Pennsylvania Code
Title 34 - LABOR AND INDUSTRY
Part VIII - Bureau of Workers' Compensation
Chapter 125 - WORKERS' COMPENSATION SELF-INSURANCE
Subchapter B - GROUP SELF-INSURANCE
Section 125.132 - Definitions
Current through Register Vol. 54, No. 38, September 21, 2024
The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise:
Act-The Workers' Compensation Act (77 P. S. §§ 1-1038.2).
Administrator-An administrator as defined in section 801 of the act (77 P. S. § 1036.1).
Aggregate excess insurance-Insurance which provides that the excess insurer pays on behalf of or reimburses a fund for its payment of benefits on claims incurred during a policy period in excess of the retention amount to the excess insurer's limit of liability.
Applicant-A group of five or more homogeneous employers requesting approval of the Bureau to operate as a fund.
Board of trustees-The governing body of a fund.
Bureau-The Bureau of Workers' Compensation of the Department.
Claims service company-An individual, corporation, partnership or association engaged in the business of servicing a fund's claims, including the adjusting and handling of claims, the payment of benefits and the provision of required reports.
Contributions-The amount of money charged each member to fund the obligations and expenses of a fund. The term includes charges calculated and made known to the members prior to the beginning of each fund year, and adjustments to those charges made during the fund year by the board of trustees.
Department-The Department of Labor and Industry of the Commonwealth.
Dividends-Cash, contribution credits or similar distributions provided to the members from surplus.
Employer-An employer as defined in section 801 of the act.
Excess insurer-An insurance company authorized to transact the class of insurance listed in section 202(c)(14) of The Insurance Company Law of 1921 (40 P. S. § 382(c)(14)).
Fiscal agent-An individual, corporation, partnership or association engaged by a fund to carry out the fiscal policies of the fund and to invest, manage, hold and disburse fund assets. The board of trustees may delegate the duties of fiscal agent to the administrator.
Fund-A fund as defined in section 801 of the act. The fund shall assume the liabilities and obligations of its members under the act and the Occupational Disease Act.
Fund year-The fiscal year and annual reporting period of a fund, which shall consist of 12 calendar months, except for the first year, which may consist of fewer or more than 12 months as established by the Bureau.
Homogeneity-Homogeneity exists where a fund is comprised of homogeneous employers.
Homogeneous employers-Employers who have been assigned to the same classification series for at least 1 year or are engaged in the same or similar types of business, including political subdivisions.
Independent actuary-An independent actuary as defined in section 801 of the act.
Loss costs-The dollar amounts per unit of exposure attributable to the payment of losses under the act and the Occupational Disease Act, filed by a rating organization based on aggregate experience of all members of that rating organization and approved by the Insurance Commissioner under Article VII of the act (77 P. S. §§ 1035.1-1035.22).
Loss-cost multiplier-A factor approved by the Bureau for each fund which is multiplied against the loss costs to recoup the fund's administrative and operating costs and expenses, including:
(i) The fund's costs in connection with the examination, investigation, handling, adjusting and litigation of claims.
(ii) The cost of excess insurance, loss control services, underwriting services, assessments and taxes.
(iii) The fees and commissions for accountants, attorneys, actuaries, investment advisors and other specialists whose services are necessary for the operation and administration of the fund.
Member-An employer participating in a fund.
Occupational Disease Act-The Pennsylvania Occupational Disease Act (77 P. S. §§ 1201-1603).
Permit-A permit as defined in section 801 of the act.
Plan committee-A plan committee as defined in section 801 of the act.
Political subdivision-A political subdivision as defined in section 801 of the act.
Retention amount-The maximum amount of benefits a fund would be required to pay without reimbursement from the excess insurer under an aggregate or specific excess insurance policy.
Runoff fund-A fund which voluntarily terminated its permit or a fund whose permit was revoked by the Bureau.
Security-Security as defined in section 801 of the act.
Service company-A claims service company and all other individuals, corporations, partnerships or associations engaged by a fund to provide the fund with services such as legal assistance, underwriting, safety engineering, loss control, medical management, information analysis, statistics compilation, loss and expense report preparation and contribution development.
Specific excess insurance-Insurance which provides that the excess insurer pays on behalf of or reimburses a fund for its payment of benefits on each occurrence in excess of the retention amount to the excess insurer's limit of liability.
Surplus-Surplus as defined in section 801 of the act. In determining surplus, incurred but not reported claims shall be included in the calculation of incurred losses.
Trust agreement-A trust as defined in section 801 of the act.
Trustee-Each person serving as a member of the board of trustees.
This section cited in 34 Pa. Code § 125.155 (relating to homogeneity).
