Code of Massachusetts Regulations
211 CMR - DIVISION OF INSURANCE
Title 211 CMR 115.00 - Requirements applicable to workers' compensation insurance deductible plans
Section 115.03 - Requirements Applicable to All Workers' Compensation Deductible Plans

(a) All policy forms and rates related to an Insurer's workers' compensation deductible plan shall be filed with and approved by the Division prior to use in the Commonwealth as required by law.

(b) The Insurer shall pay all benefits required under the provisions of M.G.L. c. 152 directly to the appropriate party. Subsequent to Insurer payment of any amount which falls within the deductible limit(s), the Insurer shall seek reimbursement from the Insured. Failure of the Insured to make complete reimbursement for deductibles within 30 days of receipt of a bill from the Insurer shall constitute for purposes of M.G.L. c. 152, § 55A, non-payment of premium and be grounds for termination of the workers' compensation policy.

(c) The first dollar loss and expense experience resulting from all workers' compensation deductible plans shall be reported by the Insurer for all statistical purposes.

(d) Except as contained in 211 CMR 115.03(1), the workers' compensation deductible plans may not provide cancellation provisions that differ in any respect from those contained in the standard Massachusetts workers' compensation policy.

(e) Retrospectively rated workers' compensation policies, including any policy written pursuant to the LRARO, shall not include any provision for deductibles or be combined in any way with a workers' compensation deductible plan; provided, however, that the expense portion of net premium after the application of a deductible credit on a large deductible policy may be retrospectively adjusted to reflect all and only legitimate expenses of the policy; and provided further, that such expenses of the policy are borne by the insurer and reflected in the premium for the policy pursuant to the rating formula promulgated by the Commissioner. No portion of the rate other than the expense component may be retrospectively adjusted in any manner for a Large Deductible Plan. No retrospective premium payment shall be deemed to be a reimbursement of deductibles for any purpose.

(f) The entire cost of all claims under a workers' compensation deductible plan relative to a particular Insured shall be included in the experience data used to determine the experience modification of that Insured, regardless of the requirement that reimbursement shall be made for the deductible amount of any claim.

(g) All Small or Medium-sized Workers' Compensation Deductible Plans shall require per-claim deductible amounts as defined in 211 CMR 115.02, and all Large Workers' Compensation Deductible Plans shall require a per claim or per occurrence deductible of at least the minimum value defined in 211 CMR 115.02. No other Workers' Compensation deductible plans shall be permitted.

(h) Large Deductible Plans may be offered only in connection with policies not written through the Pool.