reglab/statecodes huggingface dataset:
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 125.144 - Revocation and voluntary termination of permit

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Upon the revocation or voluntary
				  termination of a permit under sections 805(a) or 808(c) of the act
				  (77
				  P. S. §§
											1036.5 and
				  1036.8), members shall insure
				  their liabilities to pay compensation as required by the act.
(b) Upon the approval of the Bureau, a
				  revoked or terminated fund may be allowed to operate as a runoff fund to pay
				  claims incurred during the effective period of its permit from assets currently
				  on hand or from assessments of its members. Absent this approval, a revoked or
				  terminated fund shall make its best efforts to insure the workers' compensation
				  liability incurred prior to the revocation or termination of its permit with a
				  carrier licensed to write workers' compensation in this Commonwealth. The
				  revoked or terminated fund shall pay insurance premiums from its assets and
				  from assessments of its members, if necessary.
(c) Upon proof provided to the Bureau that a
				  revoked or terminated fund is unable to obtain insurance coverage for the
				  workers' compensation liability incurred prior to the revocation or termination
				  of its permit, the revoked or terminated fund shall operate as a runoff fund
				  and shall pay claims on the liability from its assets and from assessments of
				  its members.
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 125.145 - Merger of funds

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Subject to
				  the prior written approval of the Bureau, a fund may merge with another fund
				  with the same homogeneous characteristics if the resulting fund assumes in full
				  all obligations of the merging funds.
(b) The resulting fund may be a continuing
				  fund under the name of one or more of the merged funds or a new fund whose name
				  shall be subject to the Bureau's approval. In all respects, the continuing fund
				  or the new fund shall be subject to this subchapter. Funds merging under this
				  section shall enter into a written agreement for the merger prescribing the
				  merger's terms and conditions. The agreement shall be the following:
(1) Assented to by a majority of the plan
				  committee and the board of trustees of each fund.
(2) Executed in duplicate by a majority of
				  the board of trustees of each fund.
(3) Accompanied by copies of the resolutions
				  authorizing the merger and the execution of the agreement attested by the
				  recording officer of each fund.
(4)
				  Submitted to the Bureau, with the records of the fund pertaining
				  thereto.
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 125.146 - Payment of dividends

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Payment
				  of dividends to members as permitted in section 809 of the act (77 P. S. §
											1036.9) may not be made sooner than 60 days
				  following a fund's filing of its annual report as required by §
										125.141 (relating to annual
				  report). A runoff fund may not pay dividends sooner than 60 days following its
				  filing of the report required by §
										125.150 (relating to runoff
				  fund).
(b) If the Bureau determines
				  that the payment of proposed dividends may impair the fund's ability to meet
				  its obligations or may violate other provisions of section 809 of the act, it
				  will notify the fund that the dividend payment is prohibited. The notification
				  will be sent to the fund no later than 45 days after the filing of the annual
				  report. Payment of dividends which have not been approved by the Bureau will
				  result in the revocation of the fund's permit under section 805(a) of the act
				  (77
				  P. S. §
											1036.5(a)).
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 125.147 - Special funds assessments

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A fund
				  is responsible for the payment of assessments to maintain funds under the act,
				  including:
(1) The Workmen's Compensation
				  Administration Fund.
(2) The
				  Subsequent Injury Fund.
(3) The
				  Workmen's Compensation Supersedeas Fund.
(4) The Self-Insurance Guaranty
				  Fund.
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 125.148 - Security

Current through Register Vol. 54, No. 28, July 13, 2024
The security required in §
										125.134(d)(2)
					 (relating to decision on application) shall be in one of the following
					 forms:
(1) A surety bond on a form
				  prescribed by the Bureau issued by a company authorized to transact surety
				  business in this Commonwealth by the Insurance Department.
(i) The surety company shall possess a
				  current A.M. Best Rating of B+ or better or a Standard and Poor's rating of
				  claims paying ability of A or better.
(ii) The fund shall replace the bond with a
				  new bond issued by a surety company with an acceptable rating or with another
				  acceptable form of security if the surety company's rating falls below the
				  acceptable rating after the bond is issued. If the bond is not replaced within
				  60 days, the Bureau will have discretion to draw on the surety bond and deposit
				  the proceeds with the State Treasurer to secure the fund's
				  obligation.
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 125.149 - Specific excess insurance and aggregate excess insurance

