803 KAR 25:170. Filing of claims information with the Department of Workers' Claims.

RELATES TO: KRS 342.038, 342.039

STATUTORY AUTHORITY: KRS 342.039

NECESSITY, FUNCTION, AND CONFORMITY: KRS 342.039 requires the Commissioner of the Department of Workers' Claims to promulgate administrative regulations by which each insurance company writing workers' compensation policies in the Commonwealth, every group of self-insurers, and each employer carrying its own risk shall file detailed claim information contained in the model regulation developed by the National Association of Insurance Commissioners (NAIC) in conjunction with the International Association of Industrial Accident Boards and Commissions (IAIABC). This administrative regulation establishes the requirements for filing claims information with the department.

Section 1. Definitions. (1) "Carrier" is defined in KRS 342.0011(6).

(2) "Commissioner" means the Commissioner of the Department of Workers' Claims appointed pursuant to KRS 342.228.

(3) "Data collection agent" means a business or entity that keys information in an electronic format and transmits the resulting data to a value added network used by the Department of Workers' Claims.

(4) "Value added network" means a business or entity that accepts electronic data transmissions and sorts the transmissions for delivery to various addressees.

Section 2. Reporting Requirements. (1) Beginning with work-related injuries and occupational diseases reported to employers on or after January 1, 1996, each carrier shall file the information required on the Form IA-1 with a data collection agent or a value added network designated by the Department of Workers' Claims, in electronic format, according to the time periods prescribed by KRS 342.038.

(2) Beginning with work-related injuries and occupational diseases reported to employers on or after January 1, 1996, each carrier shall file the information required on the Form IA-2 with a data collection agent or a value added network designated by the Department of Workers' Claims, in electronic format:

(a) As soon as practicable and not later than one (1) week from the date payments to an employee are commenced, terminated, changed, or resumed; and

(b) Every sixty (60) days during temporary total disability.

(3)(a) Beginning July 1, 1999, for medical bills paid on or after that date, each carrier shall file a medical report containing the information extracted from the standardized uniform health claim forms.

(b) This information shall be filed with a data collection agent or a value added network designated by the Department of Workers' Claims, in electronic format not later than three (3) weeks following payment of the bill.

Section 3. Data Collection Agents. (1) If a carrier is unable to transmit the information required under this administrative regulation to a value added network utilized by the Department of Workers' Claims using its own facilities and resources, it shall employ a data collection agent capable of transmitting the information to a value added network utilized by the Department of Workers' Claims.

(2) The Department of Workers' Claims shall maintain a directory of authorized data collection agents.

Section 4. Acknowledgements. An acknowledgement of an accepted filing made pursuant to this administrative regulation, or a request by the Department of Workers' Claims for resubmission of a report due to incomplete or incorrect information, shall be made in electronic format through the same data collection agent or value added network used for the filing.

Section 5. Incorporation by Reference. (1) The following forms are incorporated by reference:

(a) Form IA-1 (October 10, 1995 edition); and

(b) Form IA-2 (October 10, 1995 edition).

(2) This material may be inspected, copied, or obtained at the Department of Workers' Claims, Prevention Park, 657 To Be Announced Avenue, Frankfort, Kentucky 40601, Monday through Friday, 9 a.m. to 4 p.m. (22 Ky.R. 658; Am. 926; 1084; eff. 12-7-95; 25 Ky.R. 1180; 1883; eff. 2-18-99.)