Current through Register Vol. 49, No. 9, September, 2024
SECTION 1. AUTHORITY
This Rule and Regulation is adopted and promulgated by the
Insurance Commissioner for the State of Arkansas ("Commissioner") pursuant to
the authority vested in the Commissioner by Act 561 of 1991, codified as
Arkansas Code Annotated §§
23-67-201, et
seq., and by Arkansas Code Annotated §§
23-61-108,
23-67-119,
23-79-109
and
25-15-201, et
seq.
SECTION 2. PURPOSE
The purpose of this Rule and Regulation is to establish a
mandatory workers' compensation insurance plan to assure coverage for employers
who are in good faith entitled, but unable to procure, workers' compensation
insurance in the State of Arkansas and to provide for the operation and
regulation of the workers' compensation insurance plan.
SECTION 3. EFFECTIVE DATE
This Rule and Regulation shall be effective February 1, 1992 for
new policies issued through the Arkansas Workers' Compensation Insurance Plan,
and for renewal policies issued through the Arkansas Workers' Compensation *
Insurance Plan with an effective date of February 1, 1992 and subsequent
thereto.
SECTION 4.
DEFINITIONS
A. "Commissioner" shall mean the
Insurance Commissioner for the State of Arkansas.
B. "Plan" shall mean the Arkansas Workers'
Compensation Insurance Plan.
C.
"Council" shall mean the National Council on Compensation Insurance.
D. "Agent" shall mean a person properly
licensed to sell workers' compensation insurance in the State of
Arkansas.
E. "Employer" shall mean
an entity which is applying for or has obtained a policy issued through the
Plan.
F. "Carrier" shall mean an
insurer authorized to write workers' compensation insurance in the State of
Arkansas, and who has qualified to transact workers' compensation insurance
pursuant to Arkansas Code Annotated §ll-9-302(a).
G. "Servicing Carrier" shall mean one of the
carriers approved by the Commissioner to which administration of a policy
issued through the Plan may be assigned by the Council.
H. "Assigned Carrier" shall mean the
servicing carrier which the Council has determined shall provide coverage to an
employer applying for an assignment.
I. "Voluntary Offer of Coverage" shall mean
an offer from a carrier to an employer to provide any and all commercial
insurance coverage requested by the employer, including workers' compensation
insurance coverage, in the voluntary market utilizing any rating plan approved
for use in the State of Arkansas by the Commissioner for that
carrier.
SECTION 5.
ADMINISTRATION OF PLAN
A. The Commissioner
hereby designates the National Council on Compensation Insurance ("Council") to
administer and operate the Plan. The Council shall file with the Commissioner
for approval operating rules, procedures and guidelines consistent with the
provisions of this Rule and Regulation for the administration and operation of
the Plan. 1) The operating rules, procedures and guidelines for the
administration and operation of the Plan may include provision for one or more
carriers to be designated servicing carriers to issue and service workers'
compensation policies written through the Plan.
B. The Council shall also file with the
Commissioner for approval all policy forms, endorsements, rules, rates or
supplementary rate information necessary to effectuate the Plan.
C. The Council shall publish and make
available to all carriers and agents the operating rules, procedures and
guidelines for the administration and operation of the Plan.
D. The Council shall monitor servicing
carrier compliance with the requirements of Section 12 of this Rule and
Regulation. The Council shall file with the Commissioner on or before January
31, 1993, and on or before January 31 of each year thereafter, the self-audit
reports prepared by each servicing carrier regarding such compliance for the
preceding calendar year.
The Council shall perform physical audits of servicing carriers
to monitor their compliance with the requirements of Section 12 of this Rule
and Regulation as directed by the Commissioner, but not less frequently than
every three years. The Council shall file with the Commissioner physical audit
reports within thirty (30) days of the Council's completion of the
report.
SECTION
6. PARTICIPATION IN PLAN
All carriers shall participate in the equitable apportionment
among them of risks eligible for the Plan. Participation in the Plan expenses,
profits and losses shall be in the proportion that the carrier's net direct
voluntary market workers' compensation insurance premiums written in the State
of Arkansas during the preceding calendar year bears to the aggregate net
direct voluntary market workers' compensation insurance premiums of all
carriers written in the State of Arkansas during the preceding calendar
year.
SECTION 7.
ELIGIBILITY FOR PLAN
A. Any employer required
to secure the payment of workers1 compensation
pursuant to Arkansas Code Annotated §
11-9-404(a)
CD shall be entitled to workers' compensation insurance through the Plan,
provided;
1) Within sixty (60) days preceding
the date of application, the employer must have applied for workers'
compensation insurance and been rejected by at least two (2) carriers,
specifically including, where applicable, the carrier providing coverage to the
employer at the time of application;
2) Within sixty (60) days
preceding the date of application, the employer must not have rejected a
voluntary offer of coverage from a carrier; and
3) The employer complies with the
requirements of Section 8 and Section 10 of this Rule and Regulation in
applying for workers' compensation insurance through the Plan.
B. Any employer eligible to obtain
workers' compensation insurance through the Plan, as provided in Subsection (A)
of this Section must also in good faith be entitled to such insurance. Good
faith is presumed in the absence of clear and convincing evidence to the
contrary. An employer is not in good faith entitled to insurance through the
Plan if, at the time of application or thereafter, any of the following
circumstances exist:
1) If, at the time of
application, a self-insured employer is aware of pending bankruptcy
proceedings, insolvency, cessation of operations, or conditions that would
probably result in occupational disease or cumulative injury claims from
exposures incurred while the employer was self-insured;
2) The employer has failed or refused to
comply with all effective laws, orders, rules or regulations made by public
authorities relating to the welfare, health and safety of employees;
3) The employer or an enterprise with a
common managing interest has an outstanding premium obligation for previous
workers' compensation insurance; or
4) The employer, its representative and/or
agent knowingly makes a material misrepresentation on the application for
insurance by omission or otherwise.
SECTION 8. PROCEDURE FOR APPLICATION
A. The employer, its representative and/or
agent shall file a completed application in duplicate with the Council on a
form prescribed by the Council. The application must be substantially
completed, based upon information reasonably available to the employer and the
agent, prior to its submission to the Council.
B. The employer shall include as part of the
application a copy of its latest filed Federal Employer Form 940, 941, 941E,
942 or 943, or one of the following: an equivalent Federal- or State-required
verifiable current payroll record, such as an unemployment wage report; payroll
information included in a certified profit and loss statement; or an employer
generated profit and loss statement with a notarized explanation why the
employer is unable to provide a verifiable payroll record. If the employer is a
new business without prior payroll, the employer shall provide a notarized
statement explaining the lack of verifiable payroll records.
C. The employer, its representative and/or
agent shall forward with the application and payroll verification an agency
check, a certified check or a cashier's check payable to the National Council
on Compensation Insurance -Southern Division for the estimated annual or
deposit premium, as determined after contacting the Council prior to submission
of the application for a quotation for the estimated annual premium. The amount
of deposit premium payable shall be as provided in Section 10 (BJ.
SECTION 9. BINDING COVERAGE,
ASSIGNMENTS AND POLICY ISSUE
A. The Council
will not bind coverage if the application is not substantially complete; if
payroll verification is not included; or if a check for the estimated annual or
deposit premium is not included with the application Upon determination that an
application is deficient, the Council shall immediately advise the party
submitting the application by telephone that the application is deficient, and
shall further advise the party submitting the application as to what action is
necessary to cure the deficiency. If such deficiency has not been cured within
seventy-two (72) hours, the Council shall return all materials including the
check to the submitting party with an explanation of the rejection. Coverage
shall not be considered bound on deficient or rejected applications.
B. Coverage may he bound under the Plan, for
applications submitted as provided in Section 8, in accordance with the
following procedures:
1) For all risks, other
than those formerly self-ins-ured, coverage will be bound either at 12:01 a.m.
on the first day following the United States Postal Service postmark time and
date on the envelope in which the application materials are mailed, or at the
expiration of existing coverage, whichever is later.
(a) If there should be no United States
Postal Service postmark, coverage will be effective at 12:01 a.m. of the date
of receipt by the Council, unless a later date is requested.
(b) Application materials hand delivered to
the Council will be effective at 12:01 a.m. on the date following receipt by
the Council, unless a later date is requested.
2) For risks formerly self-insured, coverage
will be bound either at 12:01 a.m. not later than sixty (60) days following the
United States Postal Service postmark time and date on the envelope in which
the application materials are mailed, or at the expiration of existing
coverage, whichever is later.
(a) If there
should be no United States Postal Service postmark, coverage will be effective
at 12:01 a.m. not later than sixty (60) days following the date of receipt by
the Council, unless a later date is requested.
C. If coverage is bound pursuant to
Subsection (B) of this Section, the Council shall immediately issue a
thirty-day (30) binder in the name of the assigned carrier with copies to the
employer, agent and assigned carrier.
D. All assignments under the Plan are to be
made on an intra-state basis. Distribution of assignments among the servicing
carriers shall be made in proportion to each servicing carrier's share of the
total net direct voluntary market workers' compensation and employers'
liability premium written in the State of Arkansas during the preceding
calendar year, so far as is practicable.
E. Prior to the expiration of the binder
issued under Subsection (C), the assigned carrier shall issue and deliver a
policy of insurance to the employer and forward a copy of the policy to the
agent. The policy shall be issued for a term of at least one year, unless a
shorter term has been requested. A copy of the policy declarations and all
endorsements must be filed with the Council and forwarded to the agent. The
assigned carrier shall stamp "ARK ffCIP" on all policies, policy declarations
and endorsements.
F. Any carrier
who wishes to insure an employer as direct business in the voluntary market may
do so at any time. If such carrier is not the assigned carrier, the assigned
carrier shall cancel its coverage pro rata, and the assignment shall
automatically terminate as of the effective date of the new carrier's insurance
policy.
G. Any employer desiring
workers' compensation insurance for operations in states other than those
covered by his assigned carrier may request that the Council make available
such insurance in such additional states. Plan policies affording coverage on
operations in more than one state must clearly indicate the premium developed
for each state separately.
