reglab/statecodes huggingface dataset:
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-07 - Rules For Selected Hearings › Section 85-7-10 - Concluding the Hearing

Current through Register Vol. XLI, No. 28, July 12, 2024
10.1. At the
				conclusion of the hearing, the parties shall be permitted to file proposed
				findings of fact, conclusions of law, and such legal briefs or memoranda as
				they wish. The parties shall be permitted seven (7) days to file such items
				which filings shall be concurrent. The parties shall be permitted three (3)
				days to respond to the filing of any other party. No further argument shall be
				permitted.
10.2. Thereafter, the
				hearing officer will prepare a report and recommendation which shall contain
				proposed findings of fact and conclusions of law as suggested by the hearing
				officer for the commission's approval. The parties to the hearing shall then be
				permitted seven (7) days in which to file objections or comments upon the
				report and recommendation and three (3) more days to respond to each others'
				objections and comments. Thereafter, the commission shall decide whether to
				accept the report and recommendation, to reject it, to modify it, or to remand
				the matter to the hearing officer for further proceedings or upon other
				instructions. The commission retains the right to review any and all proposed
				findings of facts against the record and to disagree therewith provided that
				the commissioner states the basis for the disagreement in the final order. The
				commission shall render either a final order or an interlocutory order as the
				decision may require in which the commission accepts in whole or in part the
				proposed findings of fact and conclusions of law submitted by the hearing
				officer and, to the extent that the commission rejects or modifies the report
				and recommendation of the hearing officer, the commission shall furnish his or
				her own findings of fact and conclusions of law.
10.3. A copy of the final order or decision
				of the commission shall be served upon each party and the party's attorney of
				record, if any, either in person or by certified mail.
10.4. All appeals from the final order or
				decision of the commission shall be taken pursuant to W.Va. Code, §
									29A-5-4.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-07 - Rules For Selected Hearings › Section 85-7-11 - Pending petitions

Current through Register Vol. XLI, No. 28, July 12, 2024
Petitions for hearing filed under the provisions of W. Va.
				  Code §
									23-2-17,
				  prior to the effective date of this rule, for which no hearing has been held
				  shall be transferred to hearing officers designated by the commission under
				  this rule.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-07 - Rules For Selected Hearings › Section 85-7-12 - Termination of the Commission

Current through Register Vol. XLI, No. 28, July 12, 2024
Upon termination of the Commission, this procedural rule
				  shall be administered by the insurance commissioner for the purpose of
				  processing matters arising under Article Two, Chapter Twenty-three of the West
				  Virginia Code. This rule shall have no force and effect over the collection of
				  New Fund assets or any other matters involving private carriers and their
				  insureds.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-07 - Rules For Selected Hearings › Section 85-7-13 - Severability

Current through Register Vol. XLI, No. 28, July 12, 2024
If any provision of this rule or the application thereof to
				  any entity or circumstance shall be held invalid, such invalidity shall not
				  affect the provisions or the applications of this rule which can be given
				  affect without the invalid provisions or application and to this end the
				  provisions of this rule are declared to be severable.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-08 - Workers' Compensation Policies, Coverage Issues And Related Topics › Section 85-8-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This
				exempt legislative rule provides for;
(1)
				Specific criteria, standards and other clarification as to which entities are
				required to carry West Virginia workers' compensation coverage and which
				individuals are considered employees entitled to benefits under chapter
				thirty-three of the West Virginia Code;
(2) the minimum contents of a policy issued
				for workers' compensation insurance pursuant to West Virginia Code §
										23-1-1
et seq
.;
(3)
				ratemaking provisions applicable to workers' compensation insurance in West
				Virginia;
(4) notice requirements
				regarding termination of coverage and renewal offers; and
(5) coverage related topics.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-08 - Workers' Compensation Policies, Coverage Issues And Related Topics › Section 85-8-2 - Purpose of Rule

