054.00.54-13. DISPUTE RESOLUTION PROCEDURE
AR ADC 054.00.54-13Arkansas Administrative Code
Ark. Admin. Code 054.00.54-13
054.00.54-13. DISPUTE RESOLUTION PROCEDURE
Any person affected by the operation of the Plan including, but not limited to, participating companies, employers, producers, and servicing carriers, who may have a dispute with respect to any aspect of the Plan, including rating and classification, eligibility, and auditing disputes and any dispute arising under the Articles of Agreement, may seek a review of the matter by the Plan Administrator by setting forth in writing with particularity the nature of the dispute, the parties to the dispute, the relief sought and the basis thereof. The Plan Administrator, as designee of the Commissioner, may secure such additional information as it deems necessary to make a decision and shall in the instance of disputes involving, comply with all requirements of due process and Ark. Code Ann. § 23-67-119(3) and the Arkansas Appeals Board Objectives and Rules as approved by the Commissioner.
Appeals from employers and insurers on Plan matters regarding employer disputes shall be within the jurisdiction of the mechanism established to handle such appeals under the applicable rating law i.e. Ark. Code § 23-67-119(3). All other disputes shall be handled as follows:
(1) If the dispute relates to the general operation of the Plan, excluding individual employer disputes as noted above and those arising under the Articles of Agreement, the Plan Administrator will review the matter and render a written decision with an explanation of the reasons for the decision within thirty (30) days after receipt of all the information necessary to make the decision. Any party affected by a decision made by the Plan Administrator may seek a review by a committee appointed by the President of the National Council on Compensation Insurance for such purpose. Such committee shall consist of three (3) senior officers of the Council. A request for a review by such committee must be made to the Plan Administrator in writing within thirty (30) days of the date of the Plan Administrator's decision. Any party affected by the decision of such committee may seek a de novo review by the Commissioner by requesting such review, in writing, within thirty (30) days after the date of such decision.
In reviewing any such matter not coming with the scope of Ark. Code Ann. § 23-67-119(3)(B), the Commissioner shall follow those procedures applicable to administrative hearings in this State. The Commissioner shall decide the dispute in accordance with the state law, regulation, and policy and in the interests of the reasonable and proper administration of this Plan. The Commissioner's decision shall be final, subject to court review under Ark. Code Ann. § 23-61-307.
(2) Except as provided below, if the dispute arises under the Articles of Agreement, the Administrator designated under the Articles of Agreement shall first review the matter and render a written decision with an explanation of the reasons for the decision within thirty (30) days after receipt of all the information necessary to make the decision. Any party affected by the decision may seek a review by the Board of Governors established under the Articles by requesting such review, in writing, within thirty (30) days of the date of the decision by the Administrator under the Articles of Agreement. The Board of Governors must then review the matter and render its written decision pursuant to the procedures set forth in the Articles of Agreement. Any party affected by a decision of the Board of Governors may seek a de novo review by the Commissioner by requesting such a review in writing within thirty (30) days of the date of the Board of Governors' decision.
If the dispute relates to the expulsion of a participating company under the Articles of Agreement by the Board of Governors, any appeal may be taken directly to the Commissioner without first complying with the procedures contained herein.
Current with amendments received through February 15, 2024. Some sections may be more current, see credit for details.
Ark. Admin. Code 054.00.54-13, AR ADC 054.00.54-13
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