Current through Register Vol. 35, No. 18, September 24, 2024
A. An insurer or
the assigned risk pool may require the following information from an employer,
client or leasing contractor making application for coverage:
(1) a list by jurisdiction of every name
under which an employer, client or leasing contractor has operated at any time
during the preceding five years, including but not limited to business names of
all predecessors-in-interest, together with the names of all insurers and
policy numbers of policies issued to the employer, client or leasing contractor
under each such name, and a copy of the leasing contractor's most recently
filed internal revenue service form 941 or equivalent;
(2) a list of every person and entity which
has owned a five percent or greater interest in the employer, client or leasing
contractor or any of their predecessors-in-interest at any time during the
five-year period immediately preceding the application;
(3) for each person and entity identified in
the preceding paragraph, a list of all other businesses in which each such
person and entity has owned a five percent or greater interest at any time
during the five-year period immediately preceding the application;
(4) a list by jurisdiction of every current
client of a leasing contractor, together with every name under which each
client has operated at any time during the five-year period immediately
preceding the application, and a copy of the most recently filed internal
revenue service form 941 or equivalent for each client;
(5) a sworn affidavit, signed by the chief
executive officer of each client and a responsible officer of its leasing
contractor, stating the names of each insurer and policy number of each
workers' compensation insurance policy issued to the client under each name
under which the client has operated at any time during the five-year period
immediately preceding the application;
(6) a list by name of all workers, giving the
social security number, classification code and wage of each; and
(7) a sworn affidavit, signed by the chief
executive office of each client and a responsible officer of its leasing
contractor, stating that all non-leased workers are covered by workers'
compensation coverage. In addition, the affidavit may be required to state the
name of all insurers, the policy numbers, the policy periods, the number of
workers and the aggregate payroll applicable to each classification code of the
non-leased workers. This affidavit may be required as often as an insurer or
the pool deems reasonably necessary.
B. Leasing contractors may assist in securing
and maintaining coverage for clients in the voluntary market or the pool;
provided, that this section does not authorize leasing contractors to act as
insurance agents and shall not be construed to exempt them from insurance agent
or other applicable licensing requirements.
C. Leasing contractors and clients shall
provide information in sufficient detail to satisfy the requirements of this
rule. Monthly reporting may be required.
D. If an employer provides both leased
workers and temporary workers to another, the leased workers shall be covered
as specified herein for leased workers of a leasing contractor and the
temporary workers shall be covered as specified for temporary
workers.