Current through Register Vol. XLI, No. 28, July 12, 2024
This rule provides specific criteria, standards and other
				  clarification as to which entities need to carry West Virginia workers'
				  compensation coverage and which individuals are considered employees who are
				  entitled to benefits under chapter twenty-three of tire West Virginia Code,
				  establishes tire requirements of a basic policy to be used by private carriers
				  of workers' compensation insurance, establishes ratemaking provisions
				  applicable to workers' compensation insurance in West Virginia and addresses
				  other workers' compensation coverage related topics.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-08 - Workers' Compensation Policies, Coverage Issues And Related Topics › Section 85-8-3 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
As used in this rule, the following terms, words, and phrases
				  have the meanings stated unless in any instance where such term, word, or
				  phrase is employed, and the context expressly indicates that another meaning is
				  intended.
3.1. "Casual employer," as
				the term is used in W. Va. Code §
									23-2-1(b)(4)
				and this rule, means an employer who employs not more than three (3) employees
				for a period that is temporary, intermittent, and sporadic in nature and does
				not exceed ten (10) calendar days in any calendar quarter.
3.2. "Classification" means categorization of
				employees for the purpose of assessing risk, ratemaking, and developing premium
				charges.
3.3. "Domestic services"
				means services of a household nature performed by an employee in or about a
				private home of the person by whom he or she is employed. A private home is a
				fixed place of abode of an individual or family. If a dwelling house is used
				primarily for the purpose of supplying board or lodging to the public as a
				business enterprise, it is not a private home and the services performed
				therein are not domestic services.
3.3.1. In
				general, services of a household nature in or about a private home include
				services performed by cooks, butlers, housekeepers, governesses, maids, valets,
				babysitters, caretakers, caregivers, medical providers, handymen, gardeners,
				and chauffeurs of automobile for family use.
3.3.2. The term "domestic services" does not
				include services of a household nature performed by an employee in or about the
				private home of a person when that employee is employed by someone other than a
				member of the household. For example, employees of maid services, temporary
				employment agencies, or other businesses do not provide domestic services under
				the provisions of this rule.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-08 - Workers' Compensation Policies, Coverage Issues And Related Topics › Section 85-8-5 - Auditing; Inspections; and Payroll Reporting

Current through Register Vol. XLI, No. 28, July 12, 2024
Each private carrier may include reasonable auditing,
				  inspection, and payroll reporting provisions in its policy, subject to the
				  approval of the Insurance Commissioner.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-08 - Workers' Compensation Policies, Coverage Issues And Related Topics › Section 85-8-6 - Employees Covered; Independent Contractors; Coverage Elections; and Assignment

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1.
				General. A West Virginia workers' compensation policy must cover all of the
				employees of the insured employer who are required to be provided West Virginia
				workers' compensation coverage under chapter twenty-three of the West Virginia
				Code and the rules promulgated thereunder.
6.2. Independent Contractors.
6.2.1. A West Virginia workers' compensation
				policy issued to an insured employer is not required to cover persons hired and
				classified as independent contractors pursuant to the
West Virginia
				Employment Law Worker Classification Act
, as set forth in W.Va. Code
				§ 21-51-1
et seq
., and the test established within W.Va.
				Code § 21-51-4 for classification of independent contractors.
6.2.2. Self-insured employers are not
				required to provide workers' compensation coverage to persons hired and
				classified as independent contractors pursuant to the
West Virginia
				Employment Law Worker Classification Act
, as set forth in W.Va. Code
				§ 21-51-1
et seq
., and the test established within W.Va.
				Code § 21-51-4 for classification of independent contractors.
6.2.3. A person cannot simultaneously be
				classified as an employee and as an independent contractor of the same employer
				at the same time.
6.2.4. An
				employer is not required to classify a worker who meets the criteria contained
				within W.Va. Code § 21-51-4 as an independent contractor. The employer may
				choose to hire the worker as an employee. However, the terms should be clearly
				set forth at the outset so there is no confusion between the employer and the
				hired worker in regard to the hired worker's status.
6.2.5. Independent contractors are not
				employees of employers required to be covered under chapter twenty-three of the
				West Virginia Code and are not eligible to receive payments from the Workers'
				Compensation Uninsured Employer Fund established in W.Va. Code §
										23-2C-8.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-08 - Workers' Compensation Policies, Coverage Issues And Related Topics › Section 85-8-9 - Notification of Issuance, Renewal or Termination of Coverage

