Current through Rules and Regulations filed through March 20, 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.
