Current through all regulations passed and filed through September 16, 2024
(A)
Public employer state (PES) agency that is not
currently participating in a settlement payment program may participate in the
lump sum settlement (LSS) direct reimbursement rating and payment program. A
PES agency participating in this program will have the LSS payments excluded
from the bureau's rate calculation process.
(1)
Requirements.
(a)
A PES agency shall make a three-year minimum commitment
to the LSS direct reimbursement payment and rating program.
(b)
The earliest
beginning date of the LSS program is July 1, 2004.
(c)
A PES agency
shall notify the bureau of its desire to participate in the LSS direct
reimbursement and payment program before the first day of the second month
following any quarter ending date to be effective the following quarter. For
example, if the PES agency chose to participate in the LSS program beginning
April 1, 2016, the request must be submitted before February 1, 2016. The
notification shall be made on the form provided by the bureau and signed by the
PES agency's designee.
(d)
A PES agency currently participating in a settlement
program is not eligible to participate in the LSS direct reimbursement payment
and rating program.
(2)
LSS rate
calculation.
(a)
All LSS payments will be treated the same whether the
result of a court-ordered settlement, an agency-negotiated settlement or any
other type of settlement.
(b)
Once a PES agency begins participating in the LSS
direct reimbursement and rating program, all LSS payments will be excluded from
the losses used to calculate the contribution rate for future policy
years.
(c)
When an agency terminates a LSS direct reimbursement
and rating program, the contribution rate will include all LSS payments that
were made by the bureau and not reimbursed by the PES agency.
(3)
LSS
reimburseemnt payments.
(a)
A LSS will be billed in the next month following the
date the LSS warrant was cashed.
(b)
The bureau will
bill a structured settlement to the PES agency as the warrant is
cashed.
(c)
The PES agency shall pay the LSS monthly bill within
thirty days of the billing date.
(d)
If the PES agency
fails to pay a LSS monthly bill within thirty days, the bureau will remove the
PES agency from the LSS direct reimbursement rating and payment program and the
bureau will include the outstanding LSS payments in the rate
calculation.
(e)
A PES agency may settle permanent total disability
(PTD) and death benefit claims in which the present value was previously used
in the rate calculations.
PES agencies will not be billed for the
settlement costs of PTD and death benefit claims in which the present value of
both medical and indemnity costs was included in contribution rate
calculations. These claims would likely be death benefit claims awarded before
January 1, 2001 and PTD claims awarded before January 1, 1996.
For PTD claims awarded between January
1, 1996 and December 31, 2000 and where the present value of the future
indemnity cost was previously included in the development of the agency's
contribution rates, the bureau will include only the medical portion of the
settlement amount in the quarterly billings.
(f)
A PES agency
shall file any dispute in writing, specifying the agency's objections to the
billing, with the bureau's direct billing department. The filing of a dispute
does not relieve or suspend the agency's obligation to pay the obligation.
Questions concerning the rate calculations should be directed to the bureau's
actuarial division.
(4)
Change in
status.
(a)
When a PES agency combines with another PES agency, the
succeeding agency's participation in this program will not be
affected.
(b)
A PES agency that is participating in a program and
transfers a portion of its operations to another agency shall continue to
participate in the program. Participation in this program by the agency to
which the operations were transferred will not be affected.
(c)
Where a PES
agency participating in a LSS direct reimbursement rating and payment program
becomes self-insured, the bureau will calculate a buyout and any obligations
owed by the PES agency under the program will be included in the
buyout.
(B)
Terminating a LSS
program.
(1)
A
PES agency may request, in writing, to terminate a LSS program after the three
year minimum commitment period has been completed. The agency's participation
in the program will automatically be renewed for another three years unless the
written request is submitted.
(2)
A PES agency
shall submit a request to terminate a program before the first day of the
second month of the quarter the three year commitment ends. For example, if the
PES agency started participating in the LSS program or its participation was
renewed for the policy year beginning July 1, 2013, the request must be
submitted before May 1, 2016.
(3)
Once a PES agency
terminates a LSS program, the agency is no longer eligible to participate in
this program.
Replaces: Part of 4123-17-35
