Current through Rules and Regulations filed through September 23, 2024
(1) An employer, including a vendor who provides logging services to a named entity or an association of such entities, or a self-insurer who is in good faith entitled to insurance as defined in subparagraph (1)(b) below, required under workers' compensation laws, state and federal, and who has been unable to secure such insurance (and has four Rejections and/or Declinations as defined in 120-2-38-.04) may make an application to the Plan.
(a) An application for insurance shall be made with the Administrator by the employer or his representative, in a format provided by the Administrator and approved by the Commissioner. Within seventy-five (75) days preceding the date of application, the applicant must have applied for workers' compensation insurance and been rejected as defined in 120-2-38-.04. The employer or its representative shall maintain on record for this policy period the Insurer name, contact person, address, phone number and date of contact and make such information available to the Administrator or Assigned Carrier upon request.
(b) Good Faith will be presumed in the absence of evidence to the contrary. An employer is not in good faith entitled to insurance if any of the following circumstances exist at the time of application or thereafter, or other evidence exists that such employer is not in good faith entitled to insurance:
1. 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, while insurance is in force, knowingly refuses to meet reasonable health, safety, or loss control requirements; does not allow reasonable access to the Insurer for audit or inspection under the policy; or does not comply with any other policy obligations.
3. The employer has an outstanding workers' compensation insurance premium obligation to an Assigned Carrier that is not subject to a bona fide dispute.
4. The employer, its representative, or the Licensed Producer knowingly fails to comply with Plan rules or procedures; or knowingly makes a material misrepresentation on the application by omission or otherwise.
(2) Upon receipt of the completed application, the Administrator shall assign the Risk to an Assigned Carrier, furnishing such Assigned Carrier with the application and any classification and rating data which may be available.
(3) Coverage may be bound under the Plan consistent with the Plan rules in accordance with the following procedures:
(a) At least annually, the Commissioner shall evaluate procedures for binding coverage, as described hereunder, to determine if each of the methods of binding described herein is viable;
(b) Issues to be considered shall include the comparative usage among the methods, the cost of maintaining any one method, and the effect of discontinuance of a method on employers;
(c) If the Commissioner deems any one method not to continue to be viable, the Commissioner shall have the authority to delete any such method as an authorized method of binding coverage.
Except as indicated on the binder/verification page, all assignments under this Plan are to be made on an intrastate basis. However, any employer desiring insurance for operations in states other than those covered by its Assigned Carrier may request its Assigned Carrier to furnish insurance in the additional states, subject to the rules of the Plan, including the operating rules and procedures.
(4) A requested effective date may be secured consistent with Plan rules in accordance with the following procedures:
(a) The employer or its representative shall forward an application to be Administrator using one of the submission methods established by the Administrator. The employer or its representative may request an effective date not later than seventy-five (75) days from the date of application; however, such requested effective date shall be the later of the following options:
1. 12:01 a.m. on the date following receipt by the Administrator of a complete and eligible application,
2. the date of expiration of existing coverage, or
3. a date the employer requested.
If the Licensed Producer forwards via U.S. mail a signed application to the Administrator with a check payable to the Administrator for the estimated annual or initial deposit premium, coverage will be bound at 12:01 a.m. on the day following the postmark time and date on the envelope in which the application is mailed, including the estimated annual or deposit premium, or the expiration of existing coverage. If U.S. mail is used and/or there is no postmark, or if the application does not contain the required information as described in the Plan rules, provisions for securing a requested effective date as stated above and rules for binding coverage as stated in paragraph (5) below shall apply. The Administrator shall apply all rules in securing an effective date of coverage equally, no matter what method of submission the employer or its representative chooses.
(b) Subject to the review by the Assigned Carrier, employers who were formerly self-insured shall secure a requested effective date no later than 12:01 a.m. ninety (90) days following receipt by the Administrator of a complete and eligible application.
(c) Upon receipt of the application, the Administrator shall review said application for eligibility and completeness. The Administrator may request additional information at his/her discretion to establish eligibility. The employer and/or its representative shall provide such information/documentation, or provide an acceptable explanation for failure to provide the requested items within the time frame established by the Administrator. Incomplete applications received by the Administrator may, at the discretion of the employer or its representative, be retained by the Administrator pending receipt of further information. Failure to comply in a timely manner with a request from the Administrator may result in the rejection of the application.
(d) After the application has been reviewed and eligibility has been determined, the Administrator shall calculate the total and deposit premium and inform the employer, its representative, or the Licensed Producer of the applicable premium, using the submission options identified by the Administrator.
