than three (3) years immediately preceding the
				Application for Individual Own Risk Employer Permit;
(2) have at least one hundred (100) employees
				(all states included); and
(3) have
				at least One Million Dollars ($1,000,000.00) in net assets.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 9 - Individual Own Risk Employer Permit › Section 810:25-9-3 - Financial information review

Current through Vol. 41, No. 20, July 1, 2024
(a) Factors used to determine an applicant's
				financial ability to pay compensation to its employees include:
(1) Profit and loss history;
(2) Profitability, solvency, debt and
				liquidity ratios;
(3) Cash
				flow;
(4) Ratio of net worth to
				annual workers' compensation losses.
(5) Source and reliability of financial
				information;
(6) Excess insurance
				coverage;
(7) Number of
				employees;
(8) Workers'
				compensation loss history;
(9)
				Estimated manual premium; and
(10)
				Other relevant factors as determined by the Commission.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 9 - Individual Own Risk Employer Permit › Section 810:25-9-4 - Security deposit

Current through Vol. 41, No. 20, July 1, 2024
(a) As a
				condition to self fund its workers' compensation obligations, an employer
				approved as an individual own risk employer shall post acceptable security with
				the Commission, in such form and amount as determined by the
				Commission.
(b) Acceptable forms of
				security, are:
(1) An irrevocable letter of
				credit issued by a financial institution, whose deposits are insured by the
				Federal Deposit Insurance Corporation (FDIC). The financial institution must be
				approved in advance by the Commission. The letter of credit must be on a form
				prescribed by the Commission, include an automatic renewal clause, and cannot
				be non-renewed without at least sixty (60) days' prior written notice to the
				Commission. The letter of credit shall be made payable to the Commission. The
				Commission may make demand and collect on the posted letter of credit in whole
				or in part, in the case of actual or imminent default of the employer to pay
				compensation liabilities, or the cancellation of the letter of credit without
				an adequate replacement;
(2) A
				surety bond from an admitted or surplus lines insurer with an AM Best Rating of
				B+ or better, and on a form prescribed by the Commission; and
(3) Such other forms of security approved by
				the Commission.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 9 - Individual Own Risk Employer Permit › Section 810:25-9-5 - Renewals

Current through Vol. 41, No. 20, July 1, 2024
The criteria for renewal of an individual own risk employer
				  permit shall be the same as that for a new applicant.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 9 - Individual Own Risk Employer Permit › Section 810:25-9-6 - Effectiveness of previously authorized permits, security deposits and guaranties

Current through Vol. 41, No. 20, July 1, 2024
(a)
				Individual own risk employer permits previously authorized by the Workers'
				Compensation Court Administrator pursuant to 85 O.S., § 351 and in effect
				on January 31, 2014 shall remain in full force and effect for the duration of
				the permit term thereafter, unless voluntarily terminated by the own risk
				employer or revoked by the Commission.
(b) All security deposits and parental
				guaranties posted by an individual own risk employer with the Workers'
				Compensation Court Administrator pursuant to 85 O. S., § 351 before
				February 1, 2014 as a condition for the own risk employer to self fund its
				workers' compensation obligations, which are maintained by the Court
				Administrator and in effect on January 31, 2014, shall remain in full force and
				effect, pursuant to their respective terms, on and after February 1, 2014,
				notwithstanding assumption by the Commission of the Court Administrator's
				regulatory responsibilities regarding individual own risk employers beginning
				February 1, 2014. At that time, the Commission shall be considered the
				successor entity to the Workers' Compensation Court Administrator in all
				respects regarding the security deposit and parental guaranty, with full power
				and authority in its own name to make demand and collect thereon in the same
				manner and to the same extent as and if the Commission were the Court
				Administrator. The Commission may require an individual own risk employer to
				post an adequate replacement security deposit or parental guaranty, or both,
				made payable to the Commission.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 9 - Individual Own Risk Employer Permit › Section 810:25-9-7 - Claims administration

Current through Vol. 41, No. 20, July 1, 2024
An individual own risk employer must use a third-party
				  administrator licensed by the Commission, or an in-house benefits administrator
				  approved by the Commission, to adjust its workers' compensation claims. The
				  in-house benefits administrator must hold a current and unrestricted workers'
				  compensation adjuster license for the State of Oklahoma. An out-of-state
				  employer may request waiver of the license requirement for an in-house benefit
				  administrator.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 9 - Individual Own Risk Employer Permit › Section 810:25-9-8 - Excess insurance