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A fund shall
				  obtain specific excess insurance with a retention amount and liability limit
				  acceptable to the Bureau. The Bureau may waive this requirement upon written
				  request if the fund demonstrates that it has sufficient financial strength and
				  liquidity to assure that all obligations under the act and the Occupational
				  Disease Act will be promptly met without the protection of an excess insurance
				  policy.
(b) Aggregate excess
				  insurance may be obtained by a fund. The Bureau will not recognize a contract
				  or policy of aggregate excess insurance in considering the ability of a fund to
				  fulfill its financial obligations unless the contract or policy complies with
				  subsection (c).
(c) The contract or
				  policy of aggregate excess insurance or specific excess insurance, or both,
				  shall comply with the following:
(1) It shall
				  be issued by an excess insurer which possesses an A. M. Best Rating of B+ or
				  better or a Standard and Poor's rating of claims paying ability of A or
				  better.
(2) It shall state that it
				  is not cancelable or nonrenewable unless written notice by registered or
				  certified mail is given to the other party to the policy and to the Bureau at
				  least 45 days before termination by the party desiring to cancel or not renew
				  the policy.
(3) It shall state that
				  if the fund is unable to make benefit payments under the act and the
				  Occupational Disease Act due to insolvency or bankruptcy, the excess carrier
				  shall make the payments to other parties involved in the paying of the fund's
				  obligations, as directed by the Bureau, subject to the policy's retentions and
				  limits.
(4) It shall state that the
				  following apply toward reaching the retention amount in the excess contract:
(i) Payments made by the fund.
(ii) Payments made on behalf of the fund
				  under a surety bond or other forms of security as required under this
				  subchapter.
(iii) Payments made by
				  the Self-Insurance Guaranty Fund.
(5) It shall state that it applies to any
				  losses of a fund under the act and the Occupational Disease Act; it may not
				  exclude coverage for any categories of injuries or diseases compensable under
				  the act or the Occupational Disease Act.
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 125.150 - Runoff fund

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A runoff fund
				  shall pay any obligations, prepare reports and administer transactions
				  associated with the period when it was an approved fund. A runoff fund shall
				  continue to comply with appropriate provisions of this subchapter as determined
				  by the Bureau.
(b) A runoff fund
				  shall file an annual report with the Bureau by a date prescribed by the Bureau
				  on a prescribed form. This report shall be filed until all cases incurred by
				  the runoff fund when it was a permittee are closed. The report shall include
				  the information outlined in section 815(b) of the act (77 P. S. §
											1036.15(b)).
This section cited in 34 Pa. Code §
												125.146 (relating to payment of
						dividends).
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 125.151 - Claims service companies

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A
				  claims service company desiring to engage in the business of handling and
				  adjusting claims for a fund shall register with the Bureau as provided under
				  section 441(c) of the act (77 P. S. §
											997(c)), and regulations
				  thereunder, on a prescribed form before entering into any contract to provide
				  these services. The service company shall answer the questions on the
				  registration form and shall swear to the information provided on the
				  form.
(b) A claims service company
				  shall have adequate facilities and employ competent staff to provide claims
				  services in a manner which fulfills a fund's obligations under the act, the
				  Occupational Disease Act and this part. A claims service company which
				  reportedly or unreasonably fails to provide claims adjusting or services
				  promptly with the results that compensation is not paid as required under the
				  act or the Occupational Disease Act may have the privilege of conducting the
				  business revoked or suspended under section 441(c) of the act.
(c) The claims service company shall employ
				  at least one person on a full-time basis who has the knowledge and experience
				  necessary to service claims under the act and the Occupational Disease Act. A
				  resume covering that person's background shall be attached to the registration
				  form of the claims service company.
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 125.152 - Board of trustees

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The
				  board of trustees of a fund shall establish the fund's policies, ensure its
				  fiscal stability and engage and delegate functions to its administrator, fiscal
				  agent and service companies on behalf of the plan committee.
(b) Trustees shall be appointed by a fund's
				  plan committee in accordance with the trust agreement and the bylaws.
(c) At least 2/3 of a fund's trustees shall
				  be members of its plan committee. A member may not be represented by more than
				  one trustee on the board of trustees. A fund's administrator, service companies
				  or an officer, owner, employe of or another person or corporation affiliated
				  with the administrator or service companies may not serve as a voting trustee,
				  unless the administrator or service company is an organization consisting of
				  political subdivisions, the income of which is not subject to Federal income
				  taxation. An administrator or service company may serve as a nonvoting
				  trustee.
(d) Each trustee shall act
				  as a fiduciary for the benefit of employees of members and shall carry out his
				  powers and responsibilities under the trust agreement independent of any powers
				  and responsibilities he may possess or exercise as an employee, officer or
				  director of a member.
(e) If an
				  association of employers assist in the establishment of more than one fund, the
				  plan committees of the several funds may decide to participate in a single
				  board of trustees to oversee the operations of the several funds. The following
				  restrictions and requirements apply to that single board of trustees:
(1) Each of the several funds shall be
				  equally represented on the board of trustees.
(2) The pledge of joint and several liability
				  of a member of a fund applies only to the liabilities and obligations of that
				  member's fund; it does not apply to the other funds participating in the single
				  board of trustees.
(3) Only the
				  trustee-representatives of a specific fund shall vote on matters relating to
				  the amendment of that fund's trust agreement or bylaws.
(4) Only the trustee-representatives of a
				  specific fund shall set policies and make determinations governing the
				  admission of members and the requirements for membership in that
				  fund.
(5) At least 2/3 of the
				  single board of trustees shall be members of the plan committees of the several
				  funds. Other restrictions on the makeup of the board outlined under subsection
				  (c) also apply to the single board of trustees.
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 125.153 - Additional powers of Bureau

