Effective - 28 Aug 2003
287.310. Policies to be approved by department — deductible plans authorized, requirements. — 1. Every policy of insurance against liability under this chapter shall be in accordance with the provisions of this chapter and shall be in a form approved by the director of the department of commerce and insurance. Such policy shall contain an agreement that the insurer accepts all of the provisions of this chapter, that the same may be enforced by any person entitled to any rights under this chapter as well as by the employer, that the insurer shall be a party to all agreements or proceedings under this chapter, and his appearance may be entered therein and jurisdiction over his person may be obtained as in this chapter provided, and such covenants shall be enforceable notwithstanding any default of the employer.
2. Any insurer issuing a workers' compensation policy may offer, as a part of the policy or as an optional endorsement to the policy, a deductible plan or plans to allow the insured employer to self-insure for the deductible amount, subject to the approval of the director of the department of commerce and insurance. No deductible plan shall be approved which permits, directly or indirectly, any part of the deductible to be charged to or passed on to an employee of the insured employer.
3. Any deductible plan authorized under this section may provide for the agreement between the insurer and the insured employer regarding the conditions under which the employer shall be responsible for the payment of any deductible amount to the person or health care provider entitled to such payment pursuant to this chapter, except that no deductible plan shall be approved unless the insurer shall retain the ultimate responsibility for the payment of compensable claims. Where the agreement provides for the payment of the deductible amount by the insurer, the insurer shall pay all the deductible amount applicable to a compensable claim directly to the person or health care provider entitled to the benefit pursuant to this chapter, and shall then be reimbursed by the insured employer for such payments. The insured employer shall be liable to the insurer up to the limit of the deductible, and any failure on the part of the insured employer to provide such reimbursements shall be treated under the workers' compensation policy in the same manner as a nonpayment of premium. An employer's failure to reimburse deductible amounts to the insurer shall not cause the unpaid amount to be paid from the second injury fund under section 287.220. The insurer shall have the right to offset unpaid deductible amounts against unearned premiums, if any, in the event of a cancellation of the policy.
4. Deductible plans shall provide appropriate premium reductions, as approved by the director of the department of commerce and insurance, to reflect the type and level of the deductible amount selected. Losses paid by the employer under the deductible shall be credited against the employer's experience modification while the deductible option is used, unless the employer exercises the right to purchase a gross reportable deductible plan.
5. An insurer shall not be required to offer a deductible if, as a result of a credit investigation, the insurer determines that the employer does not have the financial ability to be responsible for the payment of deductible amounts.
6. An insurer shall service and, if necessary, defend all claims that arise during the policy period, including those claims payable in whole or in part from the deductible amount.
7. No employer who self-insures for a deductible amount as provided in this section shall harass, discharge, or otherwise discriminate against any employee because the employee has taken any action or is considering taking action which might result in the insured employer being required to pay a deductible amount.
8. Any rating organization or advisory organization authorized by the provisions of section 287.330 may file on behalf of its members deductible plans for approval by the director of the department of commerce and insurance.
9. In calculating the administrative surcharge owed pursuant to the provisions of this chapter for workers' compensation policies with deductible options, the administrative surcharge owed will be based upon the total premiums, which would have been paid for the deductible credit portion of the policy. The second injury fund surcharge owed by the employer who purchases a deductible policy will be assessed upon the total premiums which would have been paid in the absence of the deductible option. The premium taxes owed pursuant to this chapter for workers' compensation policies with deductible options shall be assessed upon those total premiums paid upon the insurance policy excluding the deductible credit portion of the policy. The portion of the workers' compensation policy with a deductible option that is subject to an administrative surcharge shall not be subject to premium taxes, nor with respect to foreign insurance companies, the retaliatory tax imposed pursuant to section 375.916.
10. The director of the department of commerce and insurance shall, by rule, specify any data reporting requirements applicable to workers' compensation policies with deductible options.
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(RSMo 1939 § 3716, A.L. 1992 H.B. 975, A.L. 2003 S.B. 385)
Prior revision: 1929 § 3326
Structure Missouri Revised Statutes
Title XVIII - Labor and Industrial Relations
Chapter 287 - Workers' Compensation Law
Section 287.010 - Citation of law.
Section 287.020 - Definitions — intent to abrogate earlier case law.
Section 287.030 - Employer defined.
Section 287.040 - Liability of employer — contractors, subcontractors.
Section 287.041 - For-hire motor carrier not an employer of a lessor — definition.
Section 287.043 - Abrogation of case law regarding definition of owner.
Section 287.060 - Employers and employees affected by this act.
Section 287.100 - Legislative intent relative to other laws expressed.
Section 287.110 - Scope of chapter as to injuries and diseases covered.
Section 287.130 - Employer's liability joint and several — contribution allowable.
Section 287.143 - Vocational rehabilitation services, not mandatory — testing and assessment.
Section 287.144 - Definitions.
Section 287.145 - Rehabilitation practitioners, providers, certification of, how.
Section 287.149 - Benefits to be paid, when — reduction of benefits, when.