Current through Register Vol. XLI, No. 28, July 12, 2024
9.1. Except as provided in section 9.2 of
				this rule, upon cancellation of a West Virginia workers' compensation policy,
				every private carrier is required to notify the Insurance Commissioner's
				designated rating organization of the cancellation at least ten (10) calendar
				days in advance of the effective date of termination of the coverage. The
				notification shall be on forms and/or other procedures developed by the
				Insurance Commissioner.
9.2. If an
				insured employer expressly requests in writing to the carrier that its West
				Virginia workers' compensation policy be cancelled, the private carrier shall
				notify the Insurance Commissioner's designated rating organization of said
				cancellation within ten (10) calendar days after receipt of the written request
				or any specified requested date of cancellation, whichever is later. Such a
				request by an insured employer shall not be deemed valid until received by the
				private carrier in writing.
9.3.
				Upon issuance or renewal of a West Virginia workers' compensation policy, every
				private carrier is required to notify the Insurance Commissioner's designated
				rating organization of said issuance or renewal within thirty (30) calendar
				days after the effective date of coverage, including the effective date of
				coverage and the date of expiration of the new policy. Notification shall be on
				forms and/or other procedures developed by the Insurance
				Commissioner.
9.4. If a carrier
				timely reports the information required by section 9.3 of this rule, it shall
				be deemed sufficient to meet the requirements of W. Va. Code §
									23-2C-15(f)(2)
				as this code provision relates to refusals to renew.
9.5. Failure of a private carrier to timely
				report information to tire Insurance Commissioner as required by sections 9.1,
				9.2 and 9.3 of this rule may subject the private carrier to a fine not to
				exceed five hundred dollars ($500.00) per occurrence of untimely
				reporting.
9.6. A private carrier
				may cancel a workers' compensation policy for failure of the policyholder to
				timely remit adequate consideration upon the issuance of advance written
				notification to the policyholder of no less than ten (10) calendar days. The
				refusal of a policyholder to;
(a) permit a
				premium audit by a private carrier; or
(b) to pay any applicable surcharge or
				assessment that the carrier is required to collect pursuant to chapter
				twenty-three of the West Virginia Code, is considered "failure of the
				policyholder to timely remit adequate consideration" for purposes of this
				section. The effective date of cancellation shall be no earlier than ten (10)
				calendar days after issuance of advance written notice.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-08 - Workers' Compensation Policies, Coverage Issues And Related Topics › Section 85-8-10 - Rating Organizations

Current through Register Vol. XLI, No. 28, July 12, 2024
10.1.
				Consistent with the provisions of W. Va. Code §
									23-2C-18a(b),
				the Insurance Commissioner may designate a workers' compensation rating
				organization that has been licensed in accordance with W. Va. Code §
									33-20-6 to
				assist the commissioner with carrying out his or her regulatory duties in
				regard to the workers' compensation insurance market.
10.2. Every workers' compensation private
				carrier shall;
(1) record and report to the
				designated rating organization its workers' compensation experience as set
				forth in the uniform statistical plan submitted by the designated rating
				organization and approved by the Insurance Commissioner; and
(2) adhere to the uniform classification plan
				and uniform experience rating plan developed by the designated rating
				organization and approved by the commissioner.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-08 - Workers' Compensation Policies, Coverage Issues And Related Topics › Section 85-8-11 - Ratemaking

Current through Register Vol. XLI, No. 28, July 12, 2024
11.1. Beginning on
				the fiscal year commencing the first day of July 2008, all private carriers
				shall determine their base rates from the actuarially determined loss costs
				filed by and approved for the designated rating organization. All private
				carriers shall additionally adhere to the rating rules filed by and approved
				for the designated rating organization unless the private carrier makes an
				approved filing permitting deviation from the same.
11.2. The base rates charged by the private
				carriers may also include;
(1) a reasonable
				provision for expenses related to the administration costs of the private
				carrier, including underwriting expenses, such as commissions to agents and
				brokers, other policy acquisition or servicing expenses, premium taxes,
				assessments, surcharges and fees, catastrophe reinsurance expenses, expenses
				associated with rating organizations, loss adjustment expenses not included in
				the loss costs, such as claims defense expenses, claim administration expenses,
				and other related expenses;
(2) a
				reasonable profit and contingency provision to contribute to the private
				carrier's surplus; and
(3) all other
				ratemaking components consistent with industry practices. All such provisions
				shall be subject to the provisions of W. Va. Code §
										33-20-4.
				Any filing made to establish or amend a loss cost multiplier or multipliers
				which accounts for expenses is effective until such time as the private carrier
				makes another filing to adjust the same.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-09 - Workers' Compensation Uninsured Employers' Fund › Section 85-9-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. --
				These rules govern the administration of the Workers' Compensation Uninsured
				Employers' Fund pursuant to W. Va. Code §
									23-2C-8.
1.2. Authority. - W. Va. Code §§
									23-2C-5(c)(2);
				23-2C-22;
				33-2-10(b)
				and
				33-2-20(a).
				Pursuant to W. Va. Code §§
									23-2C-5(c)(2)
				and
				33-2-10(b),
				rules proposed by the Insurance Commissioner and adopted by the Industrial
				Council as related to workers' compensation under chapter twenty-three of the
				West Virginia Code are not subject to W. Va. Code §§
									29A-3-9
				through
				29A-3-16,
				inclusive.
1.3. Filing Date. --
				October 9, 2009.
1.4. Effective
				Date. -- November 8, 2009.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-09 - Workers' Compensation Uninsured Employers' Fund › Section 85-9-2 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
As used in this rule, the following terms have the stated
				  meanings unless the context of a specific use clearly indicates another meaning
				  is intended.
2.1. "Commissioner" means
				the Insurance Commissioner of West Virginia or the Commissioner's designated
				third-party administrator.
2.2.
				"Industrial Council" means the Industrial Council created pursuant to W. Va.
				Code §
									23-2C-5.
2.3. "Private carrier" means any insurer
				authorized by the Commissioner to provide workers' compensation insurance
				pursuant to chapters twenty-three and thirty-three of the West Virginia
				Code.
2.4. "UEF" is the Workers'
				Compensation Uninsured Employers' Fund, as defined and established in W. Va.
				Code §§
									23-2C-2(o);
				23-2C-7(a)
				and
				23-2C-8.
2.5. "Workers' compensation coverage," as the
				term is used in this rule, means mandatory workers' compensation coverage
				pursuant to W. Va. Code § 23-2C-l
etseq.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-09 - Workers' Compensation Uninsured Employers' Fund › Section 85-9-3 - Application for Benefits from the UEF