SECTION
10. PLAN RATES
A. All insurance
under the Plan shall be written in accordance with the classifications, rates
and rating plans established by the Council and approved by the Commissioner,
except as provided herein. In order to depopulate the Plan, to reduce the
residual market burden of carriers and to stimulate activity in the voluntary
market, the following rates and rating plans shall be utilized in writing
insurance through the Plan:
1) A rate
differential over the voluntary market rate, based on Plan losses or deficit,
shall be included for all policies issued through the Plan.
2) Premium discounts or credits shall not be
available for policies issued through the Plan.
3) Such other rates and rating plans
consistent with the objectives set out herein which are filed by the Council
and approved by the Commissioner for use in the Plan.
B. In order to depopulate the Plan and reduce
the amount of uncollected premium, the minimum deposit premium required to be
submitted with an application for coverage through the Plan is as follows:
|
Estimated Annual Premium
|
Payment Basis
|
Minimum Deposit Premium
|
Additional Payments During
Year
|
|
Less than $5,000
|
Annual
|
100% of Annual
|
None
|
|
$5,000 to $9,999
|
Semi-annual
|
75% of Annual
|
One
|
|
$10,000 to $49,999
|
Quarterly
|
50% of Annual
|
Three
|
|
Greater than $50,000
|
Monthly
|
25% of Annual
|
Six
|
All additional payments shall be equal payments, the sum of
which, when added to the deposit premium, shall equal one hundred percent
(100%) of the estimated annual premium. All payments are subject to adjustment
at final audit. Nothing herein shall be construed to prohibit an employer from
paying a deposit premium greater than the minimum set out above at
application.
SECTION
11. CANCELLATION AND RENEWAL
A.
An assigned carrier shall have the right to cancel any binder issued by the
Council, or any policy it has issued under the Plan:
1) Where the employer is not eligible for the
Plan as provided in Section 7 of this Rule and Regulation;
2) Where the employer has not paid premiums
due the assigned carrier for coverage under the Plan;
3) Where the employer refuses to implement
reasonable health, safety or loss control recommendations of the assigned
carrier;
4) Where the employer
refuses to allow the assigned carrier reasonable access to its facilities for
audit or inspection; or
5) Where
the employer refuses to disclose to the assigned carrier the full nature and
scope of the assigned carrier's exposure.
The assigned carrier shall proceed according to Ark. Code Ann.
§
11-9-408(b)
in cancelling any binder or policy issued under the Plan.
B. At least forty-five (45) days
prior to the expiration date of a policy issued under the Plan, the assigned
carrier shall notify the employer and the agent, in writing and forwarding the
Council a copy, of the impending expiration and instruct the employer to
request the assigned carrier to renew, provided the employer continues to be
eligible for coverage under the Plan. The assigned carrier must forward to the
employer, with a copy to the agent, the renewal proposal with a copy of such
proposal to the Council. Within thirty (30) days after receipt of the estimated
annual or minimum deposit premium, the assigned carrier shall issue a policy
properly stamped "ARK WCIP" to the employer and furnish a copy of the renewal
information page to the Council and to the agent. The renewal policy shall be
effective upon expiration of the current policy, or as provided in Section 9
(B) (1), whichever is later.
C. An
assigned carrier unwilling to renew a policy assigned to it shall notify in
writing the employer, the agent and the Council at least forty-five (45) days
prior to the expiration date of the policy. The assigned carrier shall state
the reason(s) that it is unwilling to renew the policy.
D. An employer dissatisfied with its assigned
carrier may request reassignment by forwarding to the Council application
materials specified in Section 8 of this Rule and Regulation along with
reason(s) the employer requests reassignment at least forty-five (45) days
prior to the expiration date of the policy.
SECTION 12. SERVICING CARRIER STANDARDS
In addition to the standards specified in this Rule and
Regulation and such other standards developed by the Council, servicing
carriers shall meet the following minimum standards, when assigned to provide
coverage under the Plan to an employer:
A. Servicing carriers receiving assignments
shall provide a high quality of service to the employer, at a level equal to
that provided to similar risks in the voluntary market. Any services necessary
because of regulatory or statutory requirements shall be required to be
provided and are hereby incorporated into these standards. Servicing carriers
shall deal with agents at the same level of efficiency and with the same degree
of courtesy as they do with agents with whom they have a direct contractual
relationship. Servicing carriers shall provide agents with copies of all
written communications and documents forwarded to employers.
B. Servicing carriers shall issue
endorsements requested by the employer within thirty (30) days after receipt of
the request.
1) when a servicing carrier
determines that additional premium or other endorsement is necessary, it must
issue such endorsement within sixty (60) days of making the determination.
Premium endorsements issued after the expiration date of the policy shall be
issued in accordance with Subsection (G) of this Section.
C. Servicing carriers shall verify an
employer's payroll and classification(s) through interim audit or comparable
means where the servicing carrier has reason to question the accuracy of either
or both. Servicing carriers shall consider the effects of inflation and
employment level changes in the employer's operation and shall utilize the
latest available audit information to develop current policy premium.
D. Servicing carriers shall within five (5)
working days after receipt of a request:
1)
process an employer's request for cancellation;
2) accept or deny an employer's request for
reinstatement, and communicate its response to the employer in writing;
and
3) issue certificates of
insurance.
E. Servicing
carriers shall mail additional and return premium adjustments to employers
within ten (10) working days of their recording on servicing carrier records.
If additional premium adjustments are not received from employers within
forty-five (45) days from the date of mailing of the additional premium
adjustment, and if the amount of premium due is not in good faith disputed by
the employer, the servicing carrier may implement the cancellation procedures
set out in Section 11 of this Rule and Regulation.
F. Servicing carriers shall use diligent
efforts in pursuing collection of any past due premiums owed by employers.
Except where there is evident a potential that the past due premium amount will
be compromised or settled, or where the past due premium amount is in dispute
and being actively resolved, such efforts shall include, but not be limited to,
the following:
1) At least three (3) attempts
by the servicing carrier to collect the past due premium from the employer
through telephone contacts, billing statements, notices, etc.;
2) Referral of the past due premium to
in-house collection units or to a collection agency for further
action;
3) Commencement of legal
action against the employer; and
4)
Levy and execution of a judgment obtained as a result of legal
action.
G. Except for
policies issued subject to any retrospective rating plan approved for use in
the Plan, servicing carriers shall complete and forward, and employers shall
receive, final premium audits within one hundred and twenty (120) days of
termination of a workers' compensation policy issued through the Plan. For
purposes of this Section, "final premium" means the premium determined using
payroll or other appropriate premium basis and the rates, rules and
classifications approved for use during the policy period.
If the servicing carrier has not established, as set out above,
the final premium within 120 days of termination of the policy, or within any
extension of time as provided below, the servicing carrier is prohibited from
billing or collecting any additional premium from the employer exceeding the
latest billed premium immediately prior to the 120 day time limit. However, the
employer, upon written request to the servicing carrier, shall be entitled to a
final premium audit for the purpose of determining if the employer has been
overcharged.
If the servicing carrier is unable, due solely to the failure of
the employer to cooperate, to examine and audit the records of the employer
that relate to the calculation of the final premium, then the 120 day period
set out above shall begin when the servicing carrier is able to complete
examination and audit of the employer's records. The servicing carrier must
notify the employer in writing within the 120 day period of the reasons for its
inability to establish the final premium.
For policies subject to retrospective rating, the final premium
shall be established in accordance with conditions established within the
policy, and adjustment of the final retrospective premium shall be permitted
only if there is a clerical error.
H. Servicing carriers shall notify employers,
in writing, within ninety (90) days of receipt of the assignment, of available
loss control services and safety information, which notice shall advise
employers that utilization of such services is mandatory and shall include
instructions for obtaining the services and information. Servicing carriers
shall respond to an employer's request for loss control services and safety
information within sixty (60) days of receipt of the request. Loss control
services shall include, but not be limited to, the following:
1) Review of the employer's past accident
experience to determine causes and trends;
2) Review of the employer's potential
exposures;
3) Review of the
employer's current loss control program and loss control activities, if
any;
4) Recommendations for
employer control of actual or potential exposures and, where applicable,
program activities or management principles;
5) Description of the employer's operations
and loss potentials for classification and underwriting purposes; and
6) Review of recommendations made in prior
surveys of the employer as to implementation or completion of such
recommendations.
Servicing carriers shall make reasonable recommendations, if any,
in writing to the employer within thirty (30) days of completion of the survey.
If the employer, within ninety (90) days of receipt of such recommendations,
fails to demonstrate that it intends to, or that it has already substantially
complied with, such recommendations, the servicing carrier may implement the
cancellation procedures set out in Section 11 of this Rule and Regulation. In
lieu of implementing such cancellation procedures, the servicing carrier may
impose the Assigned Risk Adjustment Program (ARAP) surcharge on the
employer.
I. In
addition to the loss control services described in Subsection (H) of this
Section, servicing carriers shall provide the following loss control consulting
surveys:
1) A minimum of one survey annually
for employers with estimated premium greater than $25,000;
2) A minimum of one survey annually for
employers with estimated premium between $5,000 and $25,000 and with a Best's
Loss Control Rating of seven (7) or greater. "Best's Loss Control Rating" means
the most recent Workers' Compensation Hazard/Exposure Index Rating published in
Best's Loss Control Engineering Manual; and
3) For employers not meeting the criteria set
out in Subdivisions (1) and (2) of this Subsection, servicing carriers will
conduct a survey if deemed necessary by the servicing carriers' Underwriting or
Loss Control Management.
Reasonable recommendations will be made by the
servicing carrier and implemented by the employer as provided in Subsection (H)
. If the employer fails to provide the servicing carrier reasonable access to
its operations, the servicing carrier may implement the cancellation procedures
set out in Section 11 of this Rule and Regulation. In lieu of implementing such
cancellation procedures, the servicing carrier may impose the Assigned Risk
Adjustment Program (ARAP) surcharge on the employer.
J. Loss records of employers shall
be maintained by servicing carriers and shall be made available to employers,
within thirty (30) days of receipt of a written request, to allow analysis of
accident causes and identification of accident trends.