Current through Register Vol. 54, No. 28, July 13, 2024
In addition to the powers enumerated elsewhere in this
					 subchapter and the act, the Bureau will have the authority, after notice and
					 opportunity for hearing, to suspend a fund's operation, to issue cease and
					 desist orders and to order corrective actions if a fund, its administrator or
					 service companies are in violation of this subchapter or the
					 act.
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 125.154 - Hearings

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The Director of
				  the Bureau will assign appeals to decisions or orders issued under this
				  subchapter and Article VIII of the act (77 P.S §§
											1036.1- 1036.18) to a hearing officer who
				  will schedule a de novo hearing on the appeal from the initial decision or
				  order. The applicant or the fund will receive reasonable notice of the hearing
				  date, time and place.
(b) The
				  hearing will be conducted in a manner to provide the applicant or the fund and
				  the Bureau the opportunity to be heard. The hearing officer will not be bound
				  by strict rules of evidence. Relevant evidence of reasonably probative value
				  may be received into evidence. Reasonable examination and cross-examination of
				  witnesses will be permitted.
(c)
				  Testimony will be recorded and a full record kept of the proceeding. The Bureau
				  and the applicant or the fund will be provided the opportunity to submit briefs
				  addressing issues raised.
(d)
				  Following the close of the record, the hearing officer will promptly issue a
				  written decision and order. The decision and order will include relevant
				  findings and conclusions, and state the rationale of the decision. The decision
				  will be served upon the applicant or the fund, the Bureau and counsel of
				  record.
(e) An applicant, fund or
				  the Bureau, aggrieved by a decision rendered under subsection (d), may appeal
				  the decision to Commonwealth Court.
This section cited in 34 Pa. Code §
												125.142 (relating to maintenance
						of fund permit).
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 125.155 - Homogeneity

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The definition
				  of "homogeneous employer" under section 801 of the act (77 P. S. §
											1036.1) and under §
										125.132 (relating to definitions)
				  is deemed satisfied as to employers who have been assigned to the same
				  classification series if the members derive a majority of their contributions
				  from codes within the same classification group listed in a manual of risk
				  classes approved by the Commissioner of the Insurance Department under Article
				  VII of the act (77 P. S. §§
											1035.1-1035.22).
(b) The definition of "homogeneous employer"
				  under section 801 of the act and under §
										125.132 is deemed satisfied as to
				  employers engaged in the same or similar types of business if the members have
				  been assigned to the same two-digit major group of the four-digit Standard
				  Industrial Classification system published by the Federal Office of Management
				  and Budget or if the members have been assigned to three-digit industry groups
				  outside of the primary two-digit major group which the Bureau has determined
				  share substantial common aspects of production or services with the industries
				  within the primary two-digit major group.
(c) Prospective members affiliated through
				  common ownership or control shall be considered one employer for the purpose of
				  calculating the number of homogeneous employers participating in a
				  fund.
(d) Political subdivisions
				  are homogeneous employers. Political subdivisions may not participate in funds
				  which include employers who are not political subdivisions.
This section cited in 34 Pa. Code §
												125.133 (relating to
						application).
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 125.156 - Computation of time

Current through Register Vol. 54, No. 28, July 13, 2024
Unless otherwise provided, reference to "days" in this
					 subchapter shall mean calendar days. For purposes of determining timeliness of
					 filing and receipt of documents transmitted by mail, 3 days shall be presumed
					 added to the prescribed period. If the last day for filing a document is a
					 Saturday, Sunday, legal holiday or a day on which the Bureau's offices are
					 closed, the time for filing shall be extended to the next business day.
					 Transmittal by mail shall mean by first-class mail.
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 125 - WORKERS' COMPENSATION SELF-INSURANCE › Subchapter C - SELF-INSURING GUARANTY FUND › Section 125.201 - Purpose