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1. If an individual believes that he or she
				may be entitled to benefits under the UEF, then he or she shall complete an
				application for benefits from the UEF on a form created by the Commissioner.
				The Commissioner reserves the right to change the UEF application form from
				time to time as deemed necessary. Completion of the application for benefits is
				an absolute prerequisite for any entitlement to benefits from the
				UEF.
3.2. Upon receipt of an
				application for benefits, the Commissioner shall send a letter to the employer
				which notifies the employer that one of its employees has made a claim against
				the UEF.
3.3. The Commissioner
				shall determine whether:
(1) the claimant's
				employer was required to carry workers' compensation coverage on the date of
				the injury or last exposure; and
(2) if the claimant's employer was required
				to carry workers' compensation coverage on the date of the injury or last
				exposure, whether applicable workers' compensation coverage existed on the date
				of injury or date of last exposure.
3.3.a. If the Commissioner determines that:
(1) applicable workers' compensation coverage
				existed on the date of injury or date of last exposure; or
(2) the employer was not required to carry
				workers' compensation coverage on the date of injury of last exposure, then the
				Commissioner shall send the claimant a letter, copied to the employer,
				informing the claimant of this determination, and that the claim is not
				eligible to receive benefits from the UEF. Additionally, in the case that the
				Commissioner determines that applicable workers' compensation coverage existed
				on the date of injury or date of last exposure, the letter described in this
				subdivision shall also be copied to the insurance carrier which provided such
				coverage.
3.3.b. If the
				Commissioner determines that:
(1) the
				employer was required to carry workers' compensation coverage on the date of
				injury or date of last exposure; and
(2) no applicable workers' compensation
				coverage existed on the date of injury or date of last exposure, then the
				Commissioner shall send the claimant a letter, copied to the employer,
				informing the claimant of this determination, and that the claim is eligible to
				receive benefits from the UEF. If the claim is deemed eligible to receive
				benefits from the UEF, the Commissioner shall begin to administer the claim
				consistent with the provisions of chapter twenty-three of the West Virginia
				Code and the rules promulgated thereunder.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-09 - Workers' Compensation Uninsured Employers' Fund › Section 85-9-4 - Subrogation

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. Pursuant to W.
				Va. Code§ 23-2A-l, the Commissioner, on behalf of the UEF, has a right to
				statutory subrogation against any claim made by a UEF claimant, his or her
				dependents or personal representatives, against a third-party for the injury or
				exposure from which the claim arose: Provided, That this statutory subrogation
				is only to the extent of the actual monetary benefits paid or to be paid to the
				claimant from the UEF.
4.2.
				Pursuant to W. Va. Code § 23-2A-l(d), it is the duty of the claimant, his
				or her representatives or dependents, or any attorney representing the claimant
				or his or her dependents or representatives, to provide the Commissioner
				reasonable notice of a claim being made against a third-party, as well as
				reasonable notice prior to the disbursement of any recovery. Failure to provide
				such notice shall waive an attorney's right to be paid reasonable attorney fees
				out of the subrogation amount and shall further give rise to a cause of action
				by the Commissioner on behalf of the UEF against the claimant, his or her
				representatives or dependents or the attorney who failed to provide such
				reasonable notice.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-09 - Workers' Compensation Uninsured Employers' Fund › Section 85-9-5 - Employer Liability