K. Servicing carriers shall assist employers
participating in the Plan to develop and establish programs for medical cost
containment, which programs shall be consistent with the provisions of the
Workers' Compensation Law, Arkansas Code Annotated §§
11-9-101, et seq.
-Such programs shall include, but not be limited to:
1) reasonable pre-certification,
pre-authorization or utilization reviews which do not unduly delay, or
interfere with or impede, the authorised practice of medicine and delivery of
reasonable medical care; '
2)
development of preferred provider organization(s) for the provision of medical
services;
3) procedures for
auditing and monitoring medical costs;
4) medical and catastrophic injury case
management systems;
5) "work
hardening", rehabilitation, "return to work" and retraining programs;
and
6) such other medical cost
containment programs which are filed by the Council and approved by the
Commissioner for use in the Plan.
SECTION 13. PENALTIES
A. Any carrier, servicing carrier or agent
who refuses or neglects to comply with the provisions of this Rule and
Regulation shall be subject to administrative action provided for in the
Arkansas Insurance Code, Arkansas Code Annotated §§
23-60-101, et
seq.
B. Any servicing carrier who
fails to comply with the requirements of Section 12 of this Rule and
Regulation, as reported to the Commissioner by the Council, may have their
designation to act as servicing carriers suspended or revoked upon notice and
hearing pursuant to Arkansas Code Annotated §§
23-61-301,
et seq.
SECTION 14.
SEVERABILITY
If any provision of this Rule and Regulation, or the application
thereof to any person or circumstance, is held invalid, such invalidity shall
not affect other provisions or applications of this Rule and Regulation which
can be given effect without the invalid provision or application, and to that
end the provisions o£ this Rule and Regulation are severable.
SECTION 1. AUTHORITY
This Rule and Regulation is adopted and promulgated by the
Insurance Commissioner for the State of Arkansas ("Commissioner") pursuant to
the authority vested in the Commissioner by Act 561 of 1991 [codified at
Arkansas Code §§
23-67-201 et
seq.]; Act 1155 of 1993 [An Act amending Arkansas Code §§
23-67-201 et
seq.]; Act 795 of 1993 An Act amending Chapter 9 of Title 11, Arkansas Code] ;
Act 1269 of 1993 [An Act supplementing Chapter 67 of Title 23, Arkansas Code];
and by Arkansas Code §§
23-61-108,
23-67-119,
23-79-109,
and
25-15-201 et
seq.
SECTION 2. EFFECTIVE
DATE: EMERGENCY
The provisions of this Rule and Regulation shall become effective
March 31, 1994.
SECTION 3.
PURPOSE
The purpose of this Rule and Regulation, as amended, is to reform
the mandatory Workers' Compensation Insurance Plan ("tfCIP" or "Plan") to
assure coverage for employers who are in good faith entitled, but unable to
procure, workers' compensation and employers' liability insurance in the
voluntary market, and. to provide for the fair, efficient, and equitable
operation and regulation of the Plan.
SECTION 4. DEFINITIONS
A. "Commissioner" shall mean the Insurance
Commissioner for the State of Arkansas.
B. "Plan" or "WCIP", shall mean the Arkansas
Workers' Compensation Insurance Plan.
C. "Plan Administrator" means such
organization or organizations to which the responsibility for administering the
affairs of the Plan may, from time to time, be delegated, including but not
limited to such functions and duties as rates, forms, and statistics.
D. "National Council on Compensation
Insurance" or "Council" means a rating organization or advisory organization of
that name which is licensed in this State to make and file rates,
classifications, and rating plans for workers' compensation insurance including
rates for the residual market.
E.
"Producer" means a person designated by and representing an employer which said
person is properly licensed to sell or place workers' compensation and
employers' liability insurance in the State of Arkansas whose privileges under
the Plan have not been suspended or revoked by the Commissioner.
F. "Affiliated Insurers" means an insurer
that directly, or indirectly through one (1) or more intermediaries, controls,
or is controlled, by, or is under common control with, the insurer specified.
The term "control" means the possession, direct or indirect, of the power to
direct or cause the direction of the management and policies of an insurer,
whether through the ownership of voting securities, by contract, or otherwise.
Control shall be deemed to exist if any person or business enterprise, directly
or indirectly, owns, controls, holds with the power to vote, or holds proxies,
representing ten (10) percent or more of the voting securities of any other
insurer.
G. "Assigned Carrier"
means the insurer that has been assigned to provide coverage to an employer
under this Plan. An assigned carrier can either be a "servicing carrier" as
hereinafter defined or a direct assignment carrier as defined below.
H. "Direct Assignment Carrier" means an
insurer, other than a servicing carrier, that has elected and been authorized
to receive direct assignments pursuant to either Option 1 or Option 2 under
Section 10 of this Plan.
I.
"Servicing Carrier" means an insurer, other than a direct assignment carrier
selected by the Commissioner pursuant to Section 12(1) to receive
assignments.
J. "Employer" means
any business organization or enterprise that is required by statute to maintain
workers compensation insurance in this State, regardless of the domicile or
principal place of business of such organization or enterprise. The term shall
include any business organizations or enterprises that are affiliated as a
result of common management or common ownership.
K. "Articles of Agreement" or "Articles"
means the reinsurance mechanism authorized under this Plan to provide
reinsurance to the servicing carriers on employers assigned to them under this
Plan, which said agreement and any amendments thereto shall be provided to the
Commissioner but which, in cases of conflict between them and this Rule and
Regulation, shall be subordinate to this Rule and Regulation.
L. "Workers' Compensation Insurance" means:
(a) Statutory workers' compensation and
occupational disease coverage as required by Arkansas Code §§
11-9-401
et. seq., 23-67-119, and
23-67-201 et
seq., including also liability under the Longshore and Harbor Workers'
Compensation Act, as amended, and the Federal Coal Mine Health and Safety Act
of 1969, as amended;
(b) Employers
liability insurance written in connection with a workers' compensation policy;
and
(c) Such other coverages as
approved by the Commissioner.
M. "Net Premiums Written" means the gross
direct premiums charged less all premiums (except dividends and savings
refunded under participating policies) returned to insureds for all Workers
Compensation and Occupational Disease Insurance, exclusive of premiums for
employers subject to this Plan, and for employers written under the National
Defense Projects Rating Plan and under excess policies.
N. "Collected Premium" means the gross direct
premium charged and physically collected and receipted for all employers
subject to this Plan.
O.
"Voluntary Offer of Coverage" means a legitimate, good faith offer of workers'
compensation insurance made by a workers' compensation insurer to an employer
on a "voluntary" basis outside this Plan, which said offer is either:
(i) of such workers' compensation insurance
on a monoline basis and on a reasonable rating plan approved for use in
Arkansas by the Commissioner for that insurer; or
(ii) of such workers' compensation insurance
in combination or coordination with other property and/or casualty coverages
and limits desired by the employer and as such insurer may also offer; provided
however, that such insurer shall apply its filed rating plan (including all
applicable discounts or credits) to such employer in a good faith,
non-discriminatory manner. "Voluntary Offer of Coverage" shall in no event be
interpreted as including or referring to an offer, entreaty or opportunity
presented for coverage under any type of self-insured workers' compensation
plan.
Neither the Plan Administrator(s) nor the assigned carrier(s)
shall have a responsibility to determine whether the putative voluntary offer
of coverage is truly "voluntary", but any agent or broker and any insurer
knowingly submitting an offer of workers compensation coverage to an employer
which does not meet the above definition of a bona fide "voluntary offer" may
be in violation of Ark. Code Ann. §§
23-66-205
et. seq. and Section 20.D. of this Rule and
Regulation.
P.
"Good faith bona fide dispute" means a dispute between an employer and an
insurer where the employer, or someone on its behalf, has provided written
notice of the dispute to the insurer. The employer must have given reasonable
notice to the insurer of the specific areas of the dispute and have requested
voluntary resolution or conciliation of the matter(s) in
dispute.
SECTION 5.
ELIGIBILITY FOR PLAN
A. Any employer required
to secure the payment of workers' compensation pursuant to "Arkansas Code
§
11-9-404(a)(1)
shall be entitled to workers' compensation insurance through the Plan,
provided:
1) Within sixty (60) days preceding
the date of application, the employer must have applied for workers'
compensation coverage and have been rejected by at least two (2) insurers,
specifically including, where applicable, the insurer providing coverage to the
employer at the time of application;
2) Within sixty (60) days preceding the date
of application, the employer must not have rejected a "voluntary offer of
coverage" from an insurer; and
3)
The employer complies with the requirements of Section 6 and Section 8 of this
Rule and Regulation in applying for workers' compensation insurance through the
Plan.
B. Any employer
eligible to obtain workers' compensation insurance through the Plan, as
provided in Subsection (A) of this Section, must also in good faith be entitled
to such insurance. Good faith will be presumed in the absence of clear and
convincing evidence to the contrary. An employer is not in good faith entitled
to insurance if any of the following circumstances exit:
1) If, at the time of application, a
self-insured employer is aware of pending bankruptcy proceedings; insolvency;
cessation or impending cessation of operations; or conditions that would
probably result in occupational disease or cumulative injury claims from
exposures incurred while the employer was self-insured.
2) If the employer has failed or refused to
comply with all effective laws, orders, rules, or regulations made by public
authorities relating to the welfare, health and safety of employees.
3) If the employer has an outstanding
obligation for workers compensation premium on previous insurance; provided,
however, that no employer shall be deemed to be in default of a premium
obligation for purposes of this paragraph if all of the sum by which he is
alleged to be in default is properly attributable to a good faith, bona fide
dispute between the insurer on-such! previous insurance and the employer over
the accuracy or legality of an audit of payroll performed by or at the request
of the insurer or of the accuracy of the Classification or Classifications
assigned to his employees. If the good faith, bona fide dispute has not been
resolved to the mutual satisfaction of the parties within sixty (60) days of
the reasonable notice to the insurer, in order for the dispute to still be
considered good faith and bona fide, the employer must have instituted the
review proceedings as provided by Ark. Code Ann. §
23-67-119(3)(B).
