§1863. Examination
A.The department shall, at least once every five years, conduct an examination of
the group self-insurance fund and at such other times as the department deems it necessary.
B.If an examination is needed, the department shall appoint one or more examiners
to perform the examination and instruct them as to the scope of the examination. In
performing its examination, the examiner or examiners shall observe the guidelines and
procedures deemed appropriate by the department.
C.The provisions of this Chapter shall not be construed to limit the department's
authority to use any final or preliminary examination report, any examiner or fund work
papers or other documents, or any other information discovered or developed during the
course of any examination in the furtherance
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§1863. Examination
A. The department shall, at least once every five years, conduct an examination of
the group self-insurance fund and at such other times as the department deems it necessary.
B. If an examination is needed, the department shall appoint one or more examiners
to perform the examination and instruct them as to the scope of the examination. In
performing its examination, the examiner or examiners shall observe the guidelines and
procedures deemed appropriate by the department.
C. The provisions of this Chapter shall not be construed to limit the department's
authority to use any final or preliminary examination report, any examiner or fund work
papers or other documents, or any other information discovered or developed during the
course of any examination in the furtherance of any legal or regulatory action which the
department may consider appropriate.
D. The provisions of this Chapter shall not be construed to limit the authority of the
department to terminate or suspend any examination in order to pursue other legal or
regulatory action pursuant to the applicable laws of this state. Findings of fact and
conclusions made pursuant to any examination shall be prima facie evidence in any legal or
regulatory action.
E. In conducting its examination, the department shall examine the affairs,
transactions, accounts, records, documents, and assets of the authorized group self-insurance
fund. For the purpose of ascertaining its condition or compliance with this Chapter, the
department may examine the accounts, records, documents, and transactions of all of the
following persons:
(1) Any insurance agent, solicitor, or broker, but only insofar as the accounts,
records, documents, and transactions relate to group self-insurance funds.
(2) Any person having a contract under which the person enjoys, in fact, the
exclusive or dominant right to manage or control the group self-insurance fund.
F. The group self-insurance fund being examined, and its officers, trustees,
employees, administrators, and representatives, shall produce and make freely accessible to
the department the accounts, records, documents, and files in its possession or control
relating to the subject of the examination and shall otherwise facilitate the examination.
G. The department may take depositions, subpoena witnesses or documentary
evidence, administer oaths, and examine under oath any individual relative to the affairs of
the group self-insurance fund being examined. Any person who testifies falsely or makes any
false affidavit during the course of an examination shall be guilty of perjury.
H. If the department conducts an examination or investigation pursuant to this
Chapter, all expenses incurred by the department, including the expenses and fees of
examiners, auditors, accountants, actuaries, attorneys, or clerical or other assistants who are
employed by the department to make the examination, shall be paid by the group self-insurance fund.
I. The department may recover all expenses incurred from time to time for the
examination or investigation of any person or entity acting as an administrator or third-party
administrator in this state for the group self-insurance fund.
J. The department shall employ the examiners, auditors, accountants, actuaries,
attorneys, and clerical or other assistants as are necessary to conduct the examination and to
compile and prepare a report thereon, and the compensation for such examination shall be
fixed according to the time actually devoted to the work, including conducting the
examination and compiling the report thereon, as required by law. Compensation paid
pursuant to this Subsection shall be reasonable and commensurate with the value of the
services performed.
K. Upon completion of the examination of the group self-insurance fund or at stated
periods during an examination, the department shall forward to the group self-insurance fund
a statement showing the amount of expenses incurred in the examination to the date of the
statement. Upon receipt, the group self-insurance fund shall pay the amount of expenses to
the department.
L. After the receipt of the billing, if the group self-insurance fund considers the
amount of expenses billed to it unreasonable or contrary to the provisions of this Chapter,
the fund, within fifteen days, may file a rule to show cause in a court of competent
jurisdiction upon the department as to the reasonableness and legality of the amount of
expenses billed to it by the department. The rule to show cause shall be tried in court by
preference as to scheduling and, upon appeal, shall be given preference in the appellate court
as provided by the law in the same manner as that given to the state for other state cases.
M. If the group self-insurance fund fails or refuses to pay the expenses of
examination as billed by the department after fifteen days from the receipt of the billing or
after final judgment of the court where a rule has been filed as provided in this Chapter, then
the department may suspend or revoke the certificate of authority of such group self-insurance fund to do business in this state until the full amount of the bill is paid.