Auditing Procedures For Applicants For Individual Self Insurance {WC-130} | Pdf Fpdf Doc Docx | Missouri

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Auditing Procedures For Applicants For Individual Self Insurance {WC-130} | Pdf Fpdf Doc Docx | Missouri

Auditing Procedures For Applicants For Individual Self Insurance {WC-130}

This is a Missouri form that can be used for Workers Comp.

Alternate TextLast updated: 7/11/2012

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MISSOURI DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS WORKERS' SAFETY PROGRAM AUDITING PROCEDURES FOR APPLICANTS FOR INDIVIDUAL SELF-INSURANCE The following represents a general outline of the procedures to be followed in auditing the safety programs of employers who are applying for authority to be individually self-insured. 1. Within one working day of the receipt of a new application for individual self-insurance, the Self-Insurance Unit will send a memorandum to the Workers' Safety Program requesting a new applicant review. The memorandum will include the company's name, telephone number, and Missouri location address(es). 2. A meeting with company administrators will be held within two weeks of receipt of an application by the Self-Insurance Unit. This meeting will be set up by a Workers' Safety field safety consultant and be held on-site at the company's Missouri location(s). Steps three through ten (below) will be performed during this on-site meeting. 3. Review of all written safety and health programs. 4. Review of credentials of loss control or safety personnel. 5. Review the structure of, and resources available to, the loss control or safety department. 6. Review of the loss history of the company, including loss runs, current experience modification factor, and occupational injury and illness incidence rates for the past three years. 7. Review of the company's safety committee functions and minutes from meetings. 8. Review of the company's safety incentive program if applicable. 9. A physical audit of the company's Missouri facilities. 10. Review of the company's established procedures for claims management, including return to work program guidelines. 11. A written report, prepared by the Workers' Safety Program field safety consultant, will be submitted to the Self-Insurance Unit within three weeks of the receipt of the application for individual self-insurance. The report may include the following types of recommendations regarding hazards, procedures, or written programs: Level I = requires an abatement plan to be submitted to Self-Insurance Unit Level II = no formal action required WC-130 (09-11) AI American LegalNet, Inc. www.FormsWorkFlow.com

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