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Missouri Workers' Compensation Legal Library


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287.335. Determinations review board, created, purpose - code classifications, classification system, review of, duties. -

1. There is hereby established the "Workers' Compensation Determinations Review Board" within the department of insurance, financial institutions and professional registration which shall exist to review determinations by an insurer or advisory organization regarding uniform code classifications, basic manual rule interpretations, uniform experience rating plan rule interpretations, calculations of an individual employer's modification factor, Missouri assigned risk plan underwriting rule interpretations, and any other related uniform rule interpretations not addressed by department rule or regulation. The board shall consist of five persons who shall be voting members appointed by the governor, with the advice and consent of the senate, who shall serve at the pleasure of the governor. Three members shall be representative of the interests of employers with at least one being representative of employers whose employees are represented by a labor union and at least one being representative of employers whose employees are not represented by a labor union. One member shall be a representative of the interests of insurers, and one member shall be a representative of the interests of independent insurance agents. One member representing employers shall act as chairman of the board elected by the board. Not more than three members of the board shall belong to the same political party. Each member shall serve for a term of three years, except that of the members first appointed, two shall be appointed for a term of one year, two for a term of two years, and one for a term of three years. Vacancies on the board shall be filled for the unexpired term in the same manner as original appointments are made. The state actuary and a representative of a rating organization licensed by the state shall be nonvoting members of the board, and their duties shall include advising the board on matters relating to code classifications, including the creation of new code classifications. The board members shall not receive any compensation, except that such members shall be reimbursed for actual and necessary expenses incurred in the performance of their duties. In addition, the board may employ staff to perform the administrative duties of the board. The department of insurance, financial institutions and professional registration may charge a fee against the classification agent as the director deems appropriate.

2. Upon application of any employer, the board shall review the code classification made on that employer. If the board determines that the classification was erroneous, it may change the classification by placing the employer under a different code classification already established or by creating a new classification code, if the board determines that there is sufficient experience to merit a new classification code. The establishment of the rate for a new classification code shall be filed with the director of the department of insurance, financial institutions and professional registration by either the affected employer or employers or by any recognized rating organization within ninety days of the establishment of the new classification code by the board. The director of the department of insurance, financial institutions and professional registration shall review the filed rate according to section 287.955. Upon application of any employer, the board shall review the calculation of an employer's experience modification factor and may order a recalculation in the experience modification factor if calculated erroneously under the formula as approved by the director of the department of insurance, financial institutions and professional registration, including an adjustment for any recovery from a third party pursuant to the employer's right of subrogation. An appeal from the determination of an appropriate classification by the board may be made to the director of the department of insurance, financial institutions and professional registration. The board may review code classifications of individual self-insured employers and self-insured employers in a group insurance arrangement.

3. The board may also recommend changes to the uniform classification system.

4. The advisory organization that makes a uniform classification system for use in setting rates in this state shall provide to the affected party or his designated agent, at a reasonable charge, information used or considered in determining the development purpose, scope and intended application of any classification comprising such uniform classification system.

(L. 1992 H.B. 975, A.L. 1993 S.B. 251)

Effective 1-01-94




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