Current through Register Vol. 54, No. 28, July 13, 2024
This subchapter is promulgated under sections 435 and 908
					 of the act (77 P. S. §§
											991 and
					 1037.8) to provide regulatory
					 guidelines for uniform and orderly administration of the guaranty
					 fund.
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 125 - WORKERS' COMPENSATION SELF-INSURANCE › Subchapter C - SELF-INSURING GUARANTY FUND › Section 125.203 - Default

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Upon receipt of
				  information that a self-insurer has failed to pay compensation due under the
				  act or the Occupational Disease Act, the Bureau will investigate whether the
				  failure to pay compensation has occurred and, if it has, determine the reason
				  for that failure.
(b) If the Bureau
				  determines that the failure to pay compensation may be due to the
				  self-insurer's financial inability to pay compensation, the Bureau will notify
				  the self-insurer of its determination and direct the compensation to be paid
				  within 15 days of the receipt of the notice.
(c) If the self-insurer fails to pay the
				  compensation as directed within 15 days, the Bureau will declare the
				  self-insurer in default. The Bureau also may at any time declare a self-insurer
				  to be in default if the self-insurer fails to pay compensation due to a filing
				  for bankruptcy or being declared bankrupt or insolvent.
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 125 - WORKERS' COMPENSATION SELF-INSURANCE › Subchapter C - SELF-INSURING GUARANTY FUND › Section 125.204 - Procedures following default

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
				  After the Bureau declares a default, it will determine whether the liabilities
				  of the self-insurer exceed or are less than the self-insurer's
				  security.
(b) If the defaulting
				  self-insurer's liabilities are less than the security, the Bureau will notify
				  the custodian of the security that it shall utilize the security to cure the
				  default. The Bureau will monitor payments made by the custodian of the security
				  to ensure that compensation is paid as due under the act or the Occupational
				  Disease Act.
(c) If at any time the
				  defaulting self-insurer's liabilities exceed or can reasonably be expected to
				  exceed the security, the Bureau will order payment of the security into a
				  self-insurer account within the appropriate custodial account. The funds
				  deposited into each self-insurer account and the interest thereon will be used
				  solely for the payment of compensation or costs associated therewith to
				  employes of the defaulting self-insurer providing the security.
(d) After the assets of a self-insurer
				  account have been exhausted, compensation shall be paid from funds obtained
				  through assessments made and collected under section 907 of the act
				  (77
				  P. S. §
											1037.7) and related provisions
				  of this subchapter and interest thereon.
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 125 - WORKERS' COMPENSATION SELF-INSURANCE › Subchapter C - SELF-INSURING GUARANTY FUND › Section 125.205 - Allocation of security

Current through Register Vol. 54, No. 28, July 13, 2024
When a security instrument posted by a self-insurer applies
					 to claims resulting from injuries and exposures occurring both prior to and on
					 or after the establishment of the guaranty fund, the Bureau may order payment
					 of a portion of the security into a self-insurer account under section 904
					 (d)(2)(ii) of the act (77 P. S. §
											1037.4(d)(2)(ii)) for the
					 payment of compensation on claims resulting from injuries and exposures
					 occurring on or after the establishment of the guaranty fund. The portion of
					 the security retained by the custodian of the security shall be used for the
					 payment of compensation on claims resulting from injuries and exposures
					 occurring prior to the establishment of the guaranty fund.
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 125 - WORKERS' COMPENSATION SELF-INSURANCE › Subchapter C - SELF-INSURING GUARANTY FUND › Section 125.206 - Payments to claimants

Current through Register Vol. 54, No. 28, July 13, 2024
When payment of compensation is ordered by the Bureau from
					 the guaranty fund relating to a defaulting self-insurer, compensation in
					 arrears to the claimants will be paid within 15 days of the issuance of the
					 order. After the initial payment of compensation, compensation will be paid in
					 the same manner as the defaulting self-insurer would be required to make those
					 payments under the act or the Occupational Disease Act.
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 125 - WORKERS' COMPENSATION SELF-INSURANCE › Subchapter C - SELF-INSURING GUARANTY FUND › Section 125.207 - Assessment of new individual self-insurer