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1.
				Pursuant to W. Va. Code §
									23-2C-8,
				an employer of a claimant who receives benefits from the UEF is liable to the
				UEF for all expenditures from the UEF on behalf of its injured employee,
				including, but not limited to:
5.1.a. All
				benefits, including all medical and indemnity payments, made from the
				UEF;
5.1.b. All claims
				administration costs related to the administration of claim(s) against the
				UEF;
5.1.c. All attorney fees
				related to defense of claim(s) made against the UEF; and
5.1.d. Interest on the above expenditures, as
				calculated under W. Va. Code §
										23-2-13.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-09 - Workers' Compensation Uninsured Employers' Fund › Section 85-9-6 - Methods for Determining and Collecting Employer Liabilities Owed to the UEF

Current through Register Vol. XLI, No. 28, July 12, 2024
The Commissioner shall have discretion to utilize one or
				  more of the following methods to determine and collect amounts owed to the
				  UEF:
6.1. As benefit payments are made
				from the UEF, issue pay orders to a liable employer ordering them to reimburse
				the UEF, within a specific and reasonable amount of time, as selected by the
				Commissioner, for the amounts described in subsection 5.1. of this
				rule;
6.2. Enter into repayment
				agreements with an employer to reimburse the UEF for the amounts described in
				subsection 5.1. of this rule, and then enter pay orders to the employer as
				described in subsection 6.1. of this section;
6.3. Using generally accepted accounting and
				actuarial principles, reduce the estimated amount of a claim or claim(s)
				against the UEF, including all the amounts described in subsection 6.1. of this
				rule, to a present value reserve for the claim, and then deem the responsible
				employer to be liable for this amount. The Commissioner may then pursue this
				amount as a judgment against the employer, including filing a civil action in
				Circuit Court against the employer, seeking a judgment lien against the
				employer, and all other accepted methods of collection as set forth in article
				two, chapter twenty-three of the West Virginia Code and 85CSR11.
6.4. The Commissioner shall have discretion
				to enter into a full and final settlement with an employer for its liability to
				the UEF or waive amounts owed to the UEF as part of a repayment agreement or a
				full and final settlement with the employer.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-09 - Workers' Compensation Uninsured Employers' Fund › Section 85-9-7 - Methods for Determining Assessments for the UEF

Current through Register Vol. XLI, No. 28, July 12, 2024
7.1. If at any time the Commissioner
				determines, based on generally accepted accounting and actuarial principles,
				despite the collection of, or projected collection of, amounts owed to the UEF,
				that:
(1) the UEF has incurred a deficit
				balance; or
(2) it appears imminent
				that it will incur a deficit balance, then, in order to maintain the solvency
				of the UEF, the Commissioner may, pursuant to W. Va. Code §
										23-2C-8,
				impose assessments against either private carriers, self-insured employers, or
				both, in the following manner:
7.1.a. Monthly or quarterly assessments
				against workers' compensation private carriers that reflect the relative hazard
				of the employments covered by the private carriers, results in an equitable
				distribution of costs among the private carriers and is based upon expected
				annual premiums to be received: Provided, this assessment may be collected by
				each private carrier from its policy holders in the form of a policy surcharge,
				and private carriers will have no liability for the amounts of this assessment
				which are not paid by employers defaulting on their premium payments;
7.1.b. Monthly or quarterly assessments
				against self-insured employers that result in an equitable distribution of
				costs among the self-insured employers and is based upon expected annual
				expenditures for claims.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-10 - Primary Contractor Liability › Section 85-10-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This
				rule implements the provisions of W. Va. Code §
									23-2-1d,
				regarding the liability of a primary contractor for payments due to the
				workers' compensation commission by a subcontractor under certain
				circumstances. The provisions of this rule shall apply generally to all work
				done by contract; the person, firm, corporation or other legal entity, which
				lets a contract for such work shall be responsible primarily and directly for
				all premiums and related obligations upon the work. This rule, as amended, is
				applicable only to contracts that are entered into or extended on or after the
				effective date of this rule.
1.2.
				Authority. -- W. Va. Code §§
									23-1-1a;
				and
				23-2-1d.
				Pursuant to W. Va. Code
				23-1-1a(j)(3),
				rules adopted by the board of managers and the commission are not subject to
				legislative approval as would otherwise be required under W. Va. Code §
									29A-3-1
				et seq. Public notice requirements of that chapter and article, however, must
				be followed.
1.3. Filing Date. --
				May 27, 2005.
1.4. Effective Date.
				-- July 1, 2005.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-10 - Primary Contractor Liability › Section 85-10-2 - Purpose of Rule

