The department must examine a group self-insurance fund regularly, may use examiners and subpoenas, and the fund must provide records and pay examination expenses.
§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. Acts 2023, No. 259, §§1, 3A, eff. June 12, 2023.