Current through Register Vol. 54, No. 28, July 13, 2024
As a condition for the issuance of a permit to operate as
					 an individual self-insurer under section 305 of the act (77 P. S. §
											501), an applicant shall submit to the Bureau
					 the calculation of its modified manual premium on a form prescribed by the
					 Bureau. Following the receipt of the calculation form and the commencement of
					 the applicant's self-insurance status, the Bureau will issue a notice to the
					 new self-insurer assessing it for the guaranty fund based on 1/2% of its
					 modified manual premium. The new self-insurer shall pay the assessment in the
					 time prescribed by the Bureau.
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 125 - WORKERS' COMPENSATION SELF-INSURANCE › Subchapter C - SELF-INSURING GUARANTY FUND › Section 125.208 - Assessment of new group self-insurance fund

Current through Register Vol. 54, No. 28, July 13, 2024
As a condition for the issuance of a permit to operate as a
					 group self-insurance fund under Article VIII of the act (77 P. S.
					 §§
											1036.1-1036.18), an applicant
					 shall submit to the Bureau the calculation of each member's modified manual
					 premium on a form prescribed by the Bureau. Following the receipt of the
					 calculation forms and the commencement of the applicant's group self-insurance
					 status, the Bureau will issue a notice to the new group self-insurance fund
					 assessing it for the guaranty fund based on 1/2% of the total of its members'
					 modified manual premiums. The new group self-insurance fund shall pay the
					 assessment within 30 days of the receipt of the assessment.
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 125 - WORKERS' COMPENSATION SELF-INSURANCE › Subchapter C - SELF-INSURING GUARANTY FUND › Section 125.209 - Assessment of new member of group self-insurance fund

Current through Register Vol. 54, No. 28, July 13, 2024
As an existing group self-insurance fund adds new members,
					 it shall submit the form prescribed by the Bureau calculating each new member's
					 modified manual premium. Following the receipt of the calculation form, the
					 Bureau will issue to the group self-insurance fund a notice assessing it for
					 the guaranty fund based on 1/2% centum of the total of its new members'
					 modified manual premiums. The group self-insurance fund shall pay the
					 assessment within 30 days of the receipt of the assessment.
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 125 - WORKERS' COMPENSATION SELF-INSURANCE › Subchapter C - SELF-INSURING GUARANTY FUND › Section 125.210 - Assessment of existing self-insurer

Current through Register Vol. 54, No. 28, July 13, 2024
(a) If the liabilities of the guaranty fund
				  exceed its assets, including funds deposited into the guaranty fund under
				  section 906(a)(1) of the act (77 P. S. §
											1037.6(a)(1)), the Bureau
				  may assess self-insurers for the additional amount needed to satisfy the
				  liabilities under section 907(b)(1) of the act (77 P. S. §
											1037.7(b)(1)).
(b) The Bureau will give notice to each
				  self-insurer of the amount assessed against the self-insurer under this
				  section. Payment of the assessment shall be made within 30 days of the receipt
				  of the assessment.
(c) Assessment
				  of a self-insurer under section 907 (b)(1) of the act shall be determined as
				  follows: the amount of compensation paid by the self-insurer during the
				  preceding calendar year multiplied by the quotient resulting from dividing the
				  amount determined by the Bureau to carry out the requirements of Article IX of
				  the act (77 P. S. §§
											1037.1-1037.8) by the total amount of
				  compensation paid by all self-insurers during the preceding calendar year. The
				  amount of compensation paid by the self-insurer and the total amount of
				  compensation paid by self-insurers shall be obtained from the annual reports
				  filed with the Bureau under sections 445 and 446(e) of the act (77 P. S.
				  §§
											1000.1 and
				  1000.2(e)).
(d) A self-insurer will not be assessed in
				  any one calendar year more than 1% of the compensation paid by that
				  self-insurer during the previous calendar year.
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 125 - WORKERS' COMPENSATION SELF-INSURANCE › Subchapter C - SELF-INSURING GUARANTY FUND › Section 125.211 - Objections to assessments

Current through Register Vol. 54, No. 28, July 13, 2024
Within 15 days after the receipt of an assessment notice
					 issued against a self-insurer under Article IX of the act (77 P. S.
					 §§
											1037.1-1037.8), the self-insurer
					 may file objections with the Bureau if it believes the assessment is excessive,
					 erroneous, unlawful or invalid. The objector shall state in detail the grounds
					 for the objections. The Bureau, after notice to the objector, will hold a
					 hearing upon the objections. After the hearing, the Bureau will record its
					 findings on the objections and will transmit to the objector, by registered
					 mail, notice of the amount, if any, charged against it in accordance with the
					 findings. That amount shall be paid by the objector within 10 days after
					 receipt of notice of the findings unless the objector initiates an action in
					 the appropriate court within 10 days after receipt of the Bureau's notice to
					 restrain the collection or payment of the assessment.
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 125 - WORKERS' COMPENSATION SELF-INSURANCE › Subchapter C - SELF-INSURING GUARANTY FUND › Section 125.212 - Calculation of outstanding liability

