Ariz. Admin. Code § R20-5-1510 - Processing of Workers' Compensation Claims; Authorization to Self-Administer
A. A Self-Insurer
shall utilize a Third-Party Administrator to process workers' compensation
claims unless the Division authorizes the Self-Insurer to
Self-Administer.
B. A Self-Insurer
seeking to Self-Administer shall file with the Division a completed Application
to Self-Administer Form and all documentation and information required under
subsection (C).
C. The Division, in
consultation with the Claims Division of the Commission, shall authorize a
Self-Insurer to Self-Administer if the Self-Insurer provides documentation and
information establishing the following:
1. The
Self-Insurer has facilities and equipment sufficient to manage, process, and
store its own information pertaining to the SelfInsurer's workers' compensation
claims;
2. The Self-Insurer's
workers' compensation claims are processed by persons with experience,
training, and knowledge regarding the processing of Arizona workers'
compensation claims and the requirements of the Act and applicable
administrative rules; and
3. The
persons processing the Self-Insurer's claims have completed the Claims
Division's workers' compensation training program within the prior two
years.
D. The Division
shall administratively review an application to Self-Administer within 20 days
of receipt to determine if the application is complete. If the application is
incomplete, the Division shall notify the Applicant in writing of the missing
documentation or information necessary to comply with this section.
E. The Division shall deem an application to
Self-Administer withdrawn if the Applicant fails to file a completed
application within 10 days of being notified by the Division that the
application is incomplete according to subsection (D).
F. Unless the substantive review time frame
is extended under A.R.S. §
41-1075, the Division shall determine whether
an application to Self-Administer meets the substantive criteria of subsection
(C) within 30 days after the application to Self-Administer is deemed
complete.
G. The overall timeframe
for processing an application to Self-Administer is 50 days, unless extended
under A.R.S. §
41-1072 et seq.
H. Upon approval of an application to
Self-Administer, the Division shall serve a certificate of authorization on the
Applicant no later than 30 days after approval.
I. The Division shall revoke a certificate of
authorization to Self-Administer if the Self-Insurer no longer satisfies the
requirements in subsection (C).
J.
If the Division denies a request to Self-Administer or revokes a certificate of
authorization, the Division shall issue and serve written findings and an order
on the Applicant no later than 30 days after the denial or
revocation.
K. Authorization to
Self-Administer shall continue until any of the following occurs:
(1) self-insurance authority
ceases;
(2) the SelfInsurer
contracts with a Third-Party Administrator to process workers' compensation
claims; or
(3) authority to
Self-Administer is revoked by the Division.
Notes
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