§ 12:1864 — Examination reports

§1864. Examination reports
A. All examination reports shall be comprised only of facts appearing upon the
books, records, or other documents of the group self-insurance fund or as ascertained from
the testimony of its officers or agents or other persons examined concerning its affairs, and
any conclusions and recommendations the examiners find reasonably warranted from the
facts. The department shall keep confidential all documents and records associated with the
provisions of this Section.
B. Not later than sixty days following completion of the examination, the examiner
in charge shall file with the department a verified written report of examination under oath.
Upon receipt of the verified report, the department shall transmit the report to the fund
examined, together with a notice which shall afford the fund examined a reasonable
opportunity of not more than thirty days to make a written submission or rebuttal with
respect to any matters contained in the examination report.
C. Within thirty days of the end of the period allowed for the receipt of written
submissions or rebuttals, the department shall fully consider and review the report, together
with any written submissions or rebuttals and any relevant portions of the examiner's work
papers, and enter an order for one of the following:
(1) Adoption of the examination report as filed or with modifications or corrections.
If the examination report reveals that the group self-insurance fund is operating in violation
of any law, rule, regulation, or prior order or directive of the department, the department may
order the fund to take any action the department determines is necessary and appropriate to
cure the violation.
(2) Rejection of the examination report with direction to the examiners to reopen the
examination for purposes of obtaining additional documentation, data, information, and
testimony.
D. Within thirty days of rejection by the department of an examination report in
accordance with Paragraph (C)(2) of this Section, unless the department extends the time for
reasonable cause, the examiner in charge shall refile with the department a verified written
report of examination, as may be modified or corrected, under oath. Upon receipt of the
refiled verified report, the department shall transmit the refiled report to the fund examined,
together with a notice similar to the notice provided for in Subsection B of this Section,
except the notice shall indicate that the report is a refiled report.
E. Within thirty days of the end of the period allowed for the receipt of written
submissions or rebuttals, as provided for in Subsections B and D of this Section, the
department shall fully consider and review the refiled report, together with any written
submissions or rebuttals and any relevant portions of the work papers of the examiner, and
enter an order for one of the following:
(1) Adoption of the examination report as refiled or with modification or corrections.
If the refiled examination report reveals that the group self-insurance fund is operating in
violation of any law, rule, regulation, or prior order or directive of the department, the
department may order the fund to take any action the department considers necessary and
appropriate to cure the violation.
(2) Rejection of the examination report and referral of the matter for hearing before
an administrative law judge within the division of administrative law in accordance with the
provisions of the Administrative Procedure Act, for purposes of obtaining additional
documentation, data, information, and testimony.
F. All orders entered pursuant to Paragraph (C)(1) or (E)(1) of this Section shall be
accompanied by findings and conclusions resulting from consideration by the department and
review of the examination report, relevant examiner work papers, and any written
submissions or rebuttals. Any order shall be served upon the fund by certified mail, together
with a copy of the adopted examination report. Within thirty days of the issuance of the
adopted report, the trustees of the group self-insurance fund shall state, under oath, that they
have received a copy of the adopted report and related orders.
G. Within thirty days after receipt of notification of the department's order pursuant
to Subsection F of this Section, the fund may make written demand for an administrative law
hearing in accordance with the provisions of the Administrative Procedure Act.
H.(1) At the conclusion of a hearing initiated pursuant to Subsection G of this
Section, the administrative law judge shall enter an order adopting the examination report
as filed, or subsequently filed again with modifications or corrections, and may order the
fund to take any action that the department considers necessary and appropriate to cure any
violation of any law, regulation, or prior order or directive of the department.
(2) The division of administrative law shall issue the order within thirty days after
the conclusion of the hearing and shall give a copy of the order to each person to whom
notice of the hearing was given or required to be given.
I.(1) Upon the adoption of the examination report prescribed in Paragraph (C)(1) or
(E)(1) or Subsection H of this Section, the department shall continue to hold the content of
the examination report as private and confidential information for a period not to exceed
thirty consecutive days, unless the provisions of R.S. 12:1863(C) and Subsection B of this