4) If the employer
or its representative and/or the producer knowingly makes a material
misrepresentation on the application for insurance by omission or otherwise;
provided however, that in no event if on or subsequent to the effective date of
insurance coverage there occurs a "compensable injury "within the meaning of
Arkansas Code §
11-9-102(5)
may an insurer effect a rescission of coverage to the prejudice of any such
covered employee.
SECTION
6. PROCEDURE FOR APPLICATION
A.
The employer, its representative and/or producer shall file a completed
application in duplicate with the Plan Administrator on a form prescribed by
the Plan Administrator. The application must be substantially completed, based
upon information reasonably available to the employer and the producer, prior
to its submission to the Plan Administrator.
B. The employer shall include as a part of
the application a copy of its latest filed federal employer 940, 941, 941E, 942
or 943 form or equivalent federal-or state-required verifiable current payroll
record, such as an unemployment wage report, payroll information included in a
certified profit and loss statement, or employer-generated profit and loss
statement with a notarized explanation why such employer is unable to provide a
verifiable payroll record.
C. The
employer, its representative and/or producer shall forward with the application
and payroll verification an agency check, * a certified
check, or a cashier's check payable to the Plan Administrator for the estimated
annual or deposit premium. The amount of deposit premium payable shall be as
provided on the application and in the deposit premium plan therefor approved
by the Commissioner, but nothing herein shall prohibit an insurer and an
employer, after application, to mutually agree to monthly reporting of payroll
and payment of premium.
D. In order
to promote competition amongst servicing carriers and to improve the service
thereof, the employer applying for initial coverage or renewal coverage within
the Plan may strike up to a maximum of six (6) servicing carriers from the list
of active eligible servicing carriers then maintained by the Commissioner and
the Plan Administrator; provided, however, that in no event shall an employer
be entitled to strike more than one-half of the active eligible servicing
carriers; and provided further, that in no event shall an employer or a
Producer acting on his behalf strike any servicing carrier from the current
list unless the employer and/or his Producer representative has a good faith
belief that such carrier does not provide adequate servicing of Plan business.
The Commissioner has the authority to investigate the exercise of the "striking
right" herein provided, to prevent any abuses thereof, to take such steps as
may be reasonably necessary to prevent negative impact upon Plan
administration, and to sanction violations and abuses, if any, under current
law. An employer may not strike a direct assignment carrier.
E. The Plan Administrator shall make
available to all Producers copies of the currently approved Application for
Workers' Compensation Insurance which has been approved for use in the Plan by
the Commissioner or shall direct Producers to the appropriate source if the
approved form be provided by another entity. The Plan Administrator shall
itself make available" to Producers at all times a current list of active
eligible servicing carriers on the "Appendix A" to such Application which said
Appendix A shall list all of the current eligible servicing carriers and
addresses and provide a reasonable mechanism thereupon for striking of same in
accordance with Ark. Code Ann. §
23-67-206(4)
and this Rule and Regulation. Each employer or Producer representative thereof
desiring to strike a servicing carrier or carriers shall physically attach the
completed "Appendix A" to the Application before forwarding it to the Plan
Administrator as otherwise provided herein. The basic form of "Appendix A" must
be filed by the Plan Administrator as required by Ark. Code Ann. §
23-67-119. Such form need not be re-filed for approval when and as the list of
current eligible servicing carriers is changed or amended, but the Plan
Administrator is, nonetheless, required to provide an informational copy to the
Commissioner upon the making of each change or amendment in the list. Each such
"Appendix A" shall bear a revision date printed upon its face.
SECTION 7. BINDING COVERAGE,
ASSIGNMENTS AND POLICY ISSUE
A. The Plan
Administrator will not bind coverage if the application is not substantially
completed; if payroll verification is not included; or if a check for the
estimated annual or deposit premium is not included with the application. Upon
determination that an application is deficient, the Plan Administrator shall
immediately advise the party submitting the application by telephone or
facsimile that the application is deficient, and shall further advise the party
submitting the application as to what action is necessary to cure the
deficiency. If such deficiency has not been cured within three (3) normal
business days of such advice, the Plan Administrator shall return all materials
including the check to the submitting party with an explanation of the
rejection. Coverage shall not be considered bound on deficient or rejected
applications; provided, however, that coverage will be considered bound from
the times set forth below and through the three (3) normal business day period
(ending at 5:00 p.m. on the third day) here described if the application is
substantially completed and if a valid check for the estimated annual or
deposit premium has been included with the application.
B. Coverage may be bound under the Plan, for
applications submitted as. provided in Section 6, in accordance with the
following procedures:
1) For all employers,
other than those formerly self-insured (either individually or as part of a
group), coverage will be bound at either 12:01 a.m. on the first day following
United States Postal Service postmark time and date on the envelope in which
the application materials are mailed, or at the expiration of existing
coverage, whichever is later.
(a) If there
should be no United States Postal Service postmark, coverage will be effective
at 12:01 a.m.- of the date following actual receipt by the Plan Administrator,
unless a later date is requested.
2) For employers formerly individually
self-insured, coverage will be bound at either 12:01 a.m. not earlier than
sixty (60) days following the United States Postal Service postmark time and
date on the envelope in which the application materials are mailed, unless a
later dated is requested.
(a) If there should
be no United States Postal Service postmark, coverage will be effective at
12:01 a.m. not earlier than sixty (60) days following the date of actual
receipt by the Plan Administrator, unless a later date is' requested.
3) For employers who have formerly
been members of self-insured groups, coverage will be bound at the earlier of:
(i) 12:01 a.m. not earlier than thirty (30)
days following the United States Postal Service postmark time and date on the
envelope in which the application materials are mailed, unless a later date is
requested;
(a) If there shall be no United
States Postal Service postmark, coverage will be effective at 12:01 a.m. not
earlier than thirty (30) days following actual receipt by the Plan
Administrator, unless a later date is requested;
OR
(ii) at the expiration of existing coverage'
under the self-insured group.
C. If coverage is bound pursuant to
Subsection (B) of this Section, the Plan Administrator shall immediately issue
a thirty (30) day binder in the name of the assigned carrier with copies to the
insured, producer, and the assigned carrier to which the Plan Administrator
assigns the employer.
D. Except
where otherwise provided in this Plan, all assignments under the Plan are to be
made on an intra-state basis.
E.
Prior to the expiration of the binder issued under Subsection (C) of this
Section, the assigned carrier shall issue and deliver a policy of insurance to
the employer and forward a copy 'of the policy to the producer. The policy
shall be issued for a term of at least one (1) year, unless a shorter term has
been requested. A copy of the policy declarations and all endorsements must be
filed with the Plan Administrator or its designee and forwarded to the
producer. The assigned carrier shall stamp "AR WCIP" on all policies, policy
declarations, and endorsements, and shall provide appropriate notice of policy
issuance to the Workers Compensation Commission.
F. Any insurer who wishes to insure an
employer as voluntary business may do so at any time. If such insurer is not
the assigned carrier, the assigned carrier shall cancel its coverage pro rata
and the assignment shall automatically terminate as of the effective date of
the voluntary insurer's insurance policy.
G. Any employer desiring insurance for
operations in states other than the state covered by this Plan may request its
assigned carrier to furnish insurance in such additional states in accordance
with Section 14 of this Plan. Plan policies affording coverage on operations in
more than one (1) state must clearly indicate the premium developed for ' each
state separately.
SECTION
8. PLAN RATES
A. All insurance
under the Plan shall be written in accordance with the classifications, rates,
and rating plans established for the Plan and approved by the Commissioner,
except as provided herein. The Plan Administrator(s) shall file for approval
with the Commissioner a rating plan which shall apply to all Arkansas risks
within the Plan which shall:
(a) incorporate
a tabular "debit" and "credit" system whereby employers which are experience
rated will be either benefited or penalized depending upon their experience
modification factor;
(b)
incorporate a "merit rating plan" for all employers which are not experience
rated but which will incorporate the concept of debits and credits as above to
the extent that the claims experience of the employer may be readily provable
to the satisfaction of the Plan Administrator.
It is to be understood that the tabular rating system and rating
plan herein described shall be "revenue neutral" in that it shall be designed
and implemented to produce the same amount of total revenue that is produced
under current rates and rating plans approved by the Commissioner and in effect
from time to time but which will, at the same time, allow the re-allocation of
that total premium burden amongst all employers in accordance with their safety
and loss claims experience.
B. The Plan Administrator shall also file for
approval an "Alternate Preferred Plan" which shall apply to employers within
the Plan who have carried workers compensation insurance continually for at
least four policy years and who have had better than average loss experience.
With respect to those employers who are experience-rated, it shall apply to all
employers who have an effective experience modification factor of 0.800 or
less, and with respect to those employers otherwise eligible but which are not
experience rated, the Plan Administrator shall, if the employer provides proof
deemed satisfactory to the Plan Administrator, place such within the Alternate
Preferred Plan. If an employer is deemed eligible for the Alternate Preferred
Plan, he or it shall receive credits against the manual rates in such amounts
or percentages as may be proposed by the Plan Administrator and approved by the
Commissioner.
All credit adjustments under the Alternate Preferred Plan shall
be made to standard premium.
There shall be a rebuttable presumption that no employer within
the WCIP or eligible for coverage thereunder pursuant to Section 5 hereof is
eligible for credits under the Alternate Preferred Plan; the burden is upon the
employer to demonstrate to the reasonable satisfaction of the Plan
Administrator and servicing carrier that it qualifies for same far the policy
year in question. Approval for credits under the Alternate Preferred Plan shall
be on a policy year by policy year'basis, and the employer shall upon each such
request be responsible to provide the Plan Administrator and servicing carrier
with all such tax returns, audits, annual reports, bank statements and the like
as may be requested.
In order that the credits to be given under the Alternate
Preferred Plan be "revenue neutral" within the Plan as a whole, the Plan
Administrator shall devise and submit a method for offsetting the credits
thereby given by increasing the burden of employers with poor experience
[regardless of length of coverage by workers compensation insurance].
