For the purposes of this chapter, an administrator or third–party administrator or TPA is a person who directly or indirectly solicits or effects coverage of, underwrites, collects charges or premiums from, or adjusts or settles claims on residents of this state, or residents of another state from offices in this state, in connection with workers’ compensation, life or health insurance coverage or annuities, except any of the following:

(1) An employer on behalf of its employees or the employees of one or more subsidiary or affiliated corporations of such employer;

(2) A union on behalf of its members;

(3) An insurer which is authorized to transact insurance in this state with respect to a policy lawfully issued and delivered in and pursuant to the laws of this state or another state;

(4) An insurance producer licensed to sell workers’ compensation, life or health insurance in this state, whose activities are limited exclusively to the sale of insurance;

(5) A creditor on behalf of its debtors with respect to insurance covering a debt between the creditor and its debtors;

(6) A trust and its trustees, agents and employees acting pursuant to such trust established in conformity with 29 U.S.C. § 186;

(7) A trust exempt from taxation under § 501(a) of the Internal Revenue Code, its trustees and employees acting pursuant to such trust, or a custodian and the custodian’s agents or employees acting pursuant to a custodian account which meets the requirements of § 401(f) of the Internal Revenue Code;

(8) A financial institution which is subject to supervision or examination by federal or state banking authorities, or a mortgage lender, to the extent they collect and remit premiums to licensed insurance producers or authorized insurers in connection with loan payments;

(9) A credit card issuing company which advances for and collects premiums or charges from its credit card holders who have authorized collection if the company does not adjust or settle claims;

(10) A person who adjusts or settles claims in the normal course of that person’s practice or employment as an attorney at law and who does not collect charges or premiums in connection with workers’ compensation, life or health insurance coverage or annuities;

(11) An adjuster whose activities are limited to adjustment of claims;

(12) A person who acts solely as an administrator of one or more bona fide employee benefit plans established by an employer or an employee organization, or both, for which the insurance laws of this state are preempted pursuant to the Employee Retirement Income Security Act of 1974. Such person shall comply with the requirements of § 58-29D-27;

(13) A licensed managing general agency;

(14) A licensed reinsurance intermediary; or

(15) A person regulated under the Broker Controlled Act.

This chapter applies to any third party administrator who performs administration functions on behalf of any workers’ compensation insurer or employer with a self–funded workers’ compensation program.

Source: SL 1992, ch 352, § 2; SL 2001, ch 285, § 1; SL 2001, ch 286, § 152.