Administrative Rules of Montana › Department 24 - LABOR AND INDUSTRY › Chapter 24.29 - WORKERS' COMPENSATION AND OCCUPATIONAL DISEASE › Subchapter 24.29.6 - Plan 1 Self-Insurance › Rule 24.29.618 - INITIAL ELECTION-EMPLOYER GROUPS

Current through Register Vol. 13, July 5, 2024
(1) An employer group applicant shall provide
				the following:
(a) a completed application on
				forms provided by the department;
(b) a list of individual employers making up
				the employer group;
(c) a signed
				copy of the by-laws adopted by the employer group, and all documents pertaining
				to formation, operation and contractual arrangements, including amendments and
				addenda;
(d) a copy of an agreement
				signed by each individual employer showing:
(i) each employer's agreement to accept joint
				and several liability for all workers' compensation and occupational disease
				liabilities incurred by the employer group;
(ii) provisions for addition of a new member
				to the self-insured employer group;
(iii) provisions for withdrawal and expulsion
				of a member from the self-insured employer group;
(iv) provision for power of attorney between
				the individual employers and the self-insured employer group;
(v) agreement to be bound by the by-laws and
				by the employer group's decisions; and
(vi) provisions for assessment for
				deficits;
(e) a copy of
				at least the most recent year's audited financial statements, or reviewed
				financial statements, if audited statements are not prepared as part of the
				employer's normal business practice, from each member of the employer group.
				The total premiums payable to the group from employers having reviewed
				financial statements shall not constitute more than 10 percent of the group's
				total premium. The department or the guaranty fund may require copies of
				additional years' audited or reviewed financial statements from the
				applicant;
(f) evidence that each
				private employer in the group has been in business for a period of not less
				than three years;
(g) a claims
				summary from insurance carriers who provided coverage for claims incurred in
				Montana for each member of the employer group for the preceding three years;
(h) evidence of specific excess
				and if required, aggregate excess insurance with policy limits and retention
				amounts acceptable to the department and guaranty fund;
(i) a security deposit in an amount as
				required by the department, with the concurrence of the guaranty
				fund;
(j) evidence of its internal
				or contracted claims adjustment service in compliance with ARM
				24.29.804;
(k) identification of the financial
				institution the employer group will use to deposit and withdraw funds for
				purposes of paying workers' compensation and occupational disease
				liabilities;
(l) an explanation of
				how claims reserves will be established on each case and the method of review
				to assure accuracy and adequacy of the amount of the reserves;
(m) the estimated annual premium to be paid
				by each member of the employer group;
(n) a projection of annual administrative
				expenses;
(o) evidence that the
				employer group has an effective written safety and loss control
				program;
(p) evidence that internal
				policies and procedures are satisfactory to operate a group self-insurance
				program;
(q) resolution by each
				member authorizing participation in the program;
(r) resolution designating authorized
				signatures for participation in the program;
(s) a feasibility study conducted by a
				certified actuary to include an actuarial forecasting of losses and recommended
				premium levels;
(t) a business plan
				for the employer group;
(u) pro
				forma financial statements for each of the first five years of the employer
				group's operation, to include any assumptions made; and
(v) copies of any contracts including, but
				not limited to, contracts with an administrative service company, claims
				examiner, and fiscal agent.