SECTION 9. CANCELLATION
AND RENEWAL
A. An assigned carrier shall have
the right to cancel prospectively and upon thirty (30) days written notice any
binder issued by the Plan Administrator, or any policy it has issued under the
Plan:
1) Where the employer is not eligible
for the Plan as provided in Section 5 of this Rule and Regulation;
2) Where the employer refuses to implement
reasonable health, safety or loss control recommendations of the assigned
carrier or of a duly-authorized government agency;
3) Where the employer refuses to allow the
assigned carrier reasonable access to its facilities or to its files and
records for audit or inspection; or
4) Where the employer refuses to disclose to
the assigned carrier the full nature and scope of the assigned carrier's
exposure.
An assigned carrier shall, however, have the right to cancel
prospectively upon ten (10) days' written notice if the cancellation is for
nonpayment of premium when due. An assigned carrier shall have the right to
extend the notice of cancellation if provided reasonable assurance of payment
by the employer, but it may not extend the original due date by more than a
total of thirty (30) days.
The assigned carrier shall proceed according to Arkansas Code
§
11-9-408(b)
in canceling any binder or policy issued under the Plan, including the
requisite notices to the employer and to the Workers Compensation Commission.
All notices of cancellation shall state the hour and date at which the
cancellation is to be effective. If, however, the employer procures other
insurance or becomes self-insured as provided by law within the notice period,
the cancellation date of the policy being cancelled shall be the effective date
of the replacement coverage.
B. At least forty-five (45) days prior to the
scheduled expiration date of a policy issued under the Plan, the assigned
carrier shall notify the employer and the producer, in writing, and forwarding
the Plan Administrator a copy, of the impending expiration and instruct the
employer to request the assigned carrier to renew, provided the employer
continues to be eligible for coverage under the Plan. The assigned carrier must
forward the renewal proposal to the employer, with a copy to the producer and
to the Plan Administrator. Within thirty (30) days after receipt of the
estimated annual or minimum deposit premium, the assigned carrier shall issue a
policy, properly stamped "AR WCIP," to the employer and furnish a copy of the
renewal Information Page to the Plan Administrator or its designee, to the
producer, and to the Workers Compensation Commission. The renewal policy shall
be effective upon expiration of the current policy, or as provided in Section 7
(B)(1), whichever is later.
C. An
assigned carrier unwilling to renew an employer assigned to it shall notify in
writing the employer, the producer, and the Plan Administrator at least
forty-five (45) days prior to the scheduled expiration date of the policy
giving the reasons therefor.
D. If
any employer to which this Plan applies is dissatisfied with its assigned
carrier, the employer may request reassignment by submitting in writing
reasonably acceptable reasons for the request to the Plan Administrator at
least thirty (30) days prior to the scheduled expiration date of the policy.
Further, if the assigned carrier is a direct assignment carrier, and the said
carrier's lack of financial size or standing results in an employer's inability
to obtain related property and casualty coverages, the employer may make
request to the Plan Administrator for re-assignment at any time such inability
becomes clear.
SECTION
10. PARTICIPATION
All insurers licensed to write workers compensation insurance in
this State are required by Ark. Code Ann. §§
23-67-202
and
23-67-205 to
participate in this Plan. An insurer must satisfy its participation requirement
by selecting one of the following options:
Option 1: becoming an "unlimited" direct assignment carrier
without limitation and receiving direct,- assignments from the Plan
Administrator within any risk or class code, as provided for in this
Plan;
Option 2: becoming a "limited" direct assignment carrier and
receiving direct assignments from the Plan Administrator either:
(i) within specific risk or class codes only;
or
(ii) excising specific risk or
class codes; the Plan Administrator shall make all of the requisite
calculations and mathematically determine on behalf of the Commissioner the
appropriate quota share reinsurance obligations of each Option 2 "limited"
direct assignment carrier, which said obligations the Commissioner hereby
imposes on all such carriers; in effect, each "limited" direct assignment
carrier shall by virture of this Rule and Regulation participate in the
Articles of Agreement and the reinsurance mechanism solely as to those risk or
class codes (Arkansas exposures only) in which it does not directly
participate; failure of any such carrier to fulfill these reinsurance
obligations may result in the suspension or revocation of the carrier's
certificate of authority;
Option 3: contracting with either an approved direct assignment
carrier or a servicing carrier to accept assignments on its behalf which
contract is to be filed and approved by the Commissioner. Any policy issued
under this option shall not be eligible for reinsurance under the Articles of
Agreement (this option shall not be available to any Plan participant until
January 1 next following the first year anniversary of the approval of the
Plan); or
Option 4: subscribing to the Articles of Agreement authorized
hereunder.
Any insurer wishing to select either Option 1 or Option 2 must
receive prior express approval from the Commissioner in writing. Except for
newly licensed insurers, application for such approval must be made at least
ninety (90) days prior to the end of any calendar year. The Commissioner must
review the application and approve or disapprove it within sixty (60) days. If
the application is approved, that insurer will become a direct assignment
carrier on January 1 of the year following the Commissioner's approval. The
Commissioner shall establish, and from time to time may amend, reasonable
written requirements that insurers must meet in order to be eligible to act as
either an unlimited or limited direct assignment carrier. Those requirements
shall consider, among other things, the insurer's financial standing,
availability of resources, length, quality and focus of experience in the state
writing workers compensation insurance, market share, capacity, and
.demonstrated compliance with the mandates of Ark. Code Ann. §§
23-67-201 et
seq. A subscriber to the Articles seeking to become a direct assignment carrier
must also comply with the withdrawal provision in the Articles of
Agreement.
An insurer applying to be licensed or authorized in this State to
write workers' compensation insurance after this Rule and Regulation has been
approved and which desires to become either class of direct assignment carrier
must submit its application to become a direct assignment carrier at the time
it submits its application for a license or request for workers' compensation
authority. The Commissioner shall approve or disapprove the application at the
same time the license is issued. All affiliated insurers must select the same
option. while one insurer may be designated by affiliated insurers to accept
direct assignments on behalf of each of them, the ultimate financial""
responsibility under the coverages issued shall be borne by all of the
affiliated insurers, 'and in such circumstances the Commissioner may require
such securities or guarantees from each of the affiliated insurers as he may
reasonably require to protect the public interest. The Plan Administrator shall
have no responsibility for determining and monitoring financial strength or
enforcing levels of service or performance of a direct assignment carrier. All
such monitoring and enforcement shall be accomplished by the
Commissioner.
Whenever participation under the Articles of Agreement consists
of those insurers cumulatively writing less than forty (40) percent of the
total net workers compensation insurance premiums written by all insurers in
this State as calculated in accordance with the preceding calendar year figures
or whenever the Plan Administrator determines the capacity of servicing
carriers to handle assignments made pursuant to this Plan and this Rule and
Regulation falls below a level which is adequate to handle all the assignments
being made, those insurers that selected Option 4 shall, as of January 1 of the
following year, automatically be deemed to have selected Option 1 for employers
insured effective on or after said January 1. Under this provision all licensed
insurers shall automatically be deemed approved as direct assignment carriers
except for those insurers that have previously made separate arrangements under
Option 3. Further, the Commissioner may, if an adequate number of servicing
carriers have not voluntarily made themselves available, appoint such number of
qualified insurers as are reasonably necessary to service the needs of Arkansas
employers under the Plan.
SECTION 11. PLAN ADMINISTRATOR
A. The Commissioner shall from time to time
designate a Plan Administrator to administer and operate the Plan.
B. The Plan Administrator (or any successor
Plan Administrator or Administrators) shall open and continually operate a
centrally - located office within the State of Arkansas reasonably and readily
accessible to the offices of the Commissioner and at a location and with such
staffing, equipment and facilities as shall be reasonably acceptable to the
Commissioner as being adequate to provide a high quality level of service to
the people of the State of Arkansas.
C. The Plan Administrator shall file with the
Commissioner for approval operating rules, procedures, and guidelines
consistent with the provisions of this Rule and Regulation for the
administration and operation of the Plan. The Plan Administrator shall publish
and make available to all insurers and producers the operating rules,
procedures, performance standards, and guidelines for the administration and
operation of the Plan. Further, the Plan Administrator shall file for approval
its schedule of fees which it proposes to remit to Producers for policies
written and services provided under the Plan.
D. The Plan Administrator shall have the
following duties and responsibilities in addition to any others set forth in
this Plan, all of which are subject to the ultimate" control and oversight of
the Commissioner:
(1) administering,
managing, and enforcing the Plan subject to the provisions contained
herein;
(2) determining the
methodology and formula for making assignments to direct assignment carriers
and servicing carriers pursuant to Section 16 and securing the necessary
information in order to make the assignments;
(3) processing assigned risk applications
pursuant to the requirements of this Plan;
(4) establishing eligibility criteria for
servicing carriers and appointing servicing carriers, each of which shall be
subject to the prior approval of the Commissioner;
(5) establishing written performance
requirements for servicing carriers, including, but not limited to:
- verification of ongoing Plan eligibility of the employer
- timely and accurate issuance of policies and
endorsements
- timely and accurate filings with administrative agencies, as
required
- maintenance of premiums on policies consistent with manual
rules, rates, rating plans, and classifications
- timely and accurate completion and billing of final
audits
- collection of premium
- claim services, including investigation, disability management,
and medical cost control
- loss control services and safety information to encourage
employers to make safety a part of their business
- Cooperation with the Commissioner and with the Workers
Compensation Commission and Arkansas Department of Labor in carrying out and
effectuating the safety mandates of Act 796 of 1993 and such Rules and
Regulations as may be promulgated thereunder -t
-payment of producer fees
- issuance of renewal proposals and non-renewal notices
- assurance of insured and insurer compliance with all terms and
conditions of policy contract
- resolution of complaints and response to insured/producer
inquiries
- reporting financial and statistical data to producers and
insureds, as well as to the Commissioner
- requirement to consult with and keep insureds apprised of
developments in incurred claim cases;
(6) keeping servicing carriers apprised of
all required Performance Standards, monitoring servicing carrier performance
and enforcing performance requirements and incentives;
(7) administering the dispute resolution
mechanism as provided in Section 17;
(8) developing and implementing assigned risk
operating rules and forms to the extent necessary to carry out the purposes of
this Plan;
(9) informing the
Commissioner of any insurer that is not participating in this Plan;
and
(10) monitoring the performance
and operation of the Plan and initiating and requesting approval of amendments
thereto as appropriate.