Current through Register Vol. 54, No. 28, July 13, 2024
The Bureau may retain the services of a casualty actuary to
					 project the outstanding liability of the guaranty fund. Fees for actuarial
					 services shall be an expense of the guaranty fund.
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 126 - HEALTH CARE UNDER THE WORKERS' COMPENSATION ACT-STATEMENT OF POLICY › Section 126.1 - Medical fee updates

Current through Register Vol. 54, No. 28, July 13, 2024
When submitting data under §
									127.155(c)
				  (relating to medical fee updates on and after January 1, 1995-outpatient acute
				  care providers, specialty hospitals and other cost-reimbursed providers), all
				  codes submitted to the Bureau of Workers' Compensation shall be based upon the
				  appropriate International Classification of Disease (ICD), Current Procedural
				  Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) code. If
				  these codes are not available, providers shall submit data in a form mandated
				  by the United States Department of Health and Human Services as published in
				  45 CFR Parts
				  160 and
				  162 (2000) (relating to general
				  administrative requirements; and requirements), as amended. Providers
				  submitting this data may append an appropriate modifier to the code to account
				  for interfacility distinctions in treatment or billing
				  procedures.
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 127 - WORKERS' COMPENSATION MEDICAL COST CONTAINMENT › Subchapter A - PRELIMINARY PROVISIONS › Section 127.1 - Purpose

Current through Register Vol. 54, No. 28, July 13, 2024
This chapter implements those sections of the act that
					 relate to payments made by insurers or self-insured employers for medical
					 treatment and the review of medical treatment provided to employes with
					 work-related injuries and illnesses.
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 127 - WORKERS' COMPENSATION MEDICAL COST CONTAINMENT › Subchapter A - PRELIMINARY PROVISIONS › Section 127.2 - Computation of time

Current through Register Vol. 54, No. 28, July 13, 2024
Unless otherwise provided, references to "days" in this
					 chapter mean calendar days. For purposes of determining timeliness of filing
					 and receipt of documents transmitted by mail, 3 days shall be presumed added to
					 the prescribed period. If the last day for filing a document is a Saturday,
					 Sunday or legal holiday, the time for filing shall be extended to the next
					 business day. Transmittal by mail means by first-class mail.
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 127 - WORKERS' COMPENSATION MEDICAL COST CONTAINMENT › Subchapter B - MEDICAL FEES AND FEE REVIEW › CALCULATIONS › Section 127.101 - Medical fee caps-Medicare

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
					 Generally, medical fees for services rendered under the act shall be capped at
					 113% of the Medicare reimbursement rate applicable in this Commonwealth under
					 the Medicare Program for comparable services rendered. The medical fees
					 allowable under the act shall fluctuate with changes in the applicable Medicare
					 reimbursement rates for services rendered prior to January 1, 1995. Thereafter,
					 for services rendered on and after January 1, 1995, medical fees shall be
					 updated only in accordance with §§
											127.151-127.162 (relating to medical fee
					 updates).
(b) Medicare coinsurance
					 and deductibles may not be used to reduce the allowable fee under the
					 act.
(c) If a provider's actual
					 charges for services rendered are less than the maximum fee allowable under the
					 act, the provider shall be paid only the actual charges for the services
					 rendered.
(d) The Medicare
					 reimbursement mechanisms that shall be used when calculating payments to
					 providers under the act are set forth in §§
					 127.103-127.128.
(e) Medical fee
					 caps based on Medicare will apply to all health care providers licensed in this
					 Commonwealth who treat injured workers, regardless of whether the health care
					 provider participates in the Medicare Program.
(f) An insurer may not make payment in excess
					 of the medical fee caps, unless payment is made pursuant to a contract with a
					 CCO certified by the Secretary of Health.
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 127 - WORKERS' COMPENSATION MEDICAL COST CONTAINMENT › Subchapter B - MEDICAL FEES AND FEE REVIEW › CALCULATIONS › Section 127.102 - Medical fee caps-usual and customary charge

Current through Register Vol. 54, No. 28, July 13, 2024
If a Medicare payment mechanism does not exist for a
						particular treatment, accommodation, product or service, the amount of the
						payment made to a health care provider shall be either 80% of the usual and
						customary charge for that treatment, accommodation, product or service in the
						geographic area where rendered, or the actual charge, whichever is
						lower.
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 127 - WORKERS' COMPENSATION MEDICAL COST CONTAINMENT › Subchapter B - MEDICAL FEES AND FEE REVIEW › CALCULATIONS › Section 127.103 - Outpatient providers subject to the Medicare fee schedule-generally

