Okla. Admin. Code § 810:25-13-4

Current through Vol. 42, No. 4, November 1, 2024

Section 810:25-13-4 - Operating requirements

The TPA must:

(1) Have adequate personnel on staff to handle the volume and type of work. The TPA may subcontract for services not provided by the TPA, but requested from the self-insurer;

(2) Be financially solvent, and must report its financial statements on an annual basis to the Commission in an approved form and manner;

(3) Maintain an adequate Errors and Omissions policy;

(4) Maintain an adequate Fidelity Bond;

(5) Establish claims reserves at the most likely outcome. Best case reserving is not allowed.

(6) Retain its independence when setting claim reserves. The TPA shall not let the self-insurer influence the amount of the reserve or the closing of a claim;

(7) Maintain an Oklahoma office, if handling a group self-insurance association program; and

(8) Maintain adequate computerized records and paper claims files on each claim. A copy of this information must be made available for the Commission's review at all times upon request.

Okla. Admin. Code § 810:25-13-4

Adopted by Oklahoma Register, Volume 32, Issue 23, August 17, 2015, eff. 8/27/2015

Amended by Oklahoma Register, Volume 34, Issue 24, September 1, 2017, eff. 9/11/2017