The Plan Administrator shall also be responsible for determining
the expenses for the operation of the Plan, exclusive of the Plan
Administrator's expenses incurred in connection with responsibilities it has
under the Articles, and shall assess each insurer participating in the Plan for
those expenses on an equitable basis as determined by the Plan Administrator
and approved by the Commissioner.
E. Commencing no later than March 1, 1994,
the Plan Administrator shall file with the Commissioner quarterly results of
the Plan, including, but not limited to, premiums written, earned, and
collected, losses paid, incurred losses, administration and servicing carrier
allowances and remuneration, and service complaints from employers and
producers per servicing carrier.
Further, and on March 1, 1994 and on such date each year
thereafter, the Plan Administrator or Administrators shall file with the
Commissioner its/their performance review and Plan results for each Arkansas
Plan servicing carrier with due and appropriate regard for the "Performance
Standards and Procedures for Measuring Servicing Carrier Performance"
referenced in Section 12 and to the criteria set forth in paragraph D.(5)
above.
SECTION
12. SERVICING CARRIERS
With respect to the servicing carriers appointed by the Plan
Administrator and approved by the Commissioner, the following shall
apply:
(1) Eligibility to Act As a
Servicing Carrier. The Plan Administrator shall establish written requirements
that insurers must meet in order to be eligible to act as a servicing carrier.
Those requirements shall consider, among other things, the insurer's financial
standing, availability of resources, length and quality of experience in the
state writing workers compensation insurance, market share, and demonstrated
compliance with the mandates of Ark. Code Ann. §§
23-67-201 et.
seq. An insurer that has been approved as a direct assignment carrier pursuant
to Option 1 under Section 10 is not eligible to be appointed as a servicing
carrier under this Plan. From among those insurers that are eligible and have
applied to act as a servicing carrier, the Plan Administrator shall appoint a
sufficient number of servicing carriers as are needed to handle the assignments
made pursuant to this Plan. The Plan Administrator may terminate the servicing
carrier status, subject to the approval of the Commissioner, of any insurer
that fails to meet the servicing carrier requirements on a continuing basis.
During the first year this Plan is in effect, any insurer that is qualified as
a servicing carrier under any similar Plan which was previously in effect in
this State and continues to be qualified as of the date this Plan takes effect
will he deemed to be a qualified servicing carrier under this Plan.
(2) Quarterly Operations Report. Each
servicing carrier shall provide a quarterly report to the Plan Administrator in
such format and at such time as determined by the Plan Administrator. This
report, among other things, shall provide information on the servicing
carrier's operations related to Plan business in the following areas:
underwriting, auditing, claims, loss control, premium collection, and customer
service.
(3) Standards for
Servicing Carrier Performance, Compensation, and Incentives. The Plan
Administrator shall, with the approval of the Commissioner, establish written
minimum levels of acceptable performance for servicing carriers and shall
establish procedures for measuring servicing carrier performance. Servicing
carriers shall manage losses in compliance with the performance standards
established hereunder. The Plan Administrator shall also establish the
compensation for servicing carriers which shall take into consideration, among
other things, provisions for (a) rewarding servicing carriers for positive
action targeted at reducing losses and costs, and (b) disincentives for
inefficiencies and poor service, and (c) servicing carrier capacity. And, in
accordance with Ark. Code §
23-67-204(k)
the performance plan shall provide that no less than Thirty-three percent (332)
of the servicing carrier's remuneration shall be based upon how well or how
poorly it complies with the standards for servicing carrier performance,
including particularly, but not limited to, a review of collected premium as
versus written premium and by review of loss ratios of its book of business and
degree of improvement therein. Such compensation system shall be made effective
with respect to and shall apply to all servicing carrier contracts effective on
or after September 1, 1993. The Plan Administrator, as approved by the
Commissioner, shall on an .equitable and consistent basis provide that those
monies that would otherwise have gone to servicing carriers that did not
perform up to an acceptable standard shall be distributed amongst those
servicing carriers that met or exceeded the performance standards.
(4) Each servicing carrier shall continually
employ such number of qualified administrative personnel and dedicate such
equipment and facilities to the administration of the Arkansas workers'
Compensation Insurance Plan as the Commissioner, in his reasonable discretion,
deems adequate to service the needs of the Plan; and, further, the standards
for servicing carrier performance shall include a requirement that each of them
shall:
(i) provide a level of service no less
than that provided to employer-insureds in its voluntary workers compensation
line of business and assure same by putting into effect internal administrative
procedures which shall assure that such is the case;
(ii) maintain with the Commissioner a list of
responsible management personnel of the insurer qualified to make
administrative decisions on the insurer's behalf concerning policies issued
within the Plan;
(iii) keep the
Commissioner continually advised of the address and telephone number of the
insurer's office servicing the Plan on its behalf;
(iv) maintain a toll-free telephone number or
numbers adequate to service the Plan and keep the Commissioner, employers, the
workers Compensation Commission, and producers continually apprised of
same;
(v) establish a program and
procedure whereby such carriers shall not make ultimate determination as to
joint settlement of claims without consulting with the employer insured;
nothing herein shall be deemed to alter or abridge the servicing carrier's
ultimate right and authority under the law and contract to handle and determine
the defense of workers' compensation claims;
(vi) maintain its billing and rating
procedure in timely compliance with applicable Orders of the Commissioner
approved rate filings and approved rule and rating plans; and
(vii) such other service or performance
standards including, but not limited to, matters relating to loss experience,
safety and loss Control success, profitability, underwriting,, billing and
collection of premium, audits, 'claims, customer service, and such accounting
and statistical results reporting as may be specifically required by the
Commissioner.
The written "Performance Standards and Procedures for Measuring
Servicing Carrier Performance" hereunder are those currently in effect and and
are those established by the Council. All of which said provisions are
expressly incorporated herein and made a part hereof; such Performance
Standards and Procedures for Measuring Servicing Carrier Performance may be
amended and supplemented from time to time with the prior, express written
approval of the Commissioner; provided, however, that no servicing carrier
shall be subjected to the administrative fine or penalty provided for in
subparagraph (7) hereof as to any particular performance standard of which it
has not had at least three (3) month's notice. All servicing carriers shall be
deemed to have Notice upon the Plan Administrator's receipt of approval from
the Commissioner.
(5) Servicing carriers may, within the
reasonable discretion of the Commissioner, join cooperatively with other
licensed casualty insurers or general business corporations for the purpose of
satisfying other duties as servicing carriers, including but not limited to
policy issuance, claim review and payment, accounting and auditing and loss
control and safety functions. Any insurer applying for approval as a servicing
carrier, or any currently approved servicing carrier which has contracted or
agreed to contract with a third party, shall make full disclosure of such party
and provide the Plan Administrator and Commissioner with all such information
regarding same as they may request. All such third party contractual
arrangements and amendments thereof shall be subject to review, examination and
approval or disapproval of the Commissioner upon request. No such contract of a
servicing carrier with another entity will in any manner lessen the duties and
obligations of the servicing carriers or the standards by which their
performance is to be measured.
(6)
Monitoring and Enforcement. The Plan Administrator, on behalf of the
Commissioner, shall monitor and review servicing carrier performance by (1)
reviewing the quarterly and annual reports; (2) requiring and reviewing
self-audits; (3) conducting on-site audits of all servicing carriers no less
often than once per biennium; and (4) reviewing any other information available
that relates to the servicing carrier. The Plan Administrator shall require
servicing carriers to maintain desired performance levels and will take
appropriate remedial action where necessary including, but not limited to the
remuneration adjustment program discussed above, and the establishment and
administration of a progressive discipline program which may lead to
terminating an insurer's servicing carrier status. In order to fulfill its
responsibilities under this Plan, the Plan Administrator shall have the right,
itself or through authorized representatives, at all reasonable times during
regular business hours, to audit and inspect the books and records of any
servicing carrier with respect to any policies, claims, or related documents
coming within the purview of this Plan, the Articles, or the reinsurance
mechanism. Each servicing carrier shall, further, have the responsibility of
reimbursing the Commissioner for any reasonable expenses of travel and lodging,
including meals, which he or any of his designees may incur in carrying out
their duty of monitoring and enforcement.
(7) In addition to the adjustments to
remuneration of servicing carriers as discussed above and the progressive
discipline procedure, servicing carriers are subject to the imposition by the
Commissioner, after notice and hearing, of administrative fine or penalty in
the sum of not more than One Thousand Dollars ($1,000.00) for each violation of
standard. Violations of standards of performance shall be reviewed annually by
the Plan Administrator and the Commissioner and determined cumulatively under
each separate performance standard.
SECTION 13. DIRECT ASSIGNMENT CARRIERS
With respect to the direct assignment carriers approved by the
Commissioner, the following shall apply:
(1) The Commissioner may terminate the
limited or unlimited direct assignment carrier status of any carrier that fails
to meet the performance requirements set forth herein on a continuing
basis.
(2) Annual Operations
Report. Each unlimited and each limited direct assignment carrier shall provide
an annual report to the Commissioner in such format and at such time as
determined by the Commissioner. This report, among other things, shall provide
information on the direct assignment carrier's operations related to Plan
business in the following areas: underwriting, auditing, claims, loss control,
premium collection, and customer service.
(3) Each direct assignment carrier shall
continually employ such number of qualified administrative personnel and
dedicate such equipment and facilities to the administration of the Arkansas
Workers' Compensation Insurance Plan as the Commissioner, in his reasonable
discretion, deems adequate to service the needs of the Plan; and, further, the
standards for direct assignment carrier performance shall include a requirement
that each of them shall:
(i) provide a level
of service no less than that provided to employer-insureds in its voluntary
workers compensation line of business and assure same by putting into effect
internal administrative procedures which shall assure that such is the case;
-
(ii) maintain with the
Commissioner a list of responsible i management personnel of the insurer
qualified to make administrative decisions on the insurer's behalf concerning
policies issued within the Plan;
(iii) keep the Commissioner continually
advised of the address and telephone number of the insurer's office servicing
the Plan on its behalf;
(iv)
maintain a toll-free telephone number or numbers adequate to service the Plan
and keep the Commissioner, employers, the Workers Compensation Commission, and
producers continually apprised of same;
(v) establish a program and procedure whereby
such direct assignment carriers shall not make ultimate determination as to
joint settlement of claims without consulting with the employer insured;
nothing herein shall be deemed to alter or abridge the direct assignment
carrier's ultimate right and authority under the law and contract to handle and
determine the defense of workers' compensation claims;
(vi) maintain its billing and rating
procedure in timely compliance with approved orders of the Commissioner,
approved rate filings and approved rule and rating plans; and
(vii) such other service or performance
standards including, but not limited to, matters relating to loss experience,
safety and loss control success, profitability, underwriting, billing and
collection of premium, audits, claims, customer service, and such accounting
and statistical results reporting as may be specifically required by the
Commissioner.