Current through Register Vol. XLI, No. 28, July 12, 2024
2.1. The
				purpose of this rule is to implement the provisions of W. Va. Code §
									23-2-1d,
				which was first adopted by the legislature during the 1993 session. The section
				was amended and reenacted by the legislature during the 1995 session. The
				section was further amended and reenacted by the legislature during the 2003
				extraordinary session and became effective on July 1, 2003.
a. This section was amended and reenacted by
				the legislature, effective January 29, 2005, and provided that upon termination
				of the commission, the provisions of W. Va. Code §
										23-2-1d
				shall be applicable only to unpaid premiums due the commission or the old fund
				as provided in article two-c of chapter twenty-three of the Code of West
				Virginia. This rule is so modified to be consistent with the amended Code upon
				termination of the commission.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-10 - Primary Contractor Liability › Section 85-10-3 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
As used in this legislative rule, the following terms have
				  the stated meanings unless the context of a specific use clearly indicates
				  another meaning is intended.
3.1.
				"Executive Director" means the executive director of the West Virginia workers'
				compensation commission pursuant to W. Va. Code §
									23-1-1b.
3.2. "Contract" means an agreement of
				sufficient duration, oral or written, under which some service is to be
				performed. "Contract" shall include a deed for ownership or a lease of rights
				for any coal, oil, gas, other minerals or timber under which some service is to
				be performed. A contract for the extraction or transportation of natural
				resources is a provision of services. A contract for the provision of goods is
				not a contract affected by this rule. For example, the service to be performed
				may be the construction of a house, the grading and laying of a roadway, the
				construction of an office building or store, the destruction of a building, the
				repair of buildings or equipment, or other activity. The contracting for the
				mere sale and purchase of goods is not an affected contract. However, if the
				contract provides for or requires for fulfillment the extraction of the coal,
				oil, gas, other minerals or timber, by the contractor , then the contract would
				be affected by this rule. Therefore, if the contracting party sells the coal,
				for example, any contracts it may enter with another employer to extract the
				coal or perform some other service such as equipment or premises maintenance or
				repair shall be a contract affected by this rule or by W. Va. Code §
									23-2-1d.
				In all instances, the exact terms of and the actual implementation of the
				contract must be examined.
3.2.a. Contracts
				affected by this rule are those which are entered into or extended on or after
				the effective date of this rule, as amended from time to time. It does not
				apply to any other contracts entered into or extended prior to that
				date.
3.2.b. Contracts affected by
				this rule are those for work or services for a period longer than thirty (30)
				days or contracts for consecutive periods of work that total more than thirty
				(30) days.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-10 - Primary Contractor Liability › Section 85-10-4 - Primary Contractor's Liability; Generally

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. The liability of the primary contractor,
				under the provisions of W. Va. Code §
									23-2-1d,
				for the payments due to the workers' compensation commission by its
				subcontractors can arise in only two ways.
4.1.a. If the subcontractor is not in good
				standing with the commission on the first date on which it begins performance
				of its work under the contract, then the primary contractor will become liable
				for any payments due by the subcontractor to the commission after the
				subcontractor begins the performance of its work. The primary contractor will
				not be liable for the payments due to the commission by the subcontractor,
				which became due prior to the start of the subcontractor's work.
4.1.b. The second way in which the primary
				contractor can become liable to the commission for the subcontractor's payments
				is if the subcontractor loses its good standing with the commission after the
				subcontractor begins the performance of its work and throughout the life of the
				contract. That is, a subcontractor can be in good standing with the commission
				at the start of its performance under the contract, but later lose that good
				standing when it fails to make a report or a payment. In this situation, the
				primary contractor can become liable for the debts of the subcontractor to the
				commission unless the primary contractor takes certain actions. In this
				situation, the primary contractor becomes liable only for certain of the
				payments that become due after the default. The primary contractor is not
				liable for any payments that were due prior to that default except as provided
				for in subdivision 4.1.a. The determination of which payments the primary
				contractor becomes liable for is set forth in subsection 5.3.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-10 - Primary Contractor Liability › Section 85-10-7 - Collections Efforts

