Performance Standards for Workers’ Compensation Carriers

PURPOSE: This rule establishes minimum standards of performance for carriers writing Workers’ Compensation coverage with regard to the writing of policies, auditing and billing accounts, and servicing. This rule was adopted pursuant to the provisions of section 374.045, RSMo and implements section 287.310, RSMo. (1) Policy Service Standards. (A) All policies are to be issued within sixty (60) days of the receipt of the application. Renewal policies are to be issued within sixty (60) days of receipt of the deposit premium. This subsection is not applicable if there exists a written agreement between the policyholder and the insurance company to delay the issuance of the policy. (B) Endorsements are to be issued within sixty (60) days of the receipt of the request. This subsection is not applicable if there exists a written agreement between the policyholder and the insurance company to delay the issuance of the endorsement. (C) Reinstatement notices are to be issued within thirty (30) days after the request for reinstatement has been received and the premium due has been paid. (D) Certificates of insurance are to be mailed within five (5) working days of receipt of the request. (2) Audit Standards. (A) Audits shall be completed, billed, and any premiums returned within one hundred twenty (120) days of policy expiration or cancellation unless— 1. Delay is caused by the policyholder’s failure to respond to reasonable audit requests provided that the requests are timely and adequately documented; or 2. A written agreement of the policyholder and insurance company provides a longer timeframe. (B) If a policyholder or insurance company has any objection to the results of any audit, the policyholder or insurance company may send a written notice demanding a reconsideration of the audit within three (3) years from the date of expiration or cancellation of that policy. The written notice shall be based upon sufficiently clear and specific facts as to why the audit should be reconsidered. AUTHORITY: sections 287.310 and 374.045, RSMo 2016.* This rule was previously filed as 4 CSR 190-18.060. Original rule filed Dec. 1, 1989, effective May 1, 1990. Amended: Filed March 8, 2019, effective Sept. 30, 2019. *Original authority: 287.310, RSMo 1939, amended 1992, 2003 and 374.045, RSMo 1967, amended 1993, 1995, 2008.