Current through August, 2024
1 Statement of Purpose
The purpose of the Workers' Compensation Administration Fund is
to provide the funds necessary to administer Vermont's Workers' Compensation
program as constitutionally and statutorily mandated.
2 Definitions
As used in these Rules:
(a) "Commissioner" means the Commissioner of
the Department of Labor & Industry or his/her designee;
(b) "Workers' Compensation Program" means the
Workers' Compensation Program under Chapter 9 of Title 21 and the Compensation
for Occupational Diseases Program under Chapter 11 of Title 21;
(c) "Insurer" means an insurance carrier as
defined in
21 VSA §
601(8) authorized to
transact the business of insurance in this state;
(d) "Self insurer" means an employer approved
by the Commissioner under
21 VSA §
687(3) or a state, county or
municipal body that retains employees for public employment as that term is
defined in
21 VSA §
601(12).
(e) "Expenditures for administration of the
program" includes but is not limited to the operational costs of the Workers'
Compensation Program necessary to process and record all injury reports, review
and approve all compensation agreements, monitor payment and insurance company
compliance with the law, mediate disputes, conduct hearings and issue orders
when appropriate, and perform all other administrative responsibilities granted
under Chapters 9 and 11 of Title 21, but shall not include the payment of any
particular benefits claimed under either of said chapters;
(f) "Direct calendar year premium" means the
direct written workers' compensation premium reported to the Vermont Department
of Banking, Insurance and Securities and the National Association of Insurance
Commissioners;
(g) "Workers'
compensation losses" means all benefits [due or] paid and/or the reasonable
value of all services provided as a consequence of an employee's work-related
injury or illness under Chapters 9 and 11 of Title 21, but does not include
attorney's fees or costs under §
678 of
Title 21.
3 Reports by
insurers; Assessment
(a) Each insurer
authorized to transact the business of workers' compensation in this state
shall collect from each employer insured for claims under the Workers'
Compensation Act a Workers' Compensation Adminstration Fund assessment at the
rate of .70 percent of the direct calendar year premium for workers'
compensation insurance to be paid by each employer. Such assessment shall
appear separately on the premium notice, shall be noted as the Workers'
Compensation Administration Fund Assessment and shall not be reported as
premiums for tax or regulation purposes. Insurers shall be guarantors of
payment to the fund, but shall not be precluded from cancelling or refusing to
renew a workers' compensation insurance policy for an insured from whom
collection is not made despite reasonable efforts by the carrier to obtain
payment, pursuant to s
696
and
697
of Title 21.
(b) Estimated payment.
Commencing January 1, 1991 said assessment shall be due and payable as follows:
(1) The estimated assessment for the period
from January 1 through March 31 shall be due and payable no later than April
30;
(2) The estimated assessment
for the period from April 1 through June 30 shall be due and payable no later
than July 31;
(3) The estimated
assessment for the period from July 1 through September 30 shall be due and
payable no later than October 31;
(4) The estimated assessment for the period
from October 1 through December 31 shall be due and payable no later than
January 31.
(c) Each
quarterly payment referred to above shall be accompanied by a verified
statement, on a form prescribed by the Commissioner, indicating the estimated
direct written workers' compensation premiums billed during the preceding
quarter.
(d) A reconciliation
payment, representing the difference between the total of the quarterly
estimated assessments paid on the above-mentioned dates and the actual
assessment due as calculated according to the actual direct written workers'
compensation premium reported annually to the Vermont Department of Banking,
Insurance and Securities, shall be due and payable no later than March 15, 1992
and annually on March 15 thereafter.
Said reconciliation payment shall be accompanied by a verified
statement, on a form prescribed by the Commissioner indicating the total direct
written workers' compensation premium billed during the preceding calendar year
as reported annually to the Vermont Department of Banking, Insurance and
Securities, and the total quarterly estimated assessments already paid. Any
overpayment established by such reconciliation statement may be credited
against the next estimated quarterly payment due.
(e) Transition Period.