The written "Performance Standards and Procedures for Measuring
Servicing Carrier Performance" hereunder (which shall also apply to direct
assignment carriers) are those currently in effect and and are those
established by the Council, all of which said provisions are expressly
incorporated herein and made a part hereof; such Performance Standards and
Procedures for Measuring Servicing Carrier Performance may be amended and
supplemented from time to time with the prior, express written approval of the
Commissioner; provided, however, that no direct assignment carrier shall be
subjected to the administrative fine or penalty provided for in subparagraph
(5) hereof as to any particular performance standard of which it has not had at
least three (3) month's notice from the Commissioner.
(4) Monitoring and Enforcement.
The Commissioner, shall monitor and review direct assignment carrier
performance by (1) reviewing the annual reports; (2) requiring and reviewing
self-audits; (3) conducting on-site audits of direct assignment carriers as
determined reasonable; and (4) reviewing any other information available that
relates to that carrier. The Commissioner shall require direct assignment
carriers to-maintain desired performance levels and will take appropriate
remedial action where necessary-including the establishment and administration
of a progressive discipline program which may lead to terminating an insurer's
direct assignment carrier status. In order to fulfill his responsibilities
under this Plan, the Commissioner shall have the right, himself or through
authorized representatives, at all reasonable times during regular business
hours, to audit and inspect the books and records of any direct assignment
carrier with respect to any policies, claims, or related documents coming
within the purview of this Plan. Each direct assignment carrier shall, further,
have the responsibility of reimbursing the Commissioner for any reasonable
expenses of travel and lodging, including meals, which he or any of his
designees may incur in carrying out their duty of monitoring and
enforcement.
(5) In addition to the
progressive discipline procedure, direct assignment carriers are subject to the
imposition by the Commissioner, after notice and hearing, of administrative
fine or penalty in the sum of not more than One Thousand Dollars ($1,000.00)
for each violation of standard. Violations of standards of performance shall be
reviewed annually by the Commissioner and determined cumulatively under each
separate enformance standard.
SECTION
14. INTERSTATE ASSIGNMENTS
A.
Voluntary Coverage. Any employer assigned under this
Plan and desiring workers' compensation insurance for operations in states
other than Arkansas may request its assigned carrier to furnish such insurance
in such additional states. Workers' compensation insurance in such additional
states may be written by the assigned carrier on a voluntary basis and in
accordance with the law, rates, rules, classifications, and regulations
applicable to the voluntary workers' compensation market in those
states.
B.
Assigned
Risk Coverage.
(1)
"
Similar" Assigned Risk States. If the assigned
carrier does not wish to provide coverage in the additional states on a
voluntary basis, if those states have a Workers Compensation Insurance Plan
that is similar to this Plan and if such other Plan allows employers applying
for coverage thereunder to obtain coverage for their operations in Arkansas,
then the assigned carrier must provide assigned risk coverage in such
additional states as follows:
(1) An assigned
carrier providing such insurance shall collect all premiums due on operations
located in such other states. The effective date of such insurance in such
additional states shall be the day after premium is received; however, in the
event coverage in such additional states is on an "if any" basis, the effective
date of such coverage shall be the day following receipt of an acceptable
request for such insurance by the assigned carrier. A copy of the policy
Information Page and all endorsements, properly stamped "AR VCIP," shall be
submitted to the appropriate Plan Administrator, /having jurisdiction in the
state where the coverage is effected.
(2) The rates, rating plans, classifications,
and policy forms used to provide coverage in such additional states shall be
those applicable to residual market risks that are on file and approved by the
regulators in those additional states.
(3) In the event the assigned" carrier is a
servicing carrier, it must also be a signatory to an agreement providing
reinsurance for residual market risks similar to the Articles of Agreement in
each state where the coverage will be provided. If the assigned carrier is a
direct assignment carrier pursuant to Section 10 Option 1 or Option 2, it must
also be authorized to act as a direct assignment carrier in each state where
the coverage will be provided.
An assigned carrier unable to provide insurance for an employer
in additional states in accordance with this Section 13.B. or unwilling to
write voluntary coverage in accordance with Section 13.A., shall refer the
request to the Plan Administrator which shall re-assign the employer to an
assigned carrier or carriers that is/are able to provide coverage in accordance
with this Section 13.A. and Section 13.B..
(2)
All Other
States. If the assigned carrier does not wish to provide coverage
in an additional state on a voluntary basis, and if the state in question does
not have a Workers Compensation Insurance Plan that is similar to this Plan,
then the assigned carrier must provide coverage for operations of an Arkansas
employer in such additional state IF AND ONLY IF:
a. the employer has made application to no
fewer than two (2) voluntary workers compensation insurers authorized to insure
such risks in such state and has been declined, if such state in fact, has a
voluntary workers' compensation insurance market; and
b. the employer has made application to
either an "unsimilar" assigned risk plan, or to either a competitive or
mandatory state workers compensation fund in such state and has been declined
for coverage.
In the event coverage in another state cannot be obtained in the
fashion as set forth above, then the services as rendered by employees of the
Arkansas employer shall be deemed to be services rendered pursuant to a
contract of "employment in this State" as provided by Ark. Code Ann. §
11-9-102(12)
and as amended by Section 2 of Act 796 of 1993, and the assigned carrier shall
provide coverage for such operations under this Plan and under the mandate of
Ark. Code Ann. §ll-9-404(a) (1); PROVIDED, HOWEVER, that in the event any
employee of any such employer incurs an injury or occupational disease
compensable under the law of such other State, elects to recover under such
laws and is finally successful in so doing, the assigned carrier shall be
entitled to recoup from such employer the additional premium, if any, that
would have, been billed to that employer for the services of that employee in
that other State by:
(i) either the
risk plan or competitive or monopolistic fund operating in such State; or
(ii) a licensed workers
compensation insurer legally providing coverage to an employer in such State
pursuant to the laws thereof. Such carrier recouping premium in this manner
shall be entitled to recoup premium for a period of coverage equal to the
period of time the injured employee performed services in such State (subject
to the maximum differential, if any, between the Arkansas rates and the other
State rates for a period of one policy year) and shall be entitled to bill and
collect from the employer the said premiums as premium due hereunder and subj
ect to the cancellation procedures set forth in Section 9 hereof.
C.
Foreign Employers
*
(1)
From Similar Assigned Risk
State. Employers who make application for workers' compensation
insurance under another state's Workers' Compensation Insurance Plan may
purchase coverage for operations in Arkansas without meeting the application
requirements of this Plan, provided:
(1) the
employer qualifies for such insurance under the other state's Plan;
(2) the employer is in good faith entitled to
insurance under this Plan;
(3) the
other state's Plan is similar to this Plan;
(4) that Plan also provides for interstate
assignments; and
(5) the payroll
for the employer's operation in this State is not greater than the payroll in
the other state.
The rates, rating plans, classifications, and policy forms used
to provide coverage in Arkansas shall be those that are applicable to residual
market risks in this State and are on file and have been approved by the
Commissioner.
The Administrator of the other Plan is authorized to assign
employers with operations in Arkansas to the other Plan's assigned carriers
subject to the following conditions:
(1) If the assigned carrier is a direct
assignment carrier, it must also be a direct assignment carrier in Arkansas
pursuant to Section 10 - Option 1 or Option 2 or a servicing carrier in
Arkansas pursuant to Section 12, paragraph (1).
(2) If the assigned carrier is a signatory to
an agreement providing reinsurance for residual market risks similar to the
Articles of Agreement in Arkansas, it must also be a signatory to the Articles
of Agreement in this State or a direct assignment carrier in this State. In
addition, if the payroll for the employer's operation in this State is greater
than $250,000 and if the assigned carrier is a signatory to the Articles of
Agreement or a similar document in the other state, it must also be a servicing
carrier in this State.
(3) The
other state's Plan must give the Plan Administrator in this State similar
authority to make interstate assignments.
(2)
From All Other
States. Employers who are either:
(i) insured under an assigned risk plan not
"similar" to that of this State;
(ii) insured voluntarily by a workers
compensation insurer from such other State; or
(iii) insured under or by a competitive or
monopolistic state fund in such other state, shall be eligible for coverage
under this Plan as to its known and anticipated operations in this State if it
is otherwise eligible for coverage under the terms of Section 5
hereof.
D.
Jurisdiction. with regard to interstate assignments
and policies, this Plan shall have jurisdiction over all disputes resulting
from the application of rules, programs, and procedures that are specific to
this State. Disputes regarding application requirements shall be under the
jurisdiction of the state's Plan where the application was filed.
SECTION 15. ASSOCIATION OR
SPONSORED MULTIPLE COORDINATED POLICIES
Pursuant to the provisions of Ark. Code Ann. §
11-9-408(d)
[as added by §12 of Act 796 of 1993] and Ark.- Code Ann. §
23-67-211
[as added by §1 of Act 1269 of 1993] the Plan Administrator shall develop
and administer a plan for the issuance of multiple coordinated policies of
workers' compensation and employers' liability insurance subject to the
approval of the Commissioner. Such multiple coordinated or group policies may
only be issued to cover groups containing no fewer than five (5) separate
employers who shall not be affiliated with one another in terms of ownership,
control, or right to participate in the profits of an affiliated enterprise.
