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 85-17 - Electronic Payments › Section 85-17-4 - Electronic Payment to Vendors

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. Any vendor who, on or after August 1,
				2021, submits an invoice for payment from one of the State-Administered
				Workers' Compensation Funds to the Insurance Commissioner, or the Insurance
				Commissioner's third-party administrator, may be required to receive payment by
				electronic means if required to do so by the Insurance Commissioner, State
				Auditor and/or State Treasurer.
4.2. Any vendor who wishes to receive payment
				from one of the State-Administered Workers' Compensation Funds shall, if
				required by the Insurance Commissioner, State Auditor and/or State Treasurer,
				register with the State Auditor's Office to receive payment through the State's
				Electronic Funds Transfer (EFT) payment system, through the State's purchasing
				card (P-Card) program or through any other electronic means deemed acceptable.
				The vendor shall provide such additional information as the Insurance
				Commissioner, State Auditor and/or State Treasurer may require to effectuate
				the payments.
4.3. Any vendor who
				does not provide the necessary information in order that payments may be made
				electronically or who fails to otherwise cooperate with the requirements of the
				Insurance Commissioner, State Treasurer or State Auditor to accept payments by
				electronic means, may not receive payment on any submitted invoice until such
				information is provided or cooperation is obtained. The Insurance Commissioner,
				State Auditor and/or State Treasurer may cease issuing paper checks to vendors
				seeking payment from the State-Administered Workers' Compensation Funds after
				August 1, 2021.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-17 - Electronic Payments › Section 85-17-5 - Electronic Payments to Claimants

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1. Any claimant receiving payment from a
				State-Administered Workers' Compensation Fund must, on or before August 1,
				2021, register to receive a direct deposit payment through the State's
				Electronic Funds Transfer (EFT) payment system. This includes payments for
				permanent total disability benefits, permanent partial disability benefits,
				temporary total disability benefits and/or dependent's benefits.
5.2. Claimants may register to receive direct
				deposit payments through the State's Electronic Funds Transfer (EFT) payment
				system by requesting a direct deposit form from the third-party administrator
				assigned to their claim or by contacting the Claims Services Division of the
				Offices of the Insurance Commissioner for assistance.
5.3. Claimants who do not register to receive
				direct deposit payments through the state's Electronic Funds Transfer (EFT)
				payment system by completing a direct deposit form on or before August 1, 2021,
				may be automatically enrolled by the State Auditor in the West Virginia Pay
				Card Program and may receive a prepaid card in lieu of a paper check or direct
				deposit. The prepaid card will automatically be reloaded with the claimant's
				workers' compensation benefit payment every month, or twice a month, in
				accordance with the appropriate benefit payment schedule.
5.4. The Insurance Commissioner, State
				Auditor and/or State Treasurer may cease issuing paper checks to claimants for
				benefits paid from the State-Administered Workers' Compensation Funds after
				August 1, 2021.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-17 - Electronic Payments › Section 85-17-6 - Exemptions

Current through Register Vol. XLI, No. 28, July 12, 2024
Any vendor or claimant who believes that the imposition of
				  the requirements of all or part of this rule will cause a severe economic
				  hardship or other extreme burden upon that vendor or claimant may file a
				  written petition with the Insurance Commissioner requesting an exemption from
				  all or part of the requirements of this rule. Exemptions are generally
				  discouraged, not guaranteed and shall only be granted at the discretion of the
				  Insurance Commissioner, State Auditor and/or State Treasurer, whichever is
				  applicable.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-17 - Electronic Payments › Section 85-17-7 - Private Carriers and Self-Insured Employers

Current through Register Vol. XLI, No. 28, July 12, 2024
This rule shall have no force and effect over private
				  carriers and self-insured employers. However, a private carrier or self-insured
				  employer may establish its own program regarding payment of workers'
				  compensation benefits to claimants or payments of invoices to vendors by
				  electronic means. Nothing herein shall permit any private carrier or
				  self-insured employer to pay a claimant less than the required benefit rate set
				  by statute or pay a provider less than the amount established by the Insurance
				  Commissioner's fee schedule or the rate negotiated pursuant to a preferred
				  provider, managed care, or other medical cost containment relationship with
				  providers of medical, hospital, or other health care as permitted by W. Va.
				  Code §
									23-4-3,
				  if applicable.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-18 - Self Insurance, Self Administration And Third Party Administrators › Section 85-18-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This
				exempt legislative rule addresses employers approved to administer and provide
				their own system of compensation to their injured employees, pursuant to W. Va.
				Code §
									23-2-9.
				This rule applies to employers who previously were in this status, currently
				are in this status or enter this status at some point in the future, and to all
				liabilities of an employer pursuant to being in this status. This rule also
				applies to the qualifications of third party administrators hired by
				self-insured employers to help administer workers' compensation claims filed by
				the injured workers of self-insured employers.
1.2. Authority. -- W. Va. Code §§
									23-2-9;
				23-2C-22;
				33-2-10(b);
				and
				33-2-21(a).
				Pursuant to W. Va. Code §§
									23-2C-5(c)(2)
				and
				33-2-10(b),
				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 West Virginia Code § 29A-3-1 et seq. Public notice
				requirements of that chapter and article, however, must be followed.
1.3. Filing Date. -- July 18, 2008.
1.4. Effective Date. -- August 17,
				2008.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-18 - Self Insurance, Self Administration And Third Party Administrators › Section 85-18-2 - Purpose of Rule