Current through Register Vol. 54, No. 28, July 13, 2024
(a) When services
					 are rendered by outpatient providers who are reimbursed under the Medicare Part
					 B Program pursuant to the Medicare fee schedule, the payment under the act
					 shall be calculated using the Medicare fee schedule as a basis. The fee
					 schedule for determining payments shall be the transition fee schedule as
					 determined by the Medicare carrier.
(b) The insurer shall pay the provider for
					 the applicable Medicare procedure code even if the service in question is not a
					 compensated service under the Medicare Program.
(c) If a Medicare allowance does not exist
					 for a reported HCPCS code, or successor codes, the provider shall be paid
					 either 80% of the usual and customary charge or the actual charge, whichever is
					 lower.
(d) When calculating payment
					 for all services rendered on and before December 31, 1995, all rate increases,
					 periodic adjustments and modifications incorporated into the Medicare Part B
					 Fee Schedule shall be used. The effective date of these changes under Medicare
					 shall also be the effective date of the fee changes under the act, as provided
					 in §
											127.151 (relating to medical fee
					 updates prior to January 1, 1995-generally).
(e) Fee updates subsequent to December 31,
					 1994, shall be in accordance with §§
											127.152 and
					 127.153 (relating to medical fee
					 updates on and after January 1, 1995-generally; and medical fee updates on and
					 after January 1, 1995-outpatient providers, services and supplies subject to
					 the Medicare fee schedule).
This section cited in 34 Pa. Code §
													127.101 (relating to medical fee
						  caps-Medicare); 34 Pa. Code §
													127.119 (relating to payments for
						  services using RCCs); 34 Pa. Code §
													127.126 (relating to new
						  providers); 34 Pa. Code §
													127.153 (relating to medical fee
						  updates on and after January 1, 1995-outpatient providers, services and
						  supplies subject to the Medicare fee
						  schedule).
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 127 - WORKERS' COMPENSATION MEDICAL COST CONTAINMENT › Subchapter B - MEDICAL FEES AND FEE REVIEW › CALCULATIONS › Section 127.104 - Outpatient providers subject to the Medicare fee schedule-physicians

Current through Register Vol. 54, No. 28, July 13, 2024
Payments to physicians for services rendered under the
						act shall be calculated by multiplying the Medicare Part B reimbursement for
						the services by 113%.
This section cited in 34 Pa. Code §
													127.101 (relating to medical fee
						  caps-Medicare); 34 Pa. Code §
													127.106 (relating to outpatient
						  providers subject to the Medicare fee schedule-spinal manipulation performed by
						  Doctors of Osteopathic Medicine); 34 Pa. Code §
													127.119 (relating to payments for
						  services using RCCs); 34 Pa. Code §
													127.153 (relating to medical fee
						  updates on and after January 1, 1995-outpatient providers, services and
						  supplies subject to the Medicare fee
						  schedule).
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 127 - WORKERS' COMPENSATION MEDICAL COST CONTAINMENT › Subchapter B - MEDICAL FEES AND FEE REVIEW › CALCULATIONS › Section 127.105 - Outpatient providers subject to the Medicare fee schedule-chiropractors

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Payments for
					 services rendered by chiropractors shall be made for those services permitted
					 by the Chiropractic Practice Act (63 P. S. §§
												625.101-625.1106).
(b) Payments for spinal manipulation
					 procedures by chiropractors shall be based on the Medicare fee schedule for
					 HCPCS codes 98940-98943, multiplied by 113%.
(c) Payments for physiological therapeutic
					 procedures by chiropractors shall be based on the Medicare fee schedule for
					 HCPCS codes 97010-97799, multiplied by 113%.
(d) Payments shall be made for documented
					 office visits and shall be based on the Medicare fee schedule for HCPCS codes
					 99201-99205 and 99211-99215, multiplied by 113%.
(e) Payment shall be made for an office visit
					 provided on the same day as another procedure only when the office visit
					 represents a significant and separately identifiable service performed in
					 addition to the other procedure. The office visit shall be billed under the
					 proper level HCPCS codes 99201-99215, and shall require the use of the
					 procedure code modifier "-25" (indicating a Significant, Separately
					 Identifiable Evaluation and Management Service by the Same Physician on the Day
					 of a Procedure).
This section cited in 34 Pa. Code §
													127.101 (relating to medical fee
						  caps-Medicare); 34 Pa. Code §
													127.153 (relating to medical fee
						  updates on and after January 1, 1995-outpatient providers, services and
						  supplies subject to the Medicare fee
						  schedule).
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 127 - WORKERS' COMPENSATION MEDICAL COST CONTAINMENT › Subchapter B - MEDICAL FEES AND FEE REVIEW › CALCULATIONS › Section 127.106 - Outpatient providers subject to the Medicare fee schedule-spinal manipulation performed by Doctors of Osteopathic Medicine

