Report Title:

Employers' Mutual Insurance Company; Workers' Compensation

Description:

Requires the Hawaii employers' mutual insurance company to provide a workers' compensation insurance plan that utilizes a coordinated system of care model to provide medical and rehabilitation services to injured employees.

HOUSE OF REPRESENTATIVES

H.B. NO.

2695

TWENTY-THIRD LEGISLATURE, 2006

 

STATE OF HAWAII

 


 

A BILL FOR AN ACT

 

relating to the hawaii employers' mutual insurance company.

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

SECTION 1. Section 431:14A-107, Hawaii Revised Statutes, is amended by to read as follows:

"§431:14A-107 Duties and responsibilities. (a) All corporate powers shall be exercised by or under the authority of the board, unless otherwise provided in this chapter or in the articles of incorporation.

(b) The board shall discharge its duties:

(1) In accordance with the company's purpose;

(2) With the care, skill, prudence, and diligence under the circumstances that a prudent director, acting in a like capacity and familiar with such matters would use in conducting a similar enterprise and purpose;

(3) By diversifying the company's investments to minimize the risk of losses, unless it is prudent not to do so;

(4) In accordance with governing legal documents;

(5) By having an annual audit of the company by an independent certified public accountant;

(6) By securing a fidelity bond for the administrator and in its discretion for other agents dealing with the company's assets at the company's expense;

(7) By purchasing liability insurance for errors and omissions for the board, each director, and any other fiduciary employed or contracted by the company to cover liability or losses caused by the act or omission of a fiduciary;

(8) By maintaining proper books of accounts and records of the company's administration;

(9) By carrying out the reporting and disclosure requirements required by law;

(10) By appointing a qualified actuary to develop and recommend a responsible schedule of premium rates with consideration of the company's investment income or refunds, or both, and to provide actuarial certification of the company's loss reserves; [and]

(11) By cooperating with and assisting the council in its duties and responsibilities[.]; and

(12) By establishing a workers' compensation insurance plan that utilizes a coordinated system of care to provide medical and rehabilitation services to injured employees subject to a valid collective bargaining agreement negotiated and executed pursuant to section 386-3.5.

(c) For the purposes of subsection (b)(12), "coordinated system of care" means a system of care that provides coverage for the medical and rehabilitative benefits of a workers' compensation insurance policy that:

(1) Minimizes workplace injuries and promotes workplace health and safety, through a cooperative effort among the employer, the employer's workers' compensation insurer, the employee, and company;

(2) Provides efficient, cost effective, and timely treatment through a coordinated and comprehensive system of quality health care, including the use of case management;

(3) Provides a high level of quality of care;

(4) Provides an understandable, accessible, and user friendly system of care, including open and direct communication and cooperation among the employer, the company, the employee, and the provider of the coordinated system of care;

(5) Provides a range of treatment, including but not limited to office, clinic, laboratory, hospital, rehabilitative, emergency, and other essential care;

(6) Makes available a variety of specialties as may be necessary and several providers within each specialty to afford comprehensive care and a choice of provider to the employee;

(7) Provides a prompt and appropriate return to work program to assist an injured employee to return to work safely without unnecessary medical delay, and provide the employer and the company with timely medical information, including work return status, recommended work restrictions, projected date of return to work, and degree of maximum medical improvement;

(8) Provides a vocational rehabilitation program under section 386-25; and

(9) Provides a program of internal dispute resolution processes such as mediation to reduce the adversarial nature of workers' compensation; provided that the administrative and appeals process under chapter 386 shall be available to the injured employee at all times.

[(c)] (d) Except as otherwise provided by law, the board may:

(1) Transact workers' compensation insurance policies required or authorized by state law to the same extent as any other insurer;

(2) Provide the terms and conditions of an insurance policy;

(3) Provide that any written instrument be executed for the company by the administrator or the administrator's agent;

(4) Enter into agreements to reinsure all or part of the company's exposure to loss and to limit the risk to the company; and

(5) Employ persons to administer the company, including legal counsel, accountants, insurance consultants, administrators, qualified actuaries, investment managers, adjustors, other experts, and clerical employees and pay compensation and expenses in connection therewith."

SECTION 2. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 3. This Act shall take effect upon its approval.

INTRODUCED BY:

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