The "sponsor" or administrator of such policies must either be a general
contractor meeting the financial capacity and continuity guidelines as shall be
set forth in the rating plan and approved by the Commissioner or a recognized
industry association which is incorporated or organized as a not-far-profit
corporation or association and which has been in existence for no fewer than
three (3) years prior to application for approval as a "sponsor".
Further,
(i) each employer within the
association or group must be engaged in the same general business activity as
determined by the Plan Administrator and within the principle s and guideline s
of the Scones of Basic Manual Classifications as published from time to time by
the National Council on Compensation Insurance, or some such similar
classification system as may be chosen by the Commissioner, such as the
Standard Industrial Classifications Manual:
(ii) the sponsor assumes joint responsibility
with each of the employers for the payment of all required premium, including
deposit, and agrees in writing to subject itself to audit and review of all of
his records and practices relating to the business to which the association or
multiple coordinated policies shall pertain; and
(iii) the sponsor provides the Plan
Administrator with such additional security in the way of cash deposit, or
marketable securities, or a letter of credit from a National Banking
Association unaffiliated with the sponsor as the Plan Administrator reasonably
deems necessary; the Plan Administrator may adjust the amount of the required
additional deposit from time to time depending upon the claim experience of the
association groups and the audited and collected premium.
Multiple coordinated policies shall be issued in the name of each
employer but delivered to the sponsor, and all premiums shall be calculated
upon the wages paid to or received by the employers in accordance with Plan
Rules. All claims experience shall be identified to each employer and records
maintained relative thereto by the Plan Administrator, including experience
modifiers as appropriate.
SECTION 16. ASSIGNMENT FORMULA
The Plan Administrator shall develop and provide to the
Commissioner detailed procedures for the equitable distribution of employers
under this Plan to assigned carriers. These procedures shall provide a
mechanism that will provide for the random distribution of employers based on
each direct assignment carrier's allocable percentage and the combined
allocable percentage of all servicing carriers, and the amount of estimated
premium in the Plan, so far as practicable.. The procedures shall also define
those circumstances where the Plan Administrator will have the discretion to
override the random selection process and shall account for the variations
necessitated by the "striking procedure" set forth at Section 6 hereinabove and
by the risk or class code limitations on limited direct assignment carriers as
set forth in Section 10 hereinabove.
The mechanism shall provide that the allocable percentage for
each assigned carrier shall be determined as follows:
(1) If the assigned carrier is a direct
assignment carrier, its allocable percentage will be equal to its net premiums
written in the risk or class codes which it is eligible to write hereunder as
compared to the total net premiums written in this State as to those same class
codes.
(2) If the assigned carrier
is a servicing carrier, it will be responsible for providing services on behalf
of those insurers that have elected to meet their Plan assignment requirements
by subscribing to the Articles of Agreement pursuant to Section 10, Option 4.
Its allocable percentage will be determined by the Plan Administrator; however,
the combined allocable percentages for all servicing carriers shall be equal to
the combined net premiums written for all signatories to the Articles of
Agreement as compared to the total net premiums written in this
State.
(3) If the assigned carrier
has entered into contracts to accept assignments on behalf of other insurers/,
pursuant to Option 3 in Section 10, its participation percentage will be
increased to reflect the assignment percentages of such insurers.
SECTION 17. DISPUTE RESOLUTION
PROCEDURE
Any person affected by the operation of the Plan including, but
not limited to, participating companies, employers, producers,.and as signed
carriers, who may have a dispute with respect to any aspect of the Plan,
including rating and classification and auditing disputes and any dispute
arising under the Articles of Agreement, may seek a review of the matter by the
Plan Administrator by setting forth in writing with particularity the nature of
the dispute, the parties to the dispute, the relief sought and the basis
thereof. The Plan Administrator, as designee of the Commissioner, may secure
such additional information as it deems necessary to make a decision and shall
in the instance of disputes involving, comply with all requirements of due
process and Ark. Code Ann. § 23-67-119(3) and the Arkansas Appeals Board
Objectives and Rules as approved by the Commissioner.
Appeals from employers and insurers on Plan matters regarding
employer disputes shall be within the jurisdiction of the mechanism established
to handle such appeals under the applicable rating law i.e. Ark. Code §
23-67-119(3). All other disputes shall be handled as follows:
(1) If the dispute relates to the general
operation of the Plan, excluding individual employer disputes as noted above
and those arising under the Articles of Agreement, the Plan Administrator will
review the matter and render a written decision with an explanation of the
reasons for the decision within thirty (30) days after receipt of all the
information necessary to make the decision. Any party affected by a decision
made by the Plan Administrator may seek a review by a committee appointed by
the President of the National Council on Compensation Insurance for such
purpose. Such committee shall consist of three (3) senior officers of the
Council. A request for a review by such committee must be made to the Plan
Administrator in writing within thirty (30) days of the date of the Plan
Administrator's decision. Any party affected by the decision of such committee
may seek a novo review by the Commissioner by requesting such review, in
writing, within thirty (30) days after the date of such decision.
In reviewing any such matter not coming with the scope of Ark.
Code Ann. § 23-67-119(3)(B), the Commissioner shall follow those
procedures applicable to administrative hearings in this State. The
Commissioner shall decide the dispute in accordance with the state law,
regulation, and policy and in the interests of the reasonable and proper
administration of this Plan. The Commissioner's decision shall be final,
subject to court review under Ark. Code Ann. §
23-61-307.
(2) Except as provided below, if
the dispute arises under the Articles of Agreement, the Administrator
designated under the Articles of Agreement shall first review the matter' and
render a written decision with an explanation of the reasons for the decision
within thirty (30) days after receipt of all the information necessary to make
the decision. Any party affected by the decision may seek a review by the Board
of Governors established under the Articles by requesting such review, in
writing, within thirty (30) days of the date of the decision by the
Administrator under the Articles of Agreement. The Board of Governors must then
review the matter and render its written decision pursuant to the procedures
set forth in the Articles of Agreement. Any party affected by a decision of the
Board of Governors may seek a de novo review by the Commissioner by requesting
such a review in writing within thirty (30) days of the date of the Board of
Governors' decision.
If the dispute relates to the expulsion of a participating
company under the Articles of Agreement by the Board of Governors, any appeal
may be taken directly to the Commissioner without first complying with the
procedures contained herein.
SECTION 18. SELF-FUNDED PLAN
It is ultimately essential for maintaining the viability of the
Plan to establish and maintain rates at a level that will permit the Plan to
operate as a self-funded mechanism. The Plan Administrator shall maintain
necessary ratemaking data in order to permit the actuarial determination of
rates and rating plans appropriate for the business insured through the Plan.
All assigned carriers are required to report their experience on business
written under the Plan to the Administrator in a format prescribed by the
Council. It is the responsibility of the Plan Administrator to monitor both
rate adequacy and Plan results. The Plan Administrator shall notify the
Commissioner if excessive losses are indicated to enable the Commissioner to
take corrective action.
SECTION
19. SMALL DEDUCTIBLE POLICY OPTION
The Commissioner deems a small deductible policy option to be
"feasible" within the meaning of Ark..Code Ann. §
11-9-812(D),
and, accordingly, a Small Deductible Policy Rating Plan which shall be
applicable to both the voluntary market and to the WCIP shall be made
effective, under which each employer shall have the option, in accordance with
the dictates of Ark. Code Ann. §
11-9-812,
of applying for coverages which incorporate deductible amounts of no less than
$1,000 per incident and further deductibles in further increments of $500 each
up to a maximum of $5,000 per incident. The Plan Administrator shall develop an
appropriate application incorporating the deductible option and policy form,
along with an actuarially sound premium adjustments for submission to and
approval by the Commissioner. The Commissioner hereby determines under the
dictates of Ark. Code Ann. §
11-9-812(D),
however, that it is not "feasible" to require insurers or the Plan
Administrator and assigned carriers to ignore claim frequency and/or severity
if losses happen to be within the deductible limit chosen by an employer, and,
accordingly, there shall be no prohibition against insurers,.. the 'Plan
Administrator, or assigned carriers using true loss data, including frequency
and severity of losses even within deductibles, for purposes of experience
rating.
SECTION 20. OTHER
STANDARDS AND PENALTIES
A. Any insurer,
assigned carrier, or producer who refuses or neglects to comply with the
provisions of this Rule and Regulation shall be subject to administrative
action provided for 'in the Arkansas Insurance Code, Arkansas Code Annotated
§§
23-60-101, et
seq.
B. Any servicing carrier who
fails to comply with the requirements of Section 12 of this Rule and
Regulation, as reported to the Commissioner by the Plan Administrator, or any
direct assignment carrier who fails to comply with the requirements of Section
13 may have their designations to act in such capacities hereunder suspended or
revoked upon notice and hearing pursuant to Arkansas Code Annotated
§§
23-61-301,
et seq.
C. No direct assignment
carrier or servicing carrier insuring an employer through the Plan may utilize
any information gained through its administrative services for the purpose of
securing other insurance business from such employer. No such carrier shall
share or reveal any such proprietary information with or to any of its agents
or brokers, with or to any other carrier, or, if it is a direct writer, with or
to any of its in-house marketing personnel. Violation of this prohibition shall
be considered an Unfair Method of Competition in violation of the Trade
Practices Act.
D. No licensed
agent, broker or solicitor or any insurer (whether or not an assigned carrier)
may knowingly submit an offer of workers' compensation insurance coverage to an
employer on a monoline basis on a rating plan that has not been previously
approved by the Commissioner, nor shall any such person or entity make any
offer of workers' compensation insurance in combination or coordination with
other property and/or casualty coverages or limits which are not desired by the
employer, nor shall such person or entity apply its filed and approved rates or
rating plans (including all applicable discounts or credits) to such employer
in an unfairly discriminatory manner. Any person or entity determined to have
knowingly violated this prohibition shall be deemed guilty of an unfair or
deceptive act or practice in the business of insurance as provided at Ark. Code
Ann. §§
23-66-205
et. seq.
SECTION 21.
SEVERABILITY
If any provision of this Rule and Regulation, or the application
thereof to any person or circumstance, is held invalid, such invalidity shall
not affect other provisions or applications of this Rule and Regulation which
can be given effect without the invalid provision or application, and to that
end the provisions of this Rule and Regulation are severable.