(i) The estimated assessment for the period
from July 1, 1990 through December 31, 1990 shall be due and payable no later
than February 1, 1991.
(ii) The
reconciliation statement and reconciliation payment if any for the above period
shall be due no later than March 15, 1991. Said statement shall separately list
the actual direct written workers' compensation premiums billed for the period
from January 1, 1990 through June 30, 1990 and for the period from July 1, 1990
through December 31, 1990. The total shall correspond to the total direct
written workers' compensation premiums billed during calendar year 1990 as
reported to the Vermont Department of Banking, Insurance &
Securities.
4 Reports by Self-Insurers; Assessment
(a) On or before March 1, 1992, and annually
on March 1 thereafter, each self insurer shall file a verified report, on forms
prescribed by the Commissioner, indicating the total amount paid for workers'
compensation losses during the preceding calendar year.
(b) Each self-insurer for workers'
compensation coverage shall pay annually a workers' compensation administration
fund assessment at the rate of one percent of the total amount paid [and/or
due] for workers' compensation losses during the preceding calendar year. Said
assessment shall be due and payable no later than March 1, 1992 and annually on
March 1 thereafter.
(c)
Notwithstanding the provisions of subparagraphs (a) and (b) above, with the
prior written approval of the Commissioner a self-insurer may elect to file its
report and pay the assessment due within 60 days of the close of its fiscal
year rather then on a calendar year basis.
(d) Transition period. The report and
assessment for the period from July 1, 1990 through December 31, 1990 shall be
due and payable no later than March 1, 1991.
5 Inspection of records; Audits
(a) The Commissioner may inspect, audit or
otherwise review and evaluate the records of any insurer or self-insurer of
workers' compensation liability in the state. Any such inspections or other
evaluation shall be made at reasonable times and in a manner reasonably
necessary to verify all information related to this section. In addition, at
least every three years an annual audit may be required, at the insurer's or
self-insurer's sole expense, which audit shall include a certification from a
certified public accountant verifying the accuracy of the direct written
workers' compensation premium and/or total amount of workers' compensation
losses reported for the audited period.
(b) A self-insurer's refusal to allow
reasonable inspection or verification shall be sufficient cause for the
revocation of the Commissioner's approval of self-insurance. After notice and
hearing the Commissioner may revoke such approval and order the employer to
obtain workers' compensation coverage pursuant to [687 of Title 21.
6 Refund
The Commissioner may credit or remit all or any part of an
assessment paid pursuant to these rules that is determined to have been paid or
collected erroneously.
7
Enforcement
An insurer or self-insurer who fails to comply with the
provisions of these rules shall be subject to prosecution by the Attorney
General upon referral by the Commissioner and in addition to the assessment
calculated pursuant to Rule 3(a) or 4(b) above also shall be liable for
interest, attorney's fees and other related costs of collection.
[Forms]
INSURER'S RECONCILIATION STATEMENT
|
1. |
Total direct written worker's compensation premium as
reported to the Vermont Department of Banking, Insurance and Securities on page
14, line 16, column (2) of the insurance carrier's annual
statement; |
$ ....
|
|
2. |
Actual annual assessment due
(line 1 X .007): |
$ ....
|
|
3. |
Quarterly assessments paid: |
|
April 15 |
$ .... |
|
July 15 |
$ .... |
|
October 15 |
$ .... |
|
January 15 |
$ .... |
|
Total: |
$ .... |
|
4. |
Balance due (line 2 - line 3): |
$ .... |
|
or |
|
Credit to be subtracted from |
|
next quarterly payment |
|
(line 3 - line 2): |
$ .... |
SELF-INSURER'S REPORT
|
1. |
Total Workers' Compensation Benefits paid for the
reporting period: |
|
(a) Indemnity |
$ .... |
|
(b) Medical |
$ .... |
|
(c) Total |
$ .... |
|
2. |
Assessment due |
|
(line 1(c) X .01) |
$ .... |
|
3. |
Claims for which benefits were paid for this reporting
period: |
|
Name |
Date of Injury |
State File # |
