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 125.132 - Definitions

Current through Register Vol. 54, No. 28, July 13, 2024
The following words and terms, when used in this
					 subchapter, have the following meanings, unless the context clearly indicates
					 otherwise:
Act
-The Workers' Compensation Act
					 (77
					 P. S. §§
											1-1038.2).
Administrator
-An administrator as defined
					 in section 801 of the act (77 P. S. §
											1036.1).
Aggregate excess insurance
-Insurance which
					 provides that the excess insurer pays on behalf of or reimburses a fund for its
					 payment of benefits on claims incurred during a policy period in excess of the
					 retention amount to the excess insurer's limit of liability.
Applicant
-A group of five or more
					 homogeneous employers requesting approval of the Bureau to operate as a
					 fund.
Board of trustees
-The governing body of a
					 fund.
Bureau
-The Bureau of Workers' Compensation
					 of the Department.
Claims service company
-An individual,
					 corporation, partnership or association engaged in the business of servicing a
					 fund's claims, including the adjusting and handling of claims, the payment of
					 benefits and the provision of required reports.
Contributions
-The amount of money charged
					 each member to fund the obligations and expenses of a fund. The term includes
					 charges calculated and made known to the members prior to the beginning of each
					 fund year, and adjustments to those charges made during the fund year by the
					 board of trustees.
Department
-The Department of Labor and
					 Industry of the Commonwealth.
Dividends
-Cash, contribution credits or
					 similar distributions provided to the members from surplus.
Employer
-An employer as defined in section
					 801 of the act.
Excess insurer
-An insurance company
					 authorized to transact the class of insurance listed in section 202(c)(14) of
					 The Insurance Company Law of 1921 (40 P. S. §
											382(c)(14)).
Fiscal agent
-An individual, corporation,
					 partnership or association engaged by a fund to carry out the fiscal policies
					 of the fund and to invest, manage, hold and disburse fund assets. The board of
					 trustees may delegate the duties of fiscal agent to the administrator.
Fund
-A fund as defined in section 801 of
					 the act. The fund shall assume the liabilities and obligations of its members
					 under the act and the Occupational Disease Act.
Fund year
-The fiscal year and annual
					 reporting period of a fund, which shall consist of 12 calendar months, except
					 for the first year, which may consist of fewer or more than 12 months as
					 established by the Bureau.
Homogeneity
-Homogeneity exists where a
					 fund is comprised of homogeneous employers.
Homogeneous employers
-Employers who have
					 been assigned to the same classification series for at least 1 year or are
					 engaged in the same or similar types of business, including political
					 subdivisions.
Independent actuary
-An independent actuary
					 as defined in section 801 of the act.
Loss costs
-The dollar amounts per unit of
					 exposure attributable to the payment of losses under the act and the
					 Occupational Disease Act, filed by a rating organization based on aggregate
					 experience of all members of that rating organization and approved by the
					 Insurance Commissioner under Article VII of the act (77 P. S. §§
											1035.1-1035.22).
Loss-cost multiplier
-A factor approved by
					 the Bureau for each fund which is multiplied against the loss costs to recoup
					 the fund's administrative and operating costs and expenses, including:
(i) The fund's costs in connection with the
				  examination, investigation, handling, adjusting and litigation of
				  claims.
(ii) The cost of excess
				  insurance, loss control services, underwriting services, assessments and
				  taxes.
(iii) The fees and
				  commissions for accountants, attorneys, actuaries, investment advisors and
				  other specialists whose services are necessary for the operation and
				  administration of the fund.
Member
-An employer participating in a
					 fund.
Occupational Disease Act
-The Pennsylvania
					 Occupational Disease Act (77 P. S. §§
												1201-1603).
Permit
-A permit as defined in section 801
					 of the act.
Plan committee
-A plan committee as defined
					 in section 801 of the act.
Political subdivision
-A political
					 subdivision as defined in section 801 of the act.
Retention amount
-The maximum amount of
					 benefits a fund would be required to pay without reimbursement from the excess
					 insurer under an aggregate or specific excess insurance policy.
Runoff fund
-A fund which voluntarily
					 terminated its permit or a fund whose permit was revoked by the Bureau.
Security
-Security as defined in section
					 801 of the act.
Service company
-A claims service company
					 and all other individuals, corporations, partnerships or associations engaged
					 by a fund to provide the fund with services such as legal assistance,
					 underwriting, safety engineering, loss control, medical management, information
					 analysis, statistics compilation, loss and expense report preparation and
					 contribution development.
Specific excess insurance
-Insurance which
					 provides that the excess insurer pays on behalf of or reimburses a fund for its
					 payment of benefits on each occurrence in excess of the retention amount to the
					 excess insurer's limit of liability.
Surplus
-Surplus as defined in section 801
					 of the act. In determining surplus, incurred but not reported claims shall be
					 included in the calculation of incurred losses.
Trust agreement
-A trust as defined in
					 section 801 of the act.
Trustee
-Each person serving as a member of
					 the board of trustees.
This section cited in 34 Pa. Code §
												125.155 (relating to
						homogeneity).