Current through Register Vol. XLI, No. 28, July 12, 2024
The purpose of this rule is to provide for the
				  administration of a system ofself-insurance consistent with the specific
				  provisions and purposes of W. Va. Code §
									23-2-9.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-18 - Self Insurance, Self Administration And Third Party Administrators › Section 85-18-3 - 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. "Audited financial
				statements" mean the financial statements accompanied by an independent
				auditor's report which provide reasonable assurance about whether the audited
				employer has presented fairly the financial position, results of operations,
				and cash flows in conformity with generally accepted accounting principles or
				those of another recognized accounting body. This assurance is derived through
				a systematic process, governed by generally accepted auditing standards or
				Public Company Accounting Oversight Board standards, of objectively obtaining
				and evaluating evidence regarding assertions about economic actions and events
				to determine whether (1) financial information is presented in accordance with
				established or stated criteria, (2) the entity has adhered to specific
				financial compliance requirements, if applicable, or (3) the entity's internal
				control structure over financial reporting and/or safeguarding assets is
				suitably designed and implemented to achieve the control objectives.
3.2. "Commissioner" means the Commissioner of
				Insurance of the State of West Virginia.
3.3. "Decision" means a written statement
				issued by the Commissioner containing the Commissioner's findings of facts and
				conclusions as to any issue presented to the Commissioner under this rule. Such
				decisions include, but are not limited to, notices of delinquency and notices
				of default. Any purported "decision" which is not in writing has no legal
				effect under this rule. "Decision" does not include a written statement in the
				form of e-mail.
3.4. "Default" for
				the purposes of a self-insured employer means the failure by a self-insured
				employer to cure a delinquency after notification within the time specified in
				the notice.
3.5. "Delinquent" means
				a self-insured employer has failed, without good cause, to timely pay workers'
				compensation benefits or to make any other payment due under the terms of
				chapter twenty-three of the West Virginia Code or the rules promulgated
				thereunder.
For purposes of this subsection, "good cause" means the
				  self-insured employer has:
a. Failed
				to receive notice of a properly entered order; or
b. Failed to act on an order that has been
				entered in substantive error, is on its face obviously in error as to the
				amount due or mandates the payment of temporary total disability benefits in
				excess of those permitted by law.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-18 - Self Insurance, Self Administration And Third Party Administrators › Section 85-18-4 - Self Insurance Status

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. Self
				insurance status. An employer may become self-insured if the Commissioner, with
				the approval of the Industrial Council, determines the employer meets the
				financial responsibility and procedural requirements set forth in W. Va. Code
				§
									23-2-9,
				and in this rule.
4.2. An employer
				owned by another business may have its self-insured workers' compensation risks
				guaranteed by a parent, if the relationship between the employer and parent is
				adequately documented, as determined by the Commissioner, and if the parent can
				satisfy the financial responsibility requirements set forth in W. Va. Code
				§
									23-2-9
				and this rule
4.3. Any employer
				granted the privilege of self-insured status shall give security or bond in the
				form, of the type, and in the amount required by the Commissioner, with the
				approval of the Industrial Council, pursuant to W. Va. Code §
									23-2-9
				and this rule. Additionally, any employer granted the privilege of self-insured
				status shall abide by the requirements for maintaining, modifying, or
				terminating the self-insured status, as set forth in W. Va. Code §
									23-2-9
				and 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 85-18 - Self Insurance, Self Administration And Third Party Administrators › Section 85-18-5 - Application for Self Insurance

