Florida Regulations 69O-190.063: Annual Review and Examination – Self-Insurers Funds
Current as of: 2024 | Check for updates
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(1) All bonds or securities issued by the State of Florida or the United States Government which are posted as security deposits shall be reviewed annually by the Office to determine market value. In the event market value is less than the deposit requirement, the Office may require that additional securities be posted by the self-insurer. In making such a determination, the Office shall consider the self-insurer’s financial condition, the amount that market value is less than the deposit requirement and the likelihood that such securities will be needed to provide benefits.
(2) All self-insurers funds shall maintain at a central location within the State of Florida such records as are necessary to verify the accuracy and completeness of all reports submitted to the Office pursuant to these rules as well as all reports necessary to establish the financial solvency of the self-insurers fund. Furthermore, the central location shall be the office of the administrator or fiscal agent of the self-insurers fund. However, the self-insurers fund shall be authorized to transfer its financial records to the offices of the Certified Public Accountant for the self-insurers fund upon the written permission of the Office. In addition, if the self-insurers fund has contracted with a service company for claims handling, then the claims files and related records may be located at the offices of the service company as long as they are within the State of Florida.
(3) All records as herein required shall be open to inspection by authorized representatives of the Office during regular business hours. Records shall be retained for a period of time sufficient to ensure their availability for audit purposes. In the absence of other guidelines, the records shall be retained according to the schedule adopted by the Office for similar records. The location of these records shall be made known to the Office upon the application for self-insurance and at such times thereafter sufficient to keep the Office informed of their location.
(4) The fund, in any agreement or contract with the administrator or fiscal agent, shall require that the records of the administrator or fiscal agent which pertain to fund operations, assets or liabilities under Florida Statutes Chapter 440, shall be open to inspection by authorized representatives of the Office during regular business hours.
(5) Each self-insurers fund’s records shall be examined in accordance with Florida Statutes § 624.316, by representatives of the Office at such time as may be determined by the Office. Prior notice of the audit shall not be required. This audit is in addition to any audit performed in preparation of the financial reports required by these rules.
(6) Each self-insurers fund shall comply with the guidelines regarding questionable claims handling techniques, questionable patterns of claims, repeated unreasonably controverted claims or poor payment practices established pursuant to Section 440.20(16), Florida Statutes.
(7) After each audit, a written report shall be prepared with a copy to the self-insurers fund; such report to be a part of the annual review for compliance with these rules. Any deficiencies cited by this report shall be considered on their merit in determining if there are grounds for revocation of the self-insurance privilege or the imposition of penalties pursuant to subsection (9). Within 45 days after the receipt of an audit report which contains findings that the fund violated a rule contained in rule Fl. Admin. Code Chapter 69O-190, the trustees shall convene a meeting to discuss the report. The discussion of the report shall be noted in the minutes of the meeting.
(8) As part of its annual review and audit, the Office shall determine if the self-insurers fund has a contingent liability. In the event the fund is found to have a contingent liability, the Office shall inform the fund and order that this liability be funded in accordance with subsections 69O-190.060(2) and 69O-190.065(5), F.A.C.
(9) In addition to the penalties prescribed in Fl. Admin. Code R. 69O-190.038, the Office may impose civil penalties not to exceed $100 for each violation of the Law or these rules. Penalties shall be imposed pursuant to Florida Statutes § 440.021
Rulemaking Authority 440.38(2)(b), (3), 624.4621 FS. Law Implemented 440.38(2)(b), 624.4621 FS. History-New 10-1-82, Amended 12-25-84, Formerly 38F-5.63, Amended 3-11-87, 12-19-93, Formerly 38F-5.063, 4-190.063.
Terms Used In Florida Regulations 69O-190.063
- Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
- Contract: A legal written agreement that becomes binding when signed.
- Liabilities: The aggregate of all debts and other legal obligations of a particular person or legal entity.
(3) All records as herein required shall be open to inspection by authorized representatives of the Office during regular business hours. Records shall be retained for a period of time sufficient to ensure their availability for audit purposes. In the absence of other guidelines, the records shall be retained according to the schedule adopted by the Office for similar records. The location of these records shall be made known to the Office upon the application for self-insurance and at such times thereafter sufficient to keep the Office informed of their location.
(4) The fund, in any agreement or contract with the administrator or fiscal agent, shall require that the records of the administrator or fiscal agent which pertain to fund operations, assets or liabilities under Florida Statutes Chapter 440, shall be open to inspection by authorized representatives of the Office during regular business hours.
(5) Each self-insurers fund’s records shall be examined in accordance with Florida Statutes § 624.316, by representatives of the Office at such time as may be determined by the Office. Prior notice of the audit shall not be required. This audit is in addition to any audit performed in preparation of the financial reports required by these rules.
(6) Each self-insurers fund shall comply with the guidelines regarding questionable claims handling techniques, questionable patterns of claims, repeated unreasonably controverted claims or poor payment practices established pursuant to Section 440.20(16), Florida Statutes.
(7) After each audit, a written report shall be prepared with a copy to the self-insurers fund; such report to be a part of the annual review for compliance with these rules. Any deficiencies cited by this report shall be considered on their merit in determining if there are grounds for revocation of the self-insurance privilege or the imposition of penalties pursuant to subsection (9). Within 45 days after the receipt of an audit report which contains findings that the fund violated a rule contained in rule Fl. Admin. Code Chapter 69O-190, the trustees shall convene a meeting to discuss the report. The discussion of the report shall be noted in the minutes of the meeting.
(8) As part of its annual review and audit, the Office shall determine if the self-insurers fund has a contingent liability. In the event the fund is found to have a contingent liability, the Office shall inform the fund and order that this liability be funded in accordance with subsections 69O-190.060(2) and 69O-190.065(5), F.A.C.
(9) In addition to the penalties prescribed in Fl. Admin. Code R. 69O-190.038, the Office may impose civil penalties not to exceed $100 for each violation of the Law or these rules. Penalties shall be imposed pursuant to Florida Statutes § 440.021
Rulemaking Authority 440.38(2)(b), (3), 624.4621 FS. Law Implemented 440.38(2)(b), 624.4621 FS. History-New 10-1-82, Amended 12-25-84, Formerly 38F-5.63, Amended 3-11-87, 12-19-93, Formerly 38F-5.063, 4-190.063.