Oklahoma Administrative Code › Title 810 - Oklahoma Workers' Compensation Commission › Chapter 25 - Workers' Compensation Insurance and Self Insurance › Subchapter 1 - General Provisions › Section 810:25-1-2 - Definitions

Current through Vol. 41, No. 20, July 1, 2024
In addition to the terms defined in 85A O.S., § 2, the
				  following words and terms, when used in this Chapter, shall have the following
				  meaning, unless the context clearly indicates otherwise:
"Administrator"
means the person designated by
				  the supervisory board of members of a group self-insurance association to
				  oversee the financial affairs of the association, accept service of process on
				  behalf of the association, act for and bind the association and members in all
				  transactions either relating to or arising out of the operation of the
				  association.
"Advisory loss costs"
means the National Council
				  on Compensation Insurance's projections of future claims costs and loss
				  adjustment expenses by classification code.
"Affidavit of exempt status"
means an affidavit
				  authorized by 85A O.S., §36 which any individual or business entity that
				  is not required to secure compensation pursuant to the AWCA may execute and
				  file with the Oklahoma Workers' Compensation Commission.
"Aggregate excess insurance"
means an insurance
				  product that limits a group self-insurance association's annual aggregate
				  liability to an agreed upon amount.
"Association"
or
"Group Self-Insurance
				  Association"
means a duly qualified group self-insurance association
				  authorized by the Commission to self fund its workers' compensation
				  obligations.
"AWCA"
means the Administrative Workers'
				  Compensation Act, 85A O.S., §§ 1, et seq.
"Board"
or
"Members' Supervisory
				  Board"
means the supervisory board of members of an association.
"Cancellation short rate penalty"
means a
				  penalty imposed on the member for cancelling its policy before the expiration
				  date of the policy.
"Certified audit"
means a financial audit
				  performed by a certified public accountant, accompanied by the auditor's
				  opinion regarding the audit.
"Claims reserves"
means workers' compensation
				  claim losses expected to be paid in the future, but does not include IBNR.
"Commission"
means the Oklahoma Workers'
				  Compensation Commission, a designee, or an administrative law judge to whom the
				  Commission has delegated responsibility as authorized by 85A O.S., §
				  21(D).
"Common interest"
means employers engaged in the
				  same industry or members of an Oklahoma trade association that has been in
				  business for at least five (5) years.
"Expense constant"
means a flat charge included
				  in a workers' compensation policy to cover the costs of issuing and servicing
				  the policy.
"Experience modifier"
means a modification to
				  premium based on the claims history of the policyholder.
"IBNR"
means incurred but not reported reserves.
				  It includes a reserve for claims that have been incurred, but not yet reported
				  to the individual own risk employer or group self-insurance association, as
				  applicable, and reserves for adverse loss development on known claims.
"Incurred loss"
means the total of the paid
				  indemnity and medical losses plus claims reserves, reported by accident year.
"Insurance Department"
means the Insurance
				  Department of the State of Oklahoma.
"Joint and several liability"
means mutual and
				  individual responsibility of members for the liabilities of the association.
"Loss portfolio transfer"
means the transfer of
				  the liabilities of the association to an insurance carrier for an agreed upon
				  premium.
"Member"
means an individual member of an
				  association.
"NCCI"
means the National Council on
				  Compensation Insurance, a national source for information on workers'
				  compensation insurance, tools and services, and the provider of advisory
				  ratemaking and statistical services in Oklahoma.
"Partnership"
means a type of unincorporated
				  business organization in which two or more individuals own the business and are
				  equally liable for its debts.
"Pro forma financial statement"
means a
				  hypothetical financial statement showing revenues and expenses that may be
				  recognized in the upcoming fiscal year.
"Proof of coverage"
means the statutory filings
				  of workers' compensation policy information to the NCCI.
"Scopes Manual"
is a catalog of four-digit
				  workers' compensation codes based on the nature of business and estimated risk
				  to its workers.
"Self insured retention"
means the individual
				  own risk employer's or group self-insurance association's retained amount of
				  risk under a specific excess insurance policy, before the liability is
				  transferred to an insurance carrier.
"Sole proprietor"
means an individual (or
				  married couple) who is sole owner of a business that is neither a partnership
				  nor an incorporated or limited liability company.
"Solvency"
means a member whose assets are
				  greater than its liabilities and who is capable of meeting its financial
				  obligations to the association.
"Specific excess insurance"
means an insurance
				  product that limits the liability of an individual own risk employer or group
				  self-insurance association specific occurrence liability to an agreed upon
				  amount.
"Standard premium"
means experience modified
				  workers' compensation premium that has not been discounted.
"Statutory limits"
means an insurance carrier's
				  amount of liability under a specific excess insurance policy, capped at the
				  maximum amount allowed by statute.
"TPA"
or
"Third-Party
				  Administrator"
means any person defined in 36 O.S., § 1442 of the
				  Third-Party Administrator Act as an "administrator".
"Unearned premium"
means the share of the
				  members' premiums applicable to the unexpired portion of the policy terms.