Current through Vol. 41, No. 20, July 1, 2024
The Commission may require an individual own risk employer to
				  provide proof of excess coverage with such terms and conditions as is
				  commensurate with the employer's ability to pay the benefits required by the
				  provisions of the AWCA. Such excess insurance must be from an admitted or
				  surplus lines insurer with an AM Best Rating of B+ or better. The self insured
				  retention must be approved by the Commission, and the excess carrier's limits
				  of liability must be statutory. An amount less than statutory limits must be
				  approved in advance by the Commission. Aggregate excess insurance may be
				  required by the Commission if necessary.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 9 - Individual Own Risk Employer Permit › Section 810:25-9-9 - Additional named insureds

Current through Vol. 41, No. 20, July 1, 2024
(a)
				Subsidiaries, subdivisions, and affiliated employers may be included on the
				individual own risk employer permit as additional named insureds. A schedule
				listing the additional employers' names, addresses and federal employer
				identification numbers (FEIN) must be submitted. The additional employers'
				workers' compensation losses, payroll and employee counts must be aggregated
				with the primary permit holder and included on the application. A guaranty from
				the primary permit holder for these additional employers must be submitted in
				accordance with
				810:25-9-10.
(b) A subsidiary may apply for a separate
				individual own risk employer permit from its parent company if desired, but
				must meet all qualifications of this Subchapter.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 9 - Individual Own Risk Employer Permit › Section 810:25-9-10 - Own risk guaranty

Current through Vol. 41, No. 20, July 1, 2024
(a) An
				own risk guaranty, on a form approved by the Commission, must be submitted for
				any additional named insured included on the permit.
(b) If the individual own risk employer has a
				parent company that is not included on the permit, and the employer is relying
				on its parent company's financial statements to apply, then an own risk
				guaranty, on a form approved by the Commission, must be submitted from the
				parent company for its subsidiary.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 9 - Individual Own Risk Employer Permit › Section 810:25-9-11 - Governmental entities

Current through Vol. 41, No. 20, July 1, 2024
(a)
				Governmental entities may carry their own risk without insurance as provided in
				85A O.S. § 107. They must apply using the same application as private
				employers, and submit the same required documents, with the exception of
				interim financial statements. Governmental entities will be exempted from
				posting a security deposit if they make an appropriation into a segregated
				workers' compensation fund. The amount of the appropriation must be at least
				the entity's average yearly workers' compensation losses paid for three (3)
				calendar or fiscal years immediately preceding the application date.
(b) Certain public trust employers will be
				required to post a security deposit in lieu of an appropriation. The Commission
				will make this determination at the time of application review.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 9 - Individual Own Risk Employer Permit › Section 810:25-9-12 - Interim monitoring

Current through Vol. 41, No. 20, July 1, 2024
(a) An
				individual own risk employer may be placed on quarterly reporting by the
				Commission for purposes of monitoring its financial condition and workers'
				compensation loss history. Companies on quarterly reporting shall submit
				financial statements and loss runs to the Commission within sixty (60) days
				after the end of each of their fiscal quarters. An adjustment in the individual
				own risk employer's security deposit may be required after the Commission
				reviews the quarterly results.
(b)
				The Commission reserves the right to audit any insureds that they have
				determined a concern exists with an insureds ability to meet its financial
				obligations. These audits will focus on the reserve estimates and ensure that
				all claims are reserved to at least the "most probable outcome". The Commission
				defines "most probable outcome" as the expected amount of money to cover a
				claim based upon information known at the time of the report. The costs of
				these audits will be borne by the individual own risk employer and/or
				association.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 9 - Individual Own Risk Employer Permit › Section 810:25-9-13 - Notification of changed status

Current through Vol. 41, No. 20, July 1, 2024
An individual own risk employer must notify the Commission
				  in advance of any change in its financial condition, such as a bankruptcy
				  filing, potential bankruptcy, or negative net income for a fiscal year, or any
				  change in ownership during the interim period between applications. Failure to
				  notify the Commission in a timely manner may result in revocation of the own
				  risk permit. If there is a change in majority ownership of an individual own
				  risk employer, the own risk privilege granted to the employer shall be at the
				  discretion of the Commission and the new entity shall be required to qualify
				  under this Subchapter.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 9 - Individual Own Risk Employer Permit › Section 810:25-9-14 - Revocation of permit

Current through Vol. 41, No. 20, July 1, 2024
(a) The
				individual own risk employer permit may be revoked by the Commission at any
				time upon reasonable notice and hearing, for good cause shown, including, but
				not limited to: failure to comply with the rules of the Commission; failure to
				pay compensation when due; and financial impairment of the employer which has
				or will bring the employer below the minimum net worth requirement of
				810:25-9-2.
(b) The employer is expected to secure its
				workers' compensation obligations at all times as provided by law,
				notwithstanding the revocation. Failure to do so may subject the employer to
				sanctions pursuant to 85A O.S., § 40 and enforcement proceedings as
				provided in Subchapter 7 of this Chapter.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 9 - Individual Own Risk Employer Permit › Section 810:25-9-15 - Assessments