(5) Coverage may be bound under the Plan consistent with Plan rules in accordance with the following procedures:
(a) The Licensed Producer or employer must submit the total required deposit premium to the Administrator using one of the submission methods established by the Administrator. The required deposit premium must be received within the time frame established by the Administrator in order for coverage to be bound on the requested effective date.
(b) The effective date on the binder will be the secured effective date as secured under paragraph (4) above, only if all of the following occur:
1. the Administrator is in receipt of a complete signed application within the established time frame,
2. the applicant is deemed eligible, and
3. the total deposit premium has been received by the Administrator within an established time frame.
(c) Coverage will not be bound by the Administrator without a complete signed application and receipt of the appropriate deposit premium. The binder/verification page shall be sent to the appropriate parties as required and shall remain in effect until canceled or a policy has been issued. In accordance with Plan procedures, coverage shall not exist if a binder was not issued.
(6) If, after the issuance of a policy, the Assigned Carrier determines that an employer is not entitled to insurance, has failed to comply with reasonable health, safety, and loss control requirements, or has violated any of the terms and conditions under which the insurance was issued, and after providing opportunity for cure, the Assigned Carrier shall initiate cancellation and inform the Administrator and appropriate state organization of the reason for such cancellation. Any insured employer so cancelled must reestablish eligibility or must demonstrate entitlement to the Administrator before any further assignment can be made under this Plan.
(7) All Risks to which this Plan applies shall be written utilizing the classifications, forms, rates and rating plans, and data filed by the Administrator and approved by the Commissioner.
(8) Any Risk or Carrier may appeal to the Georgia Workers Compensation Appeals Board if it does not agree with the established classification, rates, rules, rating data, or rating plans. The decision of the Board may be appealed to the Commissioner.
(9) At least forty-five (45) days prior to the expiration date of insurance, the Assigned Carrier shall send a renewal proposal to the insured, Licensed Producer and the Administrator. The renewal proposal shall include the dollar amount of any premium increase in excess of 15% which results from a change in rates in compliance with O.C.G.A. 33-24-47. Upon receipt of the required premium, the policy shall be issued in the normal manner and a copy of such poliy and all endorsement properly stamped "Georgia Workers' Compensation Assigned Risk Insurance Plan", furnished to the Administrator. The Carrier shall be credited with the premium for such renewal insurance.
(10) Any Assigned Carrier terminating, either by non-renewal or by cancellation, a Risk assigned to it shall notify the Risk and the Administrator in accordance with the provisions of O.C.G.A. 33-24-47.
(11) If any Risk is dissatisfied with its Assigned Carrier, the Risk may request reassignment upon expiration date.
(12) Any Carrier who wishes to insure a Risk as direct business may do so at any time provided that the Assigned Carrier shall not directly or indirectly request, encourage, or solict employers it insures under the Plan to utilize the services of any specific insurance agent, agency, broker or Insurer for purposes of providing voluntary workers' compensation insurance or other lines of insurance to such employer. If the Risk is taken out of the Plan, it shall be canceled on a pro-rata basis. The replacement Carrier shall receive the take-out credits provided for in this regulation.
(13) The commission paid to a Licensed Producer shall be based on the following percentages of the total premium charged and collected: eight (8%) percent for the first $1,000 in premium, five (5%) percent for the next $4,000, three (3%) percent for the next $95,000 and two (2%) percent for that portion of the premium over $100,000. However, if the employer designates a representative other than a Licensed Producer, the representative shall be deemed the Licensed Producer of record for all policy matters other than for payment of producer fee.
(a) The employer may designate a Licensed Producer, and with respect to any renewal of the assigned insurance, may change the designated Licensed Producer by notice to the Assigned Carrier.
(14) The Assigned Carrier shall complete a final audit and bill for any additional premium or refund excess premiums paid during the policy year within 90 (ninety) calendar days of policy expiration or cancellation.
(a)120-2-38.09(1) shall not apply when the Carrier can demonstrate to the satisfaction of the Commissioner that attempts were made in good faith to secure the relevant information from the Risk. In order for the Commissioner to allow an extension of the audit period, the Assigned Carrier must demonstrate to the Commissioner that the insured is not cooperative or that an extension is the result of a mutual agreement between the Carrier and the insured.
1. An Assigned Carrier may request an extension of the audit period by making application to the Commissioner. In order for the Commissioner to consider a request for extension, the application must be received by the Commissioner within 95 calendar days of the expiration or cancellation of the policy. The application must contain documentation of all attempts made by the Assigned Carrier to secure the relevant information. The application must also contain evidence that the employer has not been cooperative.
2. Receipt of an application for an audit extension by the Commissioner within 95 days will preserve the Assigned Carrier's right to any additional premium due as the result of the final audit, if the application is not subsequently disapproved by the Commissioner.