Current through Register Vol. XLI, No. 28, July 12, 2024
In the event that the primary contractor does not readily
				  make any payment due under this rule, the commission is authorized to take
				  collections actions for payments by the primary contractor under the provisions
				  of W. Va. Code §
									23-2-5a.
				  Reference to that section and the rules promulgated under it should be made by
				  the primary contractor.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-10 - Primary Contractor Liability › Section 85-10-8 - Appeal Process

Current through Register Vol. XLI, No. 28, July 12, 2024
Any primary contractor affected by this rule or W. Va. Code
				  §
									23-2-1d,
				  who wishes to contest any decision made by the commission may do so under the
				  provisions of W. Va. Code §
									23-2-17.
				  The rule implementing that section requires the filing of a formal request for
				  reconsideration, and following reconsideration decision, a petition within
				  thirty days of the primary contractor's receipt of notice of the disputed
				  decision or action or reconsidered decision or, in the absence of such receipt,
				  within sixty days of the date of the commission's making such disputed decision
				  or taking such disputed action or making such reconsideration decision. (See 85
				  CSR7, "Rules for Selected Hearings".)
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-10 - Primary Contractor Liability › Section 85-10-9 - Severability

Current through Register Vol. XLI, No. 28, July 12, 2024
If any provision of this rule or the application thereof to
				  any entity or circumstance shall be held invalid, such invalidity shall not
				  affect the provisions or the applications of this rule which can be given
				  effect without the invalid provisions or application and to this end the
				  provisions of this rule are declared to be severable.
NOTIFICATION REQUEST
DEFAULT OF SUBCONTRACTOR
The undersigned primary contractor hereby notifies the
				  workers' compensation commission that it has entered into a subcontract(s) and
				  that it desires to receive notice from the workers' compensation commission if
				  the subcontractor(s) defaults on any payments due to the workers' compensation
				  commission.
(Please provide the following information:)
PRIMARY CONTRACTOR'S
				  NAME:_____________________________________________________
ADDRESS TO WHICH NOTICES ARE TO BE
				  SENT:_______________________________________
PRIMARY CONTRACTOR'S POLICY
				  NUMBER:___________________________________________
PRIMARY CONTRACTOR'S FEIN1
				  NUMBER: ____________________________________________
SUBCONTRACTOR'S COMPLETE FORMAL NAME (AND INCLUDE ANY TRADE
				  NAME OR TRUE NAME OR A.K.A.)
_____________________________________________________________________________________
SUBCONTRACTOR'S ADDRESS:
				  _______________________________________________________
_____________________________________________________________________________________
SUBCONTRACTOR'S POLICY
				  NUMBER:________________________________________________
SUBCONTRACTOR'S FEIN 
				  1
				  NUMBER:__________________________________________________
GIVE A BRIEF DESCRIPTION OF CONTRACT INCLUDING
				  WORKSITE(S):
_____________________________________________________________________________________
_____________________________________________________________________________________
EXPECTED LENGTH OF THE CONTRACT (BEGINNING DATE & ENDING
				  DATE:
_____________________________________________________________________________________
(Additional sheets may be attached for additional
				  subcontractors.)
DATE:
				  ________________SIGNATURE:__________________________________________________
PRINTED
				  NAME:_____________________________________________________________________
POSITION WITH PRIMARY CONTRACTOR:
				  _____________________________________________
1 If employer does not have an FEIN,
				  please provide social security number.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-11 - Employer Default, Enforcement, Collections and Related Matters › Section 85-11-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This
				rule implements the provisions of W. Va. Code §§
									23-1-13;
				23-2-1,
				1b, 1d, 5, 5a, 5b, 5c, 5d, 8, 9, 13, 14, 15 and 17; 23-2C-19; and 33-2-22,
				regarding the determination of workers' compensation employer default;
				enforcement of compliance by employers with West Virginia's workers'
				compensation laws; and collection of obligations arising from those
				requirements and others.
1.2.
				Authority. -- W. Va. Code §§
									23-2C-19(g)
				and 22; 33-2-10(b); and 33-2-21(a).
Pursuant to W. Va. Code §
									23-2C-5(c)(2),
				  workers' compensation rules proposed by the Commissioner and approved by the
				  Industrial Council are not subject to legislative approval as would otherwise
				  be required under W. Va. Code §
									29A-3-1,
				  et seq. Public notice requirements of that chapter and article, however, must
				  be followed.
1.3. Filing Date. --
				April 10, 2012.
1.4. Effective
				Date. -- May 10, 2012.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-11 - Employer Default, Enforcement, Collections and Related Matters › Section 85-11-2 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
2.1. As used in
				this rule, the following terms, words, and phrases have the meanings stated
				unless in any instance where such term, word, or phrase is employed the context
				expressly indicates that another meaning is intended.
2.2. "Monthly base premium" means the product
				of the employer's estimated monthly payroll for each job classification and the
				current corresponding West Virginia National Council on Compensation Insurance,
				Inc. (NCCI) loss cost for each classification, without modification by any
				other factors such as, but not limited to, tiering, experience modification or
				scheduled rating.
For example, an employer's monthly payroll is $10,000, with
				  $5,000 of the payroll representing job classification "A" under the current
				  NCCI loss costs, at a rate of $10 per $100 of payroll, and $5,000 of the
				  payroll representing job classification "B" under the current NCCI loss costs,
				  at a rate of $5 per $100 of payroll. The monthly base premium would be $750
				  ($10 X $50, or $500, for classification "A"; and $5 X $50, or $250 for
				  classification "B"). In turn, the monthly base premium would be $750 ($500 for
				  classification "A" plus $250 for classification "B").
2.3. "Default" or "default employer" means an
				employer that:
2.3.a. Has an outstanding
				balance or liability to the Old Fund;
2.3.b. Has an outstanding balance or
				liability to the Uninsured Employers' Fund, including owing money to the fund
				for benefit payments, administration costs or attorney fees as well as any
				fines owed to the fund for being uninsured pursuant to W. Va. Code §
										23-2C-8(d)(3)
				and this rule;
2.3.c. Fails to
				carry West Virginia workers' compensation coverage;
2.3.d. Is a former self-insured employer
				whose status has been revoked but who has remaining unsecured obligations
				pursuant to its previous status as a self-insured employer; or
2.3.e. Has any other outstanding obligation,
				balance, debt or other liability pursuant to chapter twenty-three of the West
				Virginia Code or rules promulgated thereunder.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-11 - Employer Default, Enforcement, Collections and Related Matters › Section 85-11-3 - Default Employer not Permitted to Dissolve or Withdraw