Current through Vol. 41, No. 20, July 1, 2024
An individual own risk employer must pay all applicable
				  Multiple Injury Trust Fund assessments (85A O.S., § 31) and all Self
				  Insurance Guaranty Fund assessments (85A O.S., § 98), when due and timely
				  report payment thereof to the Commission as prescribed by law. Failure to do so
				  is grounds for revocation of the individual own risk employer permit,
				  imposition of fines by the Commission, or both revocation and fines. No report
				  to the Commission or Insurance Department shall be required where no payment is
				  due.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 9 - Individual Own Risk Employer Permit › Section 810:25-9-16 - Medicare reporting

Current through Vol. 41, No. 20, July 1, 2024
An individual own risk employer shall comply with Section 111
				  of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA), including
				  all MMSEA workers' compensation reporting requirements, to the extent and as
				  provided by Federal law.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 9 - Individual Own Risk Employer Permit › Section 810:25-9-17 - Designation of service agent

Current through Vol. 41, No. 20, July 1, 2024
An individual own risk employer must designate a service
				  agent to receive service of notice. The designation must be made in a manner
				  prescribed by the Commission and filed with the Commission as provided in
				  810:10-1-11.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 9 - Individual Own Risk Employer Permit › Section 810:25-9-18 - Former own risk employers; continuing requirements

Current through Vol. 41, No. 20, July 1, 2024
(a) A former individual own risk employer
				remains responsible for:
(1) Paying all
				workers' compensation obligations incurred during its period as an approved
				individual own risk employer;
(2)
				Reporting its workers' compensation losses on an annual basis to the
				Commission, in a manner prescribed by the Commission;
(3) Paying Self Insurance Guaranty Fund
				assessments as provided in 85A O.S., § 98; and
(4) Maintaining an adequate security deposit
				with the Commission.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 9 - Individual Own Risk Employer Permit › Section 810:25-9-19 - Release of security deposit

Current through Vol. 41, No. 20, July 1, 2024
(a) A security deposit posted with the
				Commission as required by
				810:25-9-4 must
				remain in place, at its existing amount, for two years after an individual own
				risk employer voluntarily leaves self-insurance. The Commission may review the
				adequacy or excess of the security deposit in advance of the own risk permit
				termination date and require modifications to the security deposit amount as
				necessary.
(b) A security deposit
				may be reduced at the Commission's discretion after the two year waiting period
				upon application by the employer and submission of current financial statements
				and workers' compensation loss runs.
(c) A security deposit may be released at the
				Commission's discretion upon application by the employer and submission of
				current financial statements and a signed and notarized affidavit, from a duly
				authorized officer of the employer, affirming that all workers' compensation
				claims incurred under the own risk permit of the employer have been permanently
				closed, and the statute of repose for reopening the claims has
				passed.
(d) The security deposit
				shall be released in full by the Commission within a reasonable period
				following receipt of proof of an assumption agreement or equivalent, from a
				licensed insurance carrier, whereby the claims liability under the individual
				own risk employer permit is transferred to and assumed by the insurance
				company. The assumption agreement or equivalent may be entered into before
				expiration of the two year waiting period provided in Subsection (a) of this
				Section.
Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 11 - Group Self-insurance Association Permit › Section 810:25-11-1 - Application

Current through Vol. 41, No. 20, July 1, 2024
(a) Two or more
				employers having a common interest, as defined in Section
				810:25-1-2, may be
				approved by the Commission as a group self-insurance association for the
				purpose of entering into agreements to pool their liabilities under the AWCA.
				Such application shall be submitted in a manner prescribed by the Commission
				and shall be verified by the oath of at least two members of the board or the
				administrator.
(b) The application
				shall be reviewed by the Commission's Permitting Services Division. If the
				application is determined to be sufficient, the Division will issue a permit
				licensing the applicant to act as a group self-insurance association, for a
				period of one year. If the application is determined to be deficient, the
				Division will notify the applicant thereof, stating the reasons for the
				deficiency. If the deficiency cannot be resolved within the stated time frame
				from the Division, the application will be denied.
(c) The association's application may be
				approved if the Commission has satisfactory proof of:
(1) The solvency of each member of the
				association;
(2) The financial
				ability of each employer to meet its obligations as a member;
(3) The ability of the association to pay or
				cause to be paid the compensation in the amount and manner and when due as
				provided in the AWCA;
(4) A minimum
				collective net worth of the members of at least Two Million Dollars
				($2,000,000.00);
(5) Standard
				premium of Five Hundred Thousand Dollars ($500,000.00) at the start up date of
				the association; and
(6) The common
				interest of the members as defined in
				810:25-1-2.