Subchapter B. INSURER’S ACCIDENT AND ILLNESS PREVENTION SERVICES


Sec.


129.101.    Purpose.
129.102.    Accident and illness prevention service requirements.
129.103.    Obligation of an insured employer/policyholder.
129.104.    Insurer’s accident and illness prevention services providers requirements.
129.105.    Reporting requirements for applicants for licensure.
129.106.    Reporting requirements for licensed insurers.
129.107.    Report findings.
129.108.    Recordkeeping requirements.
129.109.    Periodic audits of insurer’s accident and illness prevention services.
129.110.    Preaudit exchange of information.
129.111.    Site of audit.
129.112.    Written report of audit.
129.113.    Plan of correction/reports of progress on correcting deficiencies.
129.114.    Contesting final determinations.

§ 129.101. Purpose.

 This subchapter interprets the requirements of the act that an insurer desiring to write workers’ compensation insurance in this Commonwealth shall maintain or provide adequate accident and illness prevention services as a prerequisite for a license to write this insurance. Services shall be adequate to furnish accident and illness prevention required by the nature of the insurer’s business or its policyholders’ operations. This subchapter also establishes the criteria that the Department will employ in determining the adequacy of the services required to be maintained or provided by an insurer.

§ 129.102. Accident and illness prevention services requirements.

 The Bureau will annually evaluate the following required accident and illness prevention services components for adequacy:

   (1)  Notice of availability of services. Notice that services required by this subchapter are available to the policyholder from an insurer shall appear in at least 10 point bold type and shall accompany each workers’ compensation insurance policy delivered or issued for delivery in this Commonwealth. The notice shall include information about the 5% premium discount available to employers who form a certified workplace safety committee as described in this chapter. The required elements of the notice include the name, address and telephone number of the contact person or department for additional information about the services.

   (2)  Requirements to maintain accident and illness prevention services. An insurer shall have the capacity to provide services that are adequate to furnish accident and illness prevention required by the nature of the insurer’s business or its policyholders’ operations. Capacity to provide services is defined as an insurer having established means to deliver services such as those listed in paragraph (3) based upon anticipated policyholder requests for services or based upon an insurer’s evaluation of policyholder requirements. Capacity to provide services shall be established by an insurer utilizing its own or contracted staff who shall meet the requirements established by the Department as outlined in Subchapter E (relating to accident and illness prevention services providers requirements).

   (3)  Requirements to provide accident and illness prevention services.

     (i)   An insurer shall provide accident and illness prevention services to policyholders who request them or based on the insurer’s determination of the policyholders’ operational requirements. Services shall be provided through an insurer’s own or contracted staff who meet the requirements established by the Department in Subchapter E.

     (ii)   Services include the following:

       (A)   Surveys to identify existing or potential accident and illness hazards or safety program deficiencies. Surveys may, for example, be in the form of an underwriting risk analysis or an onsite review. If the insurer determines through a survey and analysis of survey results that the hazards or deficiencies are present, it shall propose corrective actions to the policyholder concerning the abatement of hazards or program deficiencies identified in the surveys. If one or more imminent danger situations are identified, the insurer shall inquire as to the corrective actions a policyholder has taken and propose further corrective actions if necessary.

       (B)   Providing or proposing corrective actions in the area of industrial hygiene services as requested by the policyholder or as determined by the insurer to meet the policyholders’ operational requirements, for example, air quality testing.

       (C)   Providing or proposing corrective actions in the area of industrial health services as requested by the policyholder or as determined by the insurer to meet the policyholders’ operational requirements, for example, health screenings or substance abuse awareness and prevention training policies and programs.

       (D)   Accident and illness prevention training programs which may include training for safety committee members as outlined under Subchapter F (relating to workplace safety committees).

       (E)   Consultations regarding specific safety and health problems and hazard abatement programs and techniques related to the introduction of new equipment or new materials.

Cross References

   This section cited in 34 Pa. Code §  129.105 (relating to reporting requirements for applicants for licensure).

