287.310. Policies to be approved by department--deductible plans authorized, requirements.

MISSOURI STATUTES AND CODES

287.310. Policies to be approved by department--deductible plans authorized, requirements.

Policies to be approved by department--deductible plans authorized,requirements.

287.310. 1. Every policy of insurance against liability under thischapter shall be in accordance with the provisions of this chapter and shallbe in a form approved by the director of the department of insurance,financial institutions and professional registration. Such policy shallcontain an agreement that the insurer accepts all of the provisions of thischapter, that the same may be enforced by any person entitled to any rightsunder this chapter as well as by the employer, that the insurer shall be aparty to all agreements or proceedings under this chapter, and his appearancemay be entered therein and jurisdiction over his person may be obtained as inthis chapter provided, and such covenants shall be enforceable notwithstandingany default of the employer.

2. Any insurer issuing a workers' compensation policy may offer, as apart of the policy or as an optional endorsement to the policy, a deductibleplan or plans to allow the insured employer to self-insure for the deductibleamount, subject to the approval of the director of the department ofinsurance, financial institutions and professional registration. Nodeductible plan shall be approved which permits, directly or indirectly, anypart of the deductible to be charged to or passed on to an employee of theinsured employer.

3. Any deductible plan authorized under this section may provide for theagreement between the insurer and the insured employer regarding theconditions under which the employer shall be responsible for the payment ofany deductible amount to the person or health care provider entitled to suchpayment pursuant to this chapter, except that no deductible plan shall beapproved unless the insurer shall retain the ultimate responsibility for thepayment of compensable claims. Where the agreement provides for the paymentof the deductible amount by the insurer, the insurer shall pay all thedeductible amount applicable to a compensable claim directly to the person orhealth care provider entitled to the benefit pursuant to this chapter, andshall then be reimbursed by the insured employer for such payments. Theinsured employer shall be liable to the insurer up to the limit of thedeductible, and any failure on the part of the insured employer to providesuch reimbursements shall be treated under the workers' compensation policy inthe same manner as a nonpayment of premium. An employer's failure toreimburse deductible amounts to the insurer shall not cause the unpaid amountto be paid from the second injury fund under section 287.220. The insurershall have the right to offset unpaid deductible amounts against unearnedpremiums, if any, in the event of a cancellation of the policy.

4. Deductible plans shall provide appropriate premium reductions, asapproved by the director of the department of insurance, financialinstitutions and professional registration, to reflect the type and level ofthe deductible amount selected. Losses paid by the employer under thedeductible shall be credited against the employer's experience modificationwhile the deductible option is used, unless the employer exercises the rightto purchase a gross reportable deductible plan.

5. An insurer shall not be required to offer a deductible if, as aresult of a credit investigation, the insurer determines that the employerdoes not have the financial ability to be responsible for the payment ofdeductible amounts.

6. An insurer shall service and, if necessary, defend all claims thatarise during the policy period, including those claims payable in whole or inpart from the deductible amount.

7. No employer who self-insures for a deductible amount as provided inthis section shall harass, discharge, or otherwise discriminate against anyemployee because the employee has taken any action or is considering takingaction which might result in the insured employer being required to pay adeductible amount.

8. Any rating organization or advisory organization authorized by theprovisions of section 287.330 may file on behalf of its members deductibleplans for approval by the director of the department of insurance, financialinstitutions and professional registration.

9. In calculating the administrative surcharge owed pursuant to theprovisions of this chapter for workers' compensation policies with deductibleoptions, the administrative surcharge owed will be based upon the totalpremiums, which would have been paid for the deductible credit portion of thepolicy. The second injury fund surcharge owed by the employer who purchases adeductible policy will be assessed upon the total premiums which would havebeen paid in the absence of the deductible option. The premium taxes owedpursuant to this chapter for workers' compensation policies with deductibleoptions shall be assessed upon those total premiums paid upon the insurancepolicy excluding the deductible credit portion of the policy. The portion ofthe workers' compensation policy with a deductible option that is subject toan administrative surcharge shall not be subject to premium taxes, nor withrespect to foreign insurance companies, the retaliatory tax imposed pursuantto section 375.916, RSMo.

10. The director of the department of insurance, financial institutionsand professional registration shall, by rule, specify any data reportingrequirements applicable to workers' compensation policies with deductibleoptions.