California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 8 - Office of the Director › Subchapter 2 - Administration of Self-Insurance Plans › Article 1 - Definitions › Section 15201 - Definitions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The following definitions apply in Articles 1 through 13
						of these regulations:
Actuarial Study. Also referred to as a 'study.' This is a
						complete actuarial study prepared by a qualified actuary presenting the full
						and complete results of the actuarial analysis and study performed by the
						actuary including, but not limited to, the requirements specified in section
						15209 for private self-insurers or
						section 15481 for self-insured groups. The
						study will also serve as the basis for the completion of the actuarial summary
						and be attached to the actuarial summary.
Actuarial Summary. Also referred to as a 'summary.' This
						is a summary of the study prepared by the same qualified actuary that prepared
						the study. The summary is taken directly from the actuarial study,
						electronically filed with the Office of Self-Insurance Plans, and shall include
						the data specified in sections
						15209 for private self-insurers or
						section 15481 for self-insured
						groups.
Adjusting Location. The office address designated in
						accordance with Section
						15402 of these regulations where
						the named administrator of the self-insurer fulfills his/her function.
In the event that claims are administered at the home of
						a telecommuting adjuster, the location shall be considered as a separate
						adjusting location for reporting and audit purposes unless the telecommuting
						adjuster reports to a California location of the administrator no less than
						weekly.
Administrative Agency. The person or firm that performs
						the day-to-day claims administration functions of a workers' compensation
						self-insurance program. The administrative agency may be:
(1) An independent contractor possessing a
					 certificate to administer and designated by a self-insurer to be the
					 administrative agency for all or a portion of its claims; or
(2) A partnership or corporation possessing a
					 master certificate to self-insure, which administers its own claims and the
					 claims of other affiliate or subsidiary self-insurers issued affiliate or
					 subsidiary certificates to self-insure under the same master certificate
					 number;
(3) A joint powers
					 authority possessing a master certificate to self-insure, which self
					 administers in whole or part the claims of its affiliate public self-insurers
					 issued affiliate certificates to self-insure under the same master certificate
					 number of the joint powers authority; or
(4) The claims department of an insurance
					 carrier admitted to transact workers' compensation insurance in California,
					 which is exempt from the requirement to possess a certificate to administer
					 under Labor Code Section
					 3702.1(a).
Administrative Director. The Administrative Director of
						the Division of Workers' Compensation within the Department of Industrial
						Relations.
Administrator. A competent person pursuant to Section
						15452 of these regulations, at an
						adjusting location, who is responsible for day-to-day management of an
						employer's self-insurance workers' compensation program. The responsibility
						includes but is not limited to, the making and reviewing of decisions relating
						to the furnishing of all workers' compensation benefits in accordance with law
						and the maintenance of the self-insurer's claim records.
Affiliate Certificate.
(1) A type of certificate to self-insure
					 issued to a private self-insurer that has common ownership to another private
					 self-insurer holding a master certificate to self-insure, but the affiliated
					 certificate holder is not a subsidiary to the master certificate holder;
					 or
(2) A type of certificate to
					 self-insure issued to a public self-insurer that is a member of a joint powers
					 authority for pooling of workers' compensation liabilities with the master
					 certificate number issued to the joint powers authority.
(3) A type of certificate to self-insure
					 issued to a private self-insurer that is a member of a group self-insurer for
					 pooling of workers' compensation liabilities under the master certificate
					 number issued to the group self-insurer.
Alternative Composite Deposit. A security deposit system
						pursuant to Labor Code Section
						3701.8 whereby
						all eligible private self-insurers collectively secure, in whole or in part,
						aggregate self-insured worker's compensation liabilities through the
						Self-Insurer's Security Fund.
Audit. Any examination of self-insured workers'
						compensation claim files performed by or at the request of the Office of
						Self-Insurance Plans pursuant to Labor Code Section
						3702.6.
Board of Trustees. In group self-insurance, the
						representative body in a group self-insurer selected by the group members to be
						responsible for managing the assets and directing the affairs of the group
						self-insurer corporation and assuring the group self-insurer, through the group
						members, is financially sound and able to meet the workers' compensation
						liabilities under the statutes and regulations applicable in California.
Cancellation of Surety Bond. An act whereby the surety
						gives written notice to the Chief, as beneficiary of the workers' compensation
						self-insurance surety bond, that the surety is terminating its contractual
						obligations under the named bond pursuant to Sections
						996.320
						and
						996.330
						of the California Code of Civil Procedure and the liability of the surety bond
						after the effective date of the cancellation is set forth in Section
						996.360
						of the California Code of Civil Procedure.
Certificate to Administer. A Certificate of Consent to
						Administer self-insured workers' compensation claims issued to an
						administrative agency, except exempt insurance carriers, pursuant to Labor Code
						Section
						3702.1.
Certificate to Self-Insure. A Certificate of Consent to
						Self-Insure issued to an employer pursuant to Section
						3700(b)
						of the Labor Code.
Chief. The Chief, Office of Self-Insurance Plans, in the
						Department of Industrial Relations.
Claim File. A case file containing all pertinent
						documents and matters relating to a specific work-injury claim. The claim file
						contents are specified in Section
						15400 of these regulations.
Claim Log. A manual or electronic listing of workers'
						compensation claims maintained by the self-insurer or administrative agency for
						the self-insurer. The claim log for private self-insurers shall list each work
						injury claim by the calendar year in which the claim was reported to the
						employer or the claims administrator, whichever first occurred. The log for
						public self-insurers shall list each work injury claim by the fiscal year in
						which the claim was reported. The claim log contents are specified in Section
						15400.1 of these
						regulations.
Closed Claim. A work-injury claim in which future
						provision of benefits cannot be reasonably expected to be due.
