SECTION 810:25-13-4. Operating requirements

  The TPA must:

(1)   Have adequate personnel on staff to handle the volume and type of work. The TPA may subcontract for services not provided by the TPA, but requested from the self-insurer;

(2)   Be financially solvent, and must report its financial statements on an annual basis to the Commission in an approved form and manner;

(3)   Maintain an adequate Errors and Omissions policy;

(4)   Maintain an adequate Fidelity Bond;

(5)   Establish claims reserves at the most likely outcome. Best case reserving is not allowed.

(6)   Retain its independence when setting claim reserves. The TPA shall not let the self-insurer influence the amount of the reserve or the closing of a claim;

(7)   Maintain an Oklahoma office, if handling a group self-insurance association program; and

(8)   Maintain adequate computerized records and paper claims files on each claim. A copy of this information must be made available for the Commission's review at all times upon request.

[Source: Added at 31 Ok Reg 497, eff 2-4-14 (emergency); Added at 32 Ok Reg 1493, eff 8-27-15; Amended at 34 Ok Reg 2221, eff 9-11-17]