LD 2076
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LD 2076 Title Page An Act to Move the Monitoring, Auditing and Enforcement of Workers' Compensatio... Page 2 of 6
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LR 1444
Item 1

 
Be it enacted by the People of the State of Maine as follows:

 
Sec. 1. 24-A MRSA §2164-D, sub-§9, as enacted by PL 1997, c. 634, Pt.
A, §1, is amended to read:

 
9. Applicability. This section does not apply to claims
involving workers' compensation, medical malpractice, fidelity,
suretyship or boiler and machinery insurance.

 
Sec. 2. 24-A MRSA c. 26-A is enacted to read:

 
CHAPTER 26-A

 
WORKERS' COMPENSATION

 
MONITORING, AUDITING AND ENFORCEMENT

 
§2398.__Development of audit, enforcement and monitoring program

 
The superintendent shall establish an audit, enforcement and
monitoring program to ensure that all obligations under Title 39-
A are met.__The functions of the audit and enforcement program
include, but are not limited to, auditing timeliness of payments
and claims handling practices of insurers, self-insurers and 3rd-
party administrators; determining whether insurers, self-insurers
and 3rd-party administrators are unreasonably contesting claims;
and ensuring that all reporting requirements are met.

 
§2398-A.__Auditing of claims

 
1.__Audits.__The superintendent shall audit claims records,
including files held by insurers, self-insurers and 3rd-party
administrators, on an ongoing basis to determine whether
insurers, self-insured employers and 3rd-party administrators
have met their obligations under Title 39-A and to identify
disputes that arose, the reasons for disputes, the method and
manner of their resolution, the costs incurred, the reasons for
attorney involvement and the services rendered by the attorneys.

 
2.__Notice of assessment.__If, any as a result of an
examination and after providing an opportunity for a hearing, the
superintendent determines that any compensation, interest,
penalty or other obligation is due and unpaid to an employee,
dependent or service provider, the superintendent shall issue a
notice of assessment detailing the amounts due and unpaid in each
case and shall order the amounts paid to the unpaid party or
parties.

 
3.__Penalty.__In addition to any other penalty permitted under
law, the superintendent may assess civil penalties not to exceed
$10,000 upon finding, after hearing, that an employer, insurer or
3rd-party administrator for an employer has engaged in


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