Compensation. Compensation as defined in Labor Code
						Section
						3207, which
						includes every benefit or payment conferred by Division 4 of the Labor Code on
						an injured employee or the employee's dependents.
Contribution. The amount of payments required of each
						group member in order to fund the compensation and deposit obligations of the
						group self-insurer.
Director. The Director of the Department of Industrial
						Relations.
Exoneration of Surety Bond. The discharge of a surety
						from all past, present and future liability under its workers' compensation
						self-insurance surety bond by the execution of a "Release of Surety", Form
						A4-24 (Rev. 11/92) by the Chief.
First Aid. First Aid as defined in Labor Code Section
						5401(a).
Group Administrator. The individual or business entity
						authorized to serve as the representative of a group self-insurer and its group
						members to execute the policies of the Board of Trustees of the group
						self-insurer and manage the activities of the group self-insurer
						corporation.
Group Member. A private employer issued an Affiliate
						Certificate as a member in a group self-insurance program that has, in turn,
						been issued a Certificate to Self-Insure as a group self-insurer.
Group Self-Insurer. A private, non-profit, mutual benefit
						corporation, a private, non-profit charitable corporation, a private,
						non-profit public benefit corporation, or a private, non-profit religious
						corporation created as set forth in Section
						15470 of these regulations and
						pursuant to Part 3 of Division 2 of Title 1 of the California Corporation Code.
						Said corporation shall be established for the sole purpose of operating a group
						workers' compensation self-insurance program to pool the California workers'
						compensation liabilities of two or more private employers in the same
						homogeneous grouping pursuant to Section
						15473. These regulations are not
						intended to deem a group self-insurer issued a Certificate of Consent to
						Self-Insure pursuant to Labor Code Section
						3700,
						subdivision (b) to be an insurance company subject to regulations governing
						insurers contained in Title 10, California Code of Regulations, except as
						otherwise provided by statute and by Title 8, California Code of
						Regulations.
Indemnity Agreement and Power of Attorney. The written
						agreement executed by each group member or proposed group member of a group
						self-insurer pursuant to Section
						15479 of these regulations.
Indemnity Claim. A work-injury case which has or may
						result in any of the following benefits:
(1) Temporary Disability or salary in lieu
					 thereof, including benefits provided under Labor Code Sections
					 4800 and
					 4850
(2) Permanent Disability
(3) Life Pension
(4) Death Benefits
(5) Vocational Rehabilitation
(6) Supplemental Job Displacement Benefit
					 Voucher
Industry. Employer classification as determined using the
						first three (3) digits of the North American Industry Classification System
						Code (NAICS Code), provided by the United States Department of Commerce, Bureau
						of Management and Budget.
Joint Powers Authority. A public entity created by
						agreement of two or more public agencies pursuant to Division 7, Chapter 5,
						Article 1, Sections
						6500 et seq. of the California
						Government Code. These regulations apply only to Joint Powers Authorities who
						have among their purposes for existence, the forming of workers' compensation
						liability pooling arrangements.
Labor Code. The Labor Code of the State of
						California.
Manager. The Manager, Office of Self-Insurance Plans, in
						the Department of Industrial Relations. (Synonymous with Chief, above.)
Medical-Only Claim. A work-injury case which does not
						result in compensable lost time but results in medical treatment beyond first
						aid.
NOTE: Payment of medical examinations pursuant to Labor
						Code Section
						4600 will be
						considered a medical payment.
Office of Self-Insurance Plans. The Department of
						Industrial Relations, Office of Self-Insurance Plans, that is responsible for
						the oversight and regulation of Workers' Compensation self-insurance programs
						under these regulations.
Open Claim. A work-injury case in which it appears that
						one or more future payments of workers' compensation benefits may be
						due.
Public Self-Insurer or Public Self-Insured
						Employer.
(1) Any county, city, school
					 district, special purpose district, joint powers authority or other municipal
					 corporation which has applied and received approval to be self-insured by the
					 Office of Self-Insurance Plans.
(2)
					 Any sub-agency of a public agency which is created by or pursuant to statute,
					 ordinance, or other legislative act, including but not limited to planning
					 commissions, library or park boards, commissions, and agencies which has
					 applied and received approval to be self-insured by the Office of
					 Self-Insurance Plans.
Qualified Actuary. A qualified actuary is any actuary
						that meets the minimum standards of experience, certification, licensure,
						insurance, and qualifications set forth in section
						15209, subdivisions (a)(2) and (3),
						for private self-insurers or section
						15481, subdivisions (a)(3) &
						(4), for self-insured groups.
Release of Surety Bond. Action of Chief of Self-Insurance
						Plans by which a surety is exonerated. A released surety bond does not
						constitute part of the security deposit of a self-insured entity.
Security Fund. The Self-Insurer's Security Fund as
						established by Labor Code section
						3742.
Self-Insurer. An individual public or private sector
						employer or joint powers authority or private group of employers that has been
						issued and lawfully holds a valid Certificate to Self-Insure its workers'
						compensation liabilities pursuant to:
(1) The provisions of Section
					 29(a), Chapter
					 586, Laws of 1917 and amendments thereto; and/or
(2) Labor Code, Section
					 3700(b)
					 for private sector employers or 3700(c) for public sector employers.
Special Audit. Any audit performed other than that in
						accordance with Labor Code Section
						3702.6.
Subsidiary Certificate. A type of certificate to
						self-insure issued to a subsidiary of a self-insurer, where the self-insurer
						holds the master certificate to self-insure.
Termination of Surety Bond. See definition of
						"Cancellation of Surety Bond".
Work-Injury Claim. An injury that is reported or
						reportable to the Division of Labor Statistics and Research pursuant to Labor
						Code Sections
						6409,
						6409.1 and
						6413.