Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 5 - PROPERTY AND CASUALTY INSURANCE › Subchapter G - WORKERS' COMPENSATION INSURANCE › Division 2 - GROUP SELF-INSURANCE COVERAGE › Section 5.6402 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
(a) The following words and terms, when used
					 in this division, shall have the following meanings, unless the context clearly
					 indicates otherwise.
(1) Actuary--A member in
					 good standing of the Casualty Actuarial Society or a member in good standing of
					 the American Academy of Actuaries who has been approved as qualified for
					 signing casualty loss reserves opinions by the Casualty Practice Council of the
					 American Academy of Actuaries.
(2)
					 Administrator--An individual, partnership, or corporation engaged by the board
					 of trustees of a group to implement the policies established by the board of
					 trustees and to provide day-to-day management of the group, as defined in the
					 Labor Code § 407A.001(a)(1). Day-to-day management may include, but is not
					 limited to, claims adjustment; safety engineering; compilation of statistics
					 and the preparation of premium, loss, and tax reports; preparation of other
					 required self-insurance reports; development of members' assessments and fees;
					 and administration of a claim fund. For purposes of this division,
					 administrator includes and has the same meaning as managing company, as that
					 term is defined in the Labor Code § 407A.001(a)(5-a). Any reference to the
					 term administrator in this division in all contexts necessarily includes and
					 references both administrator and managing company.
(3) Books and Records--All books, accounts,
					 records, documents, written agreements, contracts, papers, correspondence,
					 claims files, receipts, bills, notes, pleadings, investigatory files, or any
					 other written or electronic material relating to the business of a
					 group.
(4) Certified Public
					 Accountant--An accountant or firm in good standing with the American Institute
					 of Certified Public Accountants and the Texas State Board of Public Accountancy
					 and who conforms to the Code of Professional Ethics of the American Institute
					 of Certified Public Accountants.
(5) Commissioner--The Commissioner of
					 Insurance.
(6) Department--The
					 Texas Department of Insurance.
(7)
					 Group--An unincorporated association or business trust composed of five or more
					 private employers that meet all of the requirements of the Labor Code Chapter
					 407A and this division.
(8)
					 Managing company--As defined in paragraph (2) of this subsection.
(9) Modified schedule rating premium--As
					 defined in the Labor Code § 407A.001(a)(6).
(10) Person--An individual, partnership,
					 corporation, organization, government or governmental subdivision or agency,
					 business trust, estate trust, association, or any other legal entity.
(11) Same or similar--As set forth in the
					 Labor Code § 407A.001(a)(7).
(12) Service company--A person that directly
					 or indirectly provides services to or on behalf of a group, other than the
					 services provided by an administrator, including, but not limited to:
(A) claims adjustment;
(B) safety engineering;
(C) compilation of statistics and the
					 preparation of premium, loss, and tax reports;
(D) preparation of other required
					 self-insurance reports;
(E)
					 development of members' assessments and fees; and
(F) administration of a claim fund.
(13) Third party administrator--An
					 administrator or service company, as those terms are defined under this
					 division, that holds itself out or acts as an administrator, as that term is
					 defined in the Insurance Code §
												4151.001(1).