Section 287.180 - Temporary partial disability, amount to be paid — method of payment.
Section 287.195 - Claims for hernia, proof required.
Section 287.241 - Death benefits, inconsistent with section 287.240, when.
Section 287.253 - Monetary bonus, effect on benefits.
Section 287.260 - Compensation to have priority — not assignable — exceptions.
Section 287.282 - Employee leasing arrangements, coverage required.
Section 287.290 - Employee not to pay cost of insurance.
Section 287.300 - Employer's liability primary or secondary — notice and service, when sufficient.
Section 287.310 - Policies to be approved by department — deductible plans authorized, requirements.
Section 287.340 - Insurance companies must keep reserve.
Section 287.350 - Insurance companies to make report.
Section 287.360 - Director may suspend or revoke permits and ask for a receiver.
Section 287.370 - Compensation in lieu of insurance, how provided.
Section 287.400 - Accident — duty of division — employer.
Section 287.410 - Powers and functions of the division of workers' compensation.
Section 287.420 - Written notice of injury to be given to employer — exceptions.
Section 287.430 - Limitation as to action, exception.
Section 287.440 - Limitation begins to run, when.
Section 287.450 - Failure to agree on compensation — division to hold hearings.
Section 287.470 - Commission may review and change award.
Section 287.480 - Application for review, time limit — when deemed filed — bond required, when.
Section 287.500 - Circuit court may act upon memorandum — procedure.
Section 287.510 - Temporary or partial awards may be made.
Section 287.520 - Notice — manner of serving.
Section 287.530 - Commission or division may commute compensation, when and how.
Section 287.540 - Compensation commuted — funds, how paid out.
Section 287.550 - Proceedings before commission to be informal and summary.
Section 287.570 - Contempt — penalty.
Section 287.580 - Death, pending proceedings — action shall not abate.
Section 287.590 - Division may be sued — official seal.
Section 287.600 - Oath of office.
Section 287.615 - Employees of division — compensation — selection.
Section 287.620 - Attorney general legal adviser.
Section 287.630 - Forms, other material furnished by commission and division.
Section 287.642 - Public information programs, division to establish.
Section 287.650 - Division to make rules and regulations — power to destroy reports, when — rules.
Section 287.655 - Dismissal of claims, when, how, effect.
Section 287.670 - No fees for services of public officers.
Section 287.680 - Annual report to governor.
Section 287.700 - Returns delinquent — duty of director.
Section 287.710 - Tax returns — payments — use of proceeds — funds and interest not to lapse.
Section 287.713 - Director, report of expenditures.
Section 287.717 - Surcharge collection, procedure — failure to pay, interest assessed, when.
Section 287.730 - Employer carrying own risk must pay tax.
Section 287.740 - Compliance with provisions obligatory — penalty for violation.
Section 287.745 - Delinquent taxes, interest, rate — overpayment of taxes, credit.
Section 287.750 - Sufficiency of notice.
Section 287.760 - Insurance carriers exempt from other tax, when.
Section 287.790 - Penalty not specifically provided — misdemeanor.
Section 287.800 - Law to be strictly construed.
Section 287.801 - Review of claims, by whom.
Section 287.804 - Waiver of compensation by employee, procedure.
Section 287.808 - Burden of proof.
Section 287.810 - Change of administrative law judge, procedure, limitations.
Section 287.811 - Discovery in workers' compensation cases, sections not to effect.
Section 287.812 - Definitions.
Section 287.815 - Retirement, age and service qualifications.
Section 287.825 - Death of member before or after retirement — benefits of beneficiaries.
Section 287.830 - Retirement with less than twelve years service — benefits.
Section 287.840 - Practice of law after retirement — restrictions.
Section 287.845 - Administration of retirement system and funds.
Section 287.850 - Life insurance benefits.
Section 287.855 - Disability benefits.
Section 287.867 - Insolvency fund, created — purposes, audit of.
Section 287.872 - Powers and duties of division.
Section 287.877 - Insolvent member, board may determine, how — notice to division, when.
Section 287.880 - Liability, limitation of.
Section 287.882 - Automatic stay of proceedings, when, duration.
Section 287.885 - Limitations on actions.
Section 287.886 - Severability clause.
Section 287.892 - Workers' compensation insurers to report cost data to department.
Section 287.900 - Citation of law — definitions.
Section 287.902 - Missouri employers mutual insurance company, created, powers, purpose.
Section 287.905 - Board, created — members, appointment, qualifications, terms — chairman.
Section 287.910 - Rates, board to determine, how.
Section 287.912 - Investment policy, board to determine — administrator to make investments, how.
Section 287.915 - Agents may sell policies, commissions.
Section 287.930 - Definitions.
Section 287.932 - Act not applicable, when — unfair trade practices, when.
Section 287.945 - Director to monitor degree of competition, purpose.
Section 287.952 - Rate standards in noncompetitive market, factors.
Section 287.957 - Experience rating plan, contents.
Section 287.960 - Disapproval of rate, when, how — procedures, director's powers — effect.
Section 287.970 - Advisory organization not to file rates on behalf of insurer, exception.