PURPOSE: This rule establishes minimum standards of performance for carriers writing Workers’ Compensation coverage with regard to the writing of policies, auditing and billing accounts and servicing. This rule was adopted pursuant to the provisions of section 374.045, RSMo and implements section 287.310, RSMo.

1. (1) Policy Service Standards.

   1. (A) The policy shall be issued within sixty

2. (60) days of the receipt of the application. The renewal policy shall be issued within sixty (60) days of receipt of the deposit premium. This subsection is not applicable if there exists a mutual agreement between the policyholder and the insurance company to delay the issuance of the policy provided the agreement is adequately documented.

   1. (B) Endorsements are to be issued within sixty (60) days of the receipt of the request. This subsection is not applicable if there exists a mutual agreement between the policyholder and the insurance company to delay the issuance of the endorsement provided the agreement is adequately documented.
   2. (C) Reinstatement notices must be issued within thirty (30) days after the request for reinstatement has been received and the premium due has been paid.
   3. (D) Certificates of insurance must be mailed within five (5) working days of receipt of the request.

3. (2) Audit Standards.

   1. (A) Audits shall be completed, billed and premiums returned within one hundred twenty (120) days of policy expiration or cancellation. This standard of one hundred twenty

4. (120) days shall not be applicable—1) if a delay is caused by the policyholder’s failure to respond to reasonable audit requests provided that the requests are timely and adequately documented or 2) if a delay is by the mutual agreement of the policyholder and insurance company provided that the agreement is adequately documented.

   1. (B) If the policyholder or insurance company has any objection to the results of any audit, the policyholder or insurance company shall have up to three (3) years from the date of expiration or cancellation of that policy in which to send a written notice demanding a reconsideration of the audit. The written notice shall be based upon sufficiently clear and specific facts as to why the audit should be reconsidered.

AUTHORITY: sections 287.310, RSMo Supp. 1992 and 374.045, RSMo 1986.* This rule was previously filed as 4 CSR 190-18.060. Original rule filed Dec. 1, 1989, effective May 1, 1990.

*Original authority: 287.310, RSMo 1939, amended 1992 and 374.045, RSMo 1967.