Code of Maine Rules
02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION
031 - BUREAU OF INSURANCE
Chapter 450 - WORKERS' COMPENSATION INSURANCE - EXPERIENCE RATING
Section 031-450-5 - Revision of Loss Reports Used in the Experience Rating Calculation
Current through 2024-38, September 18, 2024
The experience rating plan filed by the designated advisory organization shall provide for the submission of corrected incurred loss reports for the purpose of recalculating the employer's experience modification factor. If the correction results in a decrease, it shall apply retroactively to the current policy from its date of inception and to all affected policies in force at any time during the two-year period preceding the current policy's effective date, or such longer period as may be specified in the plan. Valid reasons for filing a corrected loss report must include, at a minimum:
A. Erroneous information. If the original loss report did not accurately report the insurer's paid loss and reserve, or if the employer can demonstrate that the information used by the insurer in paying a loss or estimating an incurred loss was incorrect and that the insurer knew or should have known at the time of the payment date or required valuation date that the information was incorrect.
B. Third-party recovery. If the insurer receives a payment in satisfaction or compromise of a claim against a third party arising out of the same occurrence as a claim against the employer, the amount of the recovery, net of reasonable equitably apportioned litigation costs, shall be deducted from the incurred loss to the extent that the anticipated recovery was not previously recognized in calculating the incurred loss. For revisions made under this Subsection, the minimum required period of retroactivity for corrections shall be extended from two years to four years preceding the current policy's effective date.
C. Change in governing classification. When an employer's operations are reclassified and the reclassification is not based on a change in operations, the employer's experience modification factor shall be recalculated, effective the same day as the reclassification becomes effective, on the basis of expected loss figures for the experience period that are consistent with the new classification.
