Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 370 - RULES GOVERNING GROUP SELF-INSURERS OF LIABILITY UNDER THE VIRGINIA WORKERS' COMPENSATION ACT › Section 14VAC5-370-40 - Application for license as group self-insurance association; additional requirements

Current through Register Vol. 40, No. 24, July 15, 2024
A. An
				application submitted by a group self-insurance association shall be
				accompanied by the following items. These items shall be subject to the
				approval of the commission:
1. A copy of the
				members' indemnity agreement and power of attorney required by
				14VAC5-370-120 binding the
				association and each member of the association, jointly and severally, to
				comply with the provisions of the Act and copies of any other governing
				instruments of the proposed group self-insurance association;
2. An executed copy of the application of
				each employer for membership in the association on the effective date of the
				license of the association;
3.
				Financial statements of all applicants for membership showing that the
				membership of the proposed association has a combined net worth of at least one
				million dollars. Political subdivisions of this Commonwealth may combine to
				form associations without complying with this requirement;
4. Proof of payment by each member of at
				least 25% of its estimated first year's contribution into a designated
				depository;
5. A confirmation of
				excess insurance, if excess insurance is required, by a licensed insurer in an
				amount acceptable to the commission which complies with the requirements set
				forth in 14VAC5-370-90. However, the
				commission at its discretion may allow this insurance to be placed with an
				approved surplus lines insurer;
6.
				Designation of the board and of the administrator of the association, together
				with properly executed biographical affidavits for each member of the board and
				for the administrator or the principal officers of a corporation serving as an
				administrator. Affidavits are to be submitted on a form prescribed by the
				commission;
7. The address in this
				Commonwealth where the books and records of the pool will be maintained at all
				times;
8. Information showing that
				the association has, within its own organization or by contract with an
				approved service agent, adequate facilities and competent personnel to service
				its program with respect to underwriting matters, claims adjusting, and
				industrial safety engineering. Copies of all executed servicing agreements
				shall be filed with the commission;
9. A confirmation of a fidelity bond in a
				form and amount acceptable to the commission;
10. Deposit of securities or a surety bond
				with the State Treasurer in an amount acceptable to the commission in
				accordance with the requirements of
				14VAC5-370-60;
11. A projection of administrative expenses
				for the first year of operation in an amount and as a percentage of the
				estimated annual contributions;
12.
				A statement regarding the type of business and guidelines to be used to
				determine common interest; and
13.
				A copy of the association's contracts with the service agent and the
				administrator which sets forth the terms and obligations of the
				agreement.