§ 129.103. Obligation of an insured employer/policyholder.

 An insured employer/policyholder requesting accident and illness prevention services as mandated by the act shall provide the necessary information and access to the insurer to permit the insurer to fulfill its requirements under the act.

§ 129.104. Insurer’s accident and illness prevention services providers requirements.

 (a)  Accident and illness prevention services providers employed by or contracted with an insurer to perform accident and illness prevention services shall meet the requirements specified in Subchapter E (relating to accident and illness prevention services providers requirements).

 (b)  The Bureau may require that the insurer provide documentation or evidence to support that the requirements for accident and illness prevention services providers have been met by each individual providing accident and illness prevention services, whether employed or under contract, based on the criteria in Subchapter E.

§ 129.105. Reporting requirements for applicants for licensure.

 (a)  As part of their application for a certificate of authority submitted to the Insurance Department, applicants for a license to write workers’ compensation insurance shall provide information concerning their accident and illness prevention services required under §  129.102 (relating to accident and illness prevention services requirements) using Form LIBC-211I, Insurer’s Initial Report of Accident and Illness Prevention Services.

 (b)  As part of the process of licensing to write workers’ compensation insurance in this Commonwealth, the Insurance Department will forward to the Bureau the report in subsection (a) for a determination of adequacy. The Bureau will provide a final determination of adequate or inadequate to the Commissioner.

Cross References

   This section cited in 34 Pa. Code §  129.107 (relating to report finds).

§ 129.106. Reporting requirements for licensed insurers.

 A licensed insurer shall, by June 1 of each year, provide the Bureau with information concerning accident and illness prevention services offered or provided to the insurer’s policyholders during the preceding calendar year. The information shall be provided using the AIPS report. In addition, documentation required by other governmental regulatory agencies can be used as supporting evidence of accident and illness prevention services. Report information shall be subject to Bureau verification.

Cross References

   This section cited in 34 Pa. Code §  129.107 (relating to report finds).

§ 129.107. Report findings.

 (a)  Upon receipt of a report required under §  129.105 (relating to reporting requirements applicants for licensure), the Bureau will review the report data, make a final determination of the adequacy or inadequacy of services and provide notification to the Commissioner and the insurer of its final determination.

 (b)  Upon receipt of a report required under §  129.106 (relating to reporting requirements for licensed insurers), the Bureau will review the report data and make a final determination of adequacy or an initial determination of inadequacy of services. An inadequate determination may result in an audit of services before a final determination is made. The Bureau will provide notification to the Commissioner and the insurer of its final determination.

§ 129.108. Recordkeeping requirements.

 Insurers shall maintain records of accident and illness prevention services by a policyholder for the most complete current calendar year and 2 preceding consecutive calendar years which include:

   (1)  The dates of the requests for services.

   (2)  The services requested or problems presented.

   (3)  Reports from site inspections performed.

   (4)  Other service reports including proposed corrective actions.

   (5)  The dates on which services were provided and the policyholder’s responses to proposed corrective actions.

   (6)  The results of industrial hygiene and health surveys and consultations.

   (7)  Accident and illness prevention training conducted.

   (8)  Documentation supporting the funds expended for the delivery of accident and illness prevention services.

   (9)  Evidence of the effectiveness and accomplishments of accident and illness prevention services.

Cross References

   This section cited in 34 Pa. Code §  129.111 (relating to site of audit).

§ 129.109. Periodic audits of insurer’s accident and illness prevention services.

 (a)  The Bureau may audit an insurer’s accident and illness prevention services at least once every 2 years.

 (b)  The Bureau may audit an insurer’s accident and illness prevention services if the insurer fails to file an AIPS by specified time frames or fails to meet the requirements of this subchapter.

 (c)  The notice of the audit will include the reasons for audit.

 (d)  At least 60-calendar days prior to an audit, the Bureau will notify the insurer in writing of the date on which the audit will occur.