Section apply. Thereafter, the department may open the report for public inspection provided
no court of competent jurisdiction has stayed its publication.
(2) Notwithstanding any provision of law to the contrary, nothing shall prevent or
be construed to prohibit the department from disclosing the content of an examination report,
a preliminary examination report or results, or any matter relating thereto, to another office
of the department or to the insurance department of any other state or country, or to law
enforcement officials of this or any other state or agency of the federal government at any
time, provided the agency or office receiving the report or matters relating thereto agrees, in
writing, to hold it confidential and in a manner consistent with this Chapter.
(3) If the department determines that regulatory action is appropriate as a result of
any examination, it may initiate any proceedings or actions as provided by law.
J. All work papers, recorded information, and documents, as well as all copies
thereof produced by, obtained by, or disclosed to the department, or any other person, in the
course of an examination made pursuant to this Chapter, or in accordance with the authority
of the commissioner pursuant to this Chapter, shall be given confidential treatment and are
not subject to subpoena and may not be made public by the department or any other person,
unless the provisions of R.S. 12:1863(C) and Subsection I of this Section apply. The parties
shall agree, in writing prior to receiving the information, to provide to it the same
confidential treatment as required by this Section, unless the prior written consent of the fund
has been obtained.
K.(1) No examiner may be appointed by the department if that examiner, either
directly or indirectly, has a conflict of interest or is affiliated with the management of or
owns a pecuniary interest in any person or entity subject to examination pursuant to this
Chapter.
(2) Notwithstanding the requirements of this Section, the department may retain from
time to time, on an individual basis, qualified actuaries, certified public accountants, or other
similar individuals who are independently practicing their professions, even though those
persons may from time to time be similarly employed or retained by persons subject to
examination pursuant to this Chapter.
L.(1) No cause of action shall arise nor shall any liability be imposed against the
department, the authorized representative of the department, or any examiner appointed by
the department for any statement made or conduct performed in good faith while carrying
out the provisions of this Chapter.
(2) No cause of action shall arise nor shall any liability be imposed against any
person for the act of communicating or delivering information or data to the department, or
the authorized representative of the department, or an examiner, as part of an examination
made pursuant to this Chapter, if that act of communication or delivery was performed in
good faith and without fraudulent intent or the intent to deceive.
M.(1) In addition to those examinations performed pursuant to R.S. 12:1863, the
department shall conduct financial reviews of the group self-insurance fund. The reviews
shall include the audited financial statements of the group self-insurance fund rendered
pursuant to generally acceptable accounting principles, results of prior examinations and
office reviews, management changes, consumer complaints, and any other relevant
information as from time to time may be required by the department.
(2) Failure by the group self-insurance fund to supply information requested by the
department during the course of a financial review shall subject the group self-insurance fund
to revocation or suspension of its license or a fine not to exceed ten thousand dollars per
occurrence.
(3) All work papers, recorded information, and documents as well as all copies
thereof produced by, obtained by, or disclosed to the department or any other person in the
course of conducting a financial review, shall be given confidential treatment and are not
subject to subpoena and may not be made public by the department or any other person,
except that any access may be granted to insurance departments of other states; international,
federal, or state law enforcement agencies; or international, federal, or state regulatory
agencies with statutory oversight over the financial services industry, if the recipient agrees
to maintain the confidentiality of those documents which are confidential under the laws of
this state.
(4) In conducting financial reviews, the examiner or examiners shall observe those
guidelines and procedures as the department may deem appropriate.
(5) Nothing contained in this Chapter shall be construed to limit the department's
authority to use any final or preliminary analysis findings, any department or fund work
papers or other documents, or any other information discovered or developed during the
course of any analysis in the furtherance of any legal or regulatory action.
(6) The group self-insurance fund against whom a fine has been levied shall be given
ten days' notice of imposition of the fine. Upon receipt of this notice, the aggrieved party may
apply for and is entitled to an administrative hearing pursuant to the Administrative
Procedure Act.
N. The provisions of this Section shall not be construed to prohibit the legislative
auditor from reviewing records and conducting an audit in accordance with R.S. 24:513.

Legislative History

Acts 2023, No. 259, §§1, 3A, eff. June 12, 2023.