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1. The
				Commissioner shall not certify to the Secretary of State of West Virginia that
				all payments and interest due the Commissioner under chapter twenty-three of
				the West Virginia Code or the rules promulgated thereunder by an employer have
				been made until the employer cures any default or makes arrangements
				satisfactory to the Commissioner for that cure or until all payments due by the
				employer under chapter twenty-three of the West Virginia Code or the rules
				promulgated thereunder have been made or arranged for by agreement with the
				Commissioner.
3.2. Pursuant to W.
				Va. Code §
									23-2-5a,
				the Secretary of State shall withhold the issuance of any certificate of
				dissolution or withdrawal in the case of any corporation organized under the
				laws of West Virginia or organized under the laws of any other state and
				admitted to do business in this state until the Secretary of State receives the
				subsection 3.1 certification.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-11 - Employer Default, Enforcement, Collections and Related Matters › Section 85-11-5 - Audits of Employers

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1.
				Pursuant to W. Va. Code §§
									23-1-1b(g)(20),
				23-2-2,
				and
				33-2-22(a),
				the Commissioner has authority to perform audits of any employer in order to
				determine the amount of money owed to the Old Fund. The audits shall be in a
				manner as prescribed by the Commissioner, and employers shall be required to
				comply with all requirements of such audits. Any employer refusing to comply
				with a Commissioner audit as described in this subsection shall be deemed in
				default based on the estimated liability to the Old Fund as calculated by the
				Commissioner based on available and credible information, and shall further be
				subject to all enforcement provisions as contained in chapter twenty-three of
				the West Virginia Code and the rules promulgated thereunder.
5.2. Pursuant to W. Va. Code §§
									23-1-8,
				23-2-2
				and
				33-2-22(a),
				the Commissioner is entitled to hold administrative hearings, conduct
				depositions, and issue subpoenas for production of persons for deposition or
				documents for inspection in order to obtain relevant information for
				determination of amount owed to the Old Fund. All administrative hearings or
				depositions shall be convened and conducted in accordance with section 12 of
				this rule.