3. No application is required if an extension of the audit period is the result of a mutual agreement between the Carrier and the insured. The Carrier shall properly document their records with evidence that the extension was mutually agreed upon.
(b) Neither the Assigned Carrier nor the Administrator shall demand an additional premium resulting from an audit if the audit was not conducted in accordance with this regulation.
(c) The Administrator shall submit procedures including a standard application for audit extensions or a plan of operation to ensure compliance, and provide procedures to apportion write-offs for audits not conducted in accordance with this Regulation.
(d) Failure of the Assigned Carrier to conduct the audit within ninety (90) days or within an extended period approved by the Commissioner shall not relieve the Carrier from the duty to refund an excess premium.
(e) The Administrator shall file a policy or endorsement(s) which conforms with subparagraph (14) above.
(15) Proper classification of Risk and proper allocation of payroll shall be the duty of the Administrator or the Assigned Carrier.
(16) The Administrator or the Assigned Carrier shall categorize Risks written in accordance with this regulation.
(a) Manual rates for Groups 1, 2 & 3 shall be determined by applying a deviation factor for each group to Involuntary Rates.
(b) All Risks written with an effective date prior to the effective date of this regulation shall be properly categorized upon the first renewal following the effective date of this regulation.
(c) The Administrator shall file the deviation factors and applicable rules mandated by this regulation upon its effective date.
(17) The Assigned Carrier shall verify with the Risk the data to be submitted to the Administrator who shall determine the experience modification factor. Verification of such data shall be accomplished in accordance with this regulation:
(a) The Assigned Carrier shall provide the Risk with a copy of the statistical data being submitted to the Administrator. The statistical data shall be presented in a legible and understandable format. Technical terms shall be avoided wherever possible. It shall be permissible for the Insurer to provide the unit statistical report, by whatever name called, in lieu of an independently created form, provided the unit statistical report is accompanied by a legible and understandable explanation of the format of the unit statistical report.
(b) The disclosure statement contained in Form GID-63 attached hereto and incorporated herein, or one substantially the same, shall be attached to the statistical data provided to the Risk.
1. The disclosure shall provide a statement in bold face type, to be signed by an authorized representative of the Risk, that the statistical data has been reviewed and is accurate, and a representative of the Assigned Carrier has explained to the Risk's representative that the statistical data may affect the Risk's premium for the Plan.
2. The disclosure shall indicate that the statistical data will be deemed accurate if the disclosure is not returned to the address provided by the Assigned Carrier within 30 days from the date mailed.
(i) The Assigned Carrier shall deliver the statistical data and disclosure in person or by depositing the information in the United States mail to be dispatched by at least first-class mail to the last address of record of the Risk, and receiving the receipt provided by the United States Postal Service or such other evidence of mailing as prescribed or accepted by the United States Postal Service.
(ii) Statistical data that is deemed to be accurate will not in any way affect the right of the Risk to appeal to the Georgia Workers' Compensation Appeals Board.
3. The disclosure shall also provide a statement for an authorized representative of the Risk to dispute the accuracy of the data. The statement shall direct the Risk to clearly identify any discrepancies. The disputed data shall be furnished to the Assigned Carrier by the return date indicated on the disclosure statement.
(i) If the Assigned Carrier confirms the accuracy of the information provided by the Risk, the designated Carrier shall correct their records and proceed to furnish the amended data to the Administrator.
(ii) If the Assigned Carrier does not agree with the data provided by the Risk, the designated carrier shall submit the Carrier's date to the Administrator,
(I) The Assigned Carrier shall notify the Risk within 60 days of the original mail date that the experience modification factor will be promulgated from the information provided by the Assigned Carrier.
(II) The Risk shall be instructed, in detail, of its right to appeal to the Georgia Workers' Compensation Appeals Board.
(III) Failure to respond to the Risk in the time prescribed shall be deemed an acknowledgement that the insured's records are accurate, and amendments are to be made before reporting the statistical data to the Assigned Carrier.
(c) Verification of data shall not be mandatory for insureds who are not eligible for experience rating; however, the data and explanation shall be furnished to insureds upon request.
(18) Assigned Carriers shall provide the same type or level of services to Plan policyholders that it would to its voluntary business.
(19) Assigned Carriers shall provide cooperation to Plan policyholders wanting to implement safety programs. No Plan policyholders shall be denied a safety program or loss control program if so requested; provided, however, the Assigned Carrier shall only be obligated to provide such services that are reasonably commensurate with the exposures, hazards, loss experience and size of the policyholder's operations.
O.C.G.A. Secs. 33-2-9, 33-9-20, 33-9-21, 34-9-133, 33-24-47, 34-9-136.