§ 129.110. Preaudit exchange of information.

 (a)  At least 45-calendar days prior to the audit, the insurer shall provide the Bureau with:

   (1)  If not already submitted, a completed, annual AIPS report for the most recently completed calendar year and, if requested, the AIPS reports for the 2 preceding consecutive calendar years including those of its affiliated companies, if applicable.

   (2)  A description of the type of accident and illness prevention services provided during the last completed calendar year and a list of current insured employers/policyholders specifying name and premium size grouping which: received services; requested but did not receive services; and have reported to the carrier that they have a certified workplace safety committee.

   (3)  The name, address, business telephone number, credentials, experience and status (whether employed or contracted) of each person acting as an accident and illness prevention services provider for the insurer.

 (b)  The Bureau will keep the list of insured employers/policyholders confidential.

 (c)  Within 10-calendar days of receipt of the list of policyholders, the Bureau will notify the insurer of the accounts selected for audit and the information required concerning these accounts.

 (d)  At least 15-calendar days prior to the date of the audit, the insurer shall provide the account information referenced in subsection (c) to the Bureau.

 (e)  If the information necessary for the audit is not furnished, the Bureau may cancel the audit, and a final determination of inadequate will be forwarded to the Director. The Director will provide notification to the Commissioner and to the insurer of its final determination. A rating may be challenged by the insurer in accordance with Subchapter G (relating to hearings).

§ 129.111. Site of audit.

 (a)  The audit of the insurer’s accident and illness prevention services will take place at the insurer’s main office in this Commonwealth unless otherwise agreed by the Bureau and the insurer. If the insurer has no office in this Commonwealth, the audit will take place at the Bureau’s headquarters.

 (b)  At the site where the audit will occur, the insurer shall provide the documentation required by §  129.108 (relating to recordkeeping requirements) and any other documentation chosen by the insurer supporting the existence and adequacy of required services.

§ 129.112. Written report of audit.

 (a)  After the conclusion of the audit, the Bureau will issue a written report containing its findings. The report will indicate whether the Bureau has issued a final determination of adequate or an initial determination of inadequate with regard to an insurer’s accident and illness prevention services.

 (b)  The Bureau will notify the insurer of a final determination of adequate.

 (c)  The Bureau will provide written notification to the insurer of specific deficiencies and recommendations for corrective action if it assigns an initial determination of inadequate. Within 60-calendar days from the date of the audit report, the insurer shall provide written documentation that it has complied with the Bureau’s recommendations. If the insurer believes that it will take more than 60 days to implement the recommendations, it shall file a plan of correction in accordance with §  129.113 (relating to plan of correction/reports of progress on correcting deficiencies). At the end of the 60-calendar day correction period, a final determination of adequate or inadequate will be assigned. The insurer will receive notification of this final determination. The Commissioner will receive notification of final determinations of inadequate.

Cross References

   This section cited in 34 Pa. Code §  129.113 (relating to plan of correction/reports of progress on correcting deficiencies).

§ 129.113. Plan of correction/reports of progress on correcting deficiencies.

 An insurer shall file a plan of correction to implement audit report recommendations referenced in §  129.112(c) (relating to written report of audit) for any deficiency requiring more than 60 days to correct. The plan shall include a timetable for correction acceptable to the Bureau. Progress reports shall be filed by the insurer detailing corrective actions at the end of each 30-day period of the correction plan period. The Bureau may audit the insurer’s accident and illness prevention services if the insurer fails to file progress reports, implement recommendations, or provide acceptable documentation of corrective actions. At the end of the correction plan period, a final determination of adequate or inadequate will be made, and the insurer will be notified of the determination. The Commissioner will be notified of final determinations of inadequate.

Cross References

   This section cited in 34 Pa. Code §  129.112 (relating to written report of audit).

§ 129.114. Contesting final determinations.

 An insurer may contest a final determination of inadequate under Subchapter G (relating to hearings).



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