Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 115.00 - Requirements applicable to workers' compensation insurance deductible plans › Section 115.03 - Requirements Applicable to All Workers' Compensation Deductible Plans

Current through Register 1525, July 5, 2024
(1)211 CMR 115.03(1)(a) through (h) shall be
			 adhered to in all workers' compensation deductible plans:
(a) All policy forms and rates related to an
			 Insurer's workers' compensation deductible plan shall be filed with and
			 approved by the Division prior to use in the Commonwealth as required by
			 law.
(b) The Insurer shall pay all
			 benefits required under the provisions of M.G.L. c. 152 directly to the
			 appropriate party. Subsequent to Insurer payment of any amount which falls
			 within the deductible limit(s), the Insurer shall seek reimbursement from the
			 Insured. Failure of the Insured to make complete reimbursement for deductibles
			 within 30 days of receipt of a bill from the Insurer shall constitute for
			 purposes of M.G.L. c. 152, § 55A, non-payment of premium and be grounds
			 for termination of the workers' compensation policy.
(c) The first dollar loss and expense
			 experience resulting from all workers' compensation deductible plans shall be
			 reported by the Insurer for all statistical purposes.
(d) Except as contained in 211 CMR 115.03(1),
			 the workers' compensation deductible plans may not provide cancellation
			 provisions that differ in any respect from those contained in the standard
			 Massachusetts workers' compensation policy.
(e) Retrospectively rated workers'
			 compensation policies, including any policy written pursuant to the LRARO,
			 shall not include any provision for deductibles or be combined in any way with
			 a workers' compensation deductible plan; provided, however, that the expense
			 portion of net premium after the application of a deductible credit on a large
			 deductible policy may be retrospectively adjusted to reflect all and only
			 legitimate expenses of the policy; and provided further, that such expenses of
			 the policy are borne by the insurer and reflected in the premium for the policy
			 pursuant to the rating formula promulgated by the Commissioner. No portion of
			 the rate other than the expense component may be retrospectively adjusted in
			 any manner for a Large Deductible Plan. No retrospective premium payment shall
			 be deemed to be a reimbursement of deductibles for any purpose.
(f) The entire cost of all claims under a
			 workers' compensation deductible plan relative to a particular Insured shall be
			 included in the experience data used to determine the experience modification
			 of that Insured, regardless of the requirement that reimbursement shall be made
			 for the deductible amount of any claim.
(g) All Small or Medium-sized Workers'
			 Compensation Deductible Plans shall require per-claim deductible amounts as
			 defined in
			 211 CMR 115.02, and
			 all Large Workers' Compensation Deductible Plans shall require a per claim or
			 per occurrence deductible of at least the minimum value defined in
			 211 CMR 115.02. No
			 other Workers' Compensation deductible plans shall be permitted.
(h) Large Deductible Plans may be offered
			 only in connection with policies not written through the Pool.