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Payments for spinal manipulation
					 procedures by Doctors of Osteopathic Medicine shall be based on the Medicare
					 fee schedule for HCPCS codes M0702-M0730 (through 1993) or HCPCS codes
					 98925-98929 (1994 and thereafter), multiplied by 113%.
(b) Payment shall be made for an office visit
					 provided on the same day as a spinal manipulation only when the office visit
					 represents a significant and separately identifiable service performed in
					 addition to the manipulation. The office visit shall be billed under the proper
					 level HCPCS codes 99201-99215, and shall require the use of the procedure code
					 modifier "-25" (indicating a Significant, Separately Identifiable Evaluation
					 Management Service by the Same Physician on the Day of a Procedure).
(c) Payments for other services provided by
					 Doctors of Osteopathic Medicine shall be calculated as provided for in §
											127.104 (relating to outpatient
					 providers subject to the Medicare fee schedule-physicians).
This section cited in 34 Pa. Code §
													127.101 (relating to medical fee
						  caps-Medicare); 34 Pa. Code §
													127.153 (relating to medical fee
						  updates on and after January 1, 1995-outpatient providers, services and
						  supplies subject to the Medicare fee
						  schedule).
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 127 - WORKERS' COMPENSATION MEDICAL COST CONTAINMENT › Subchapter B - MEDICAL FEES AND FEE REVIEW › CALCULATIONS › Section 127.107 - Outpatient providers subject to the Medicare fee schedule-physical therapy centers and independent physical therapists

Current through Register Vol. 54, No. 28, July 13, 2024
Payments to outpatient physical therapy centers and
						independent physical therapists not reimbursed in accordance with §
											127.118 (relating to
						RCCs-generally) shall be calculated by multiplying the Medicare Part B
						reimbursement for the services by 113%.
This section cited in 34 Pa. Code §
													127.101 (relating to medical fee
						  caps-Medicare); 34 Pa. Code §
													127.153 (relating to medical fee
						  updates on and after January 1, 1995-outpatient providers, services and
						  supplies subject to the Medicare fee
						  schedule).
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 127 - WORKERS' COMPENSATION MEDICAL COST CONTAINMENT › Subchapter B - MEDICAL FEES AND FEE REVIEW › CALCULATIONS › Section 127.108 - Durable medical equipment and home infusion therapy

Current through Register Vol. 54, No. 28, July 13, 2024
Payments for durable medical equipment, home infusion
						therapy and the applicable HCPCS codes related to the infusion equipment,
						supplies, nutrients and drugs, shall be calculated by multiplying the Medicare
						Part B Fee Schedule reimbursement for the equipment or therapy by
						113%.
This section cited in 34 Pa. Code §
													127.101 (relating to medical fee
						  caps-Medicare); 34 Pa. Code §
													127.153 (relating to medical fee
						  updates on and after January 1, 1995-outpatient providers, services and
						  supplies subject to the Medicare fee
						  schedule).
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 127 - WORKERS' COMPENSATION MEDICAL COST CONTAINMENT › Subchapter B - MEDICAL FEES AND FEE REVIEW › CALCULATIONS › Section 127.109 - Supplies and services not covered by fee schedule

Current through Register Vol. 54, No. 28, July 13, 2024
Payments for supplies provided over those included with
						the billed office visit shall be made at 80% of the provider's usual and
						customary charge when the provider supplies sufficient documentation to support
						the necessity of those supplies. Supplies included in the office visit code by
						Medicare may not be fragmented or unbundled in accordance with §
											127.204 (relating to fragmenting
						or unbundling of charges by providers).
This section cited in 34 Pa. Code §
													127.101 (relating to medical fee
						  caps-Medicare).
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 127 - WORKERS' COMPENSATION MEDICAL COST CONTAINMENT › Subchapter B - MEDICAL FEES AND FEE REVIEW › CALCULATIONS › Section 127.110 - Inpatient acute care providers-generally

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Payments to providers of inpatient acute
					 care hospital services shall be based on the sum of the following:
(1) One hundred thirteen percent of the DRG
					 payment.
(2) One hundred percent of
					 payments that are reimbursed on the prospective payment system, as listed in
					 subsection (b).
(3) One hundred
					 percent of pass-through costs.
(4)
					 One hundred percent of applicable cost outliers or 100% of applicable day
					 outliers.