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1. An employer may apply for self-insured
				status by filing with the Commissioner an application for self-insured status
				in theform prescribed by the Commissioner. If an employer relies on the audited
				financial statements of its parent to be granted self-insured status, the
				relationship between the employer and the parent must be documented on the
				application, and the parent company must provide a parental guaranty in a form
				acceptable to the Commissioner. The required parental guaranty must be received
				and accepted by the Commissioner before the application for self-insured status
				can be processed.
5.2. A disclosure
				of the employer's management and financial structures and the employer's
				audited financial statements for each of the three (3) fiscal years preceding
				the date of application must be attached to the application. If a parent
				business is to insure the employer's self-insured workers' compensation risk,
				the parent's disclosure of management and financial structures, and its audited
				financial statements for the three (3) years preceding the date of application
				must also be attached to the application. The employer shall disclose to the
				Commissioner all of the business entities acquired, bought, transferred or
				merged by or into the employer applicant. Failure to disclose this information
				at the time the application is filed without good cause, as determined in the
				sole discretion of the Commissioner, may result in rejection of the application
a. The employer's application, the
				requiredaudited financial statements and other information must be signed and
				sworn to by:
1. Either the president alone or
				vice-president and secretary or assistant secretary if the employer making
				application is a corporation or limited corporation;
2. All of the partners if the employer making
				application is a partnership;
3. If
				the employer making application is a limited liability company ("LLC"), then by
				all of the general members;
4. The
				owner if the employer making application is a sole proprietorship; or
5. The appropriate officer(s), partner(s),
				member(s) or owner(s) of the parent shall also sign and swear to the
				application and information included therewith, as described in this
				subdivision, if the employer making application is relying on the financial
				statements of the employer's parent in making the application.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-18 - Self Insurance, Self Administration And Third Party Administrators › Section 85-18-6 - Reconciliation and Settlement of Applicant's Account

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1. The Commissioner will review the
				standing of any employer making application for self-insured status regarding
				the West Virginia Workers' Compensation Old Fund and Uninsured Fund and any
				other potential liabilities owed to the State of West Virginia pursuant to
				chapter twenty-three of the West Virginia Code or the rules promulgated
				thereunder. The Commissioner will not approve any application for self-insured
				status made by an employer whose record upon the books of the Commissioner
				shows any money owed pursuant to chapter twenty-three of the West Virginia Code
				or rules promulgated thereunder until the employer has paid in full all
				existing liabilities.
6.2. This
				section applies equally to any outstanding liabilities as described herein owed
				by any employer with whom any owner, officer, partner or member of the applying
				employer was previously affiliated as an owner, officer, partner or member. In
				other words, the employer making application for self-insured status will not
				be approved until all liabilities of all employers with whom any owner,
				officer, partner or member of the applying company is or was previously
				affiliated have been paid in full.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-18 - Self Insurance, Self Administration And Third Party Administrators › Section 85-18-7 - Coverage for catastrophic occurrences

Current through Register Vol. XLI, No. 28, July 12, 2024
In addition to all other security required to be posted for
				  the purpose of maintaining self-insured status under this rule and 85 CSR 19,
				  the Commissioner may require self-insured employers to post an additional
				  amount of security, procure a policy of excess insurance, or both, for the
				  purpose of covering potential catastrophic occurrences. Whether a self-insured
				  employer is required to post security and/or maintain a policy of excess
				  insurance pursuant to this section, and, if so, the amount of security and/or
				  excess insurance required, shall be determined by the application of objective
				  criteria by the Commissioner which will be used to determine the need for
				  additional financial protection against catastrophic risks. Any policy of
				  excess insurance or security required in this section shall be in a form
				  approved by the Commissioner. The self-insured retention amount of any excess
				  policy as described in this section shall be subject to the approval of 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 85-18 - Self Insurance, Self Administration And Third Party Administrators › Section 85-18-9 - Self-insured Employer's Modification of Business

Current through Register Vol. XLI, No. 28, July 12, 2024
9.1. In the event a self-insured employer
				reorganizes its business, assumes additional liability, acquires new assets or
				operations, buys an additional business, merges with another business, or
				otherwise changes its operation in any manner which is likely to impact its
				West Virginia workers' compensation claims liability, or ability to satisfy its
				financial responsibility requirements, the self-insured employer must
				immediately notify the Commissioner of the business modification. The notice of
				modification must contain specific information as to the nature of the
				modification, including, but not limited to, a copy of the executed contract
				causing the modification and the names of other employers or businesses
				affected by the modification, any information filed with the Securities
				Exchange Commission related to the modification, any audited or restated
				audited financial information related to the modification which was not
				previously submitted to the Commissioner and any pro forma financial
				information prepared pursuant to the modification. The employer shall also
				provide any additional information requested by the Commissioner regarding the
				transaction, within the timeframes specified.
9.2. If, after reviewing and analyzing all
				relevant information regarding the self-insured employer's business
				modification, the Commissioner determines that the transaction creates a
				substantial new risk to the self-insured community, the Commissioner may, in
				his or her sole discretion, require any entity involved in the relevant
				transaction to file a new application for self-insured status.
9.3. Under subsections 9.1. and 9.2. of this
				section, the Commissioner will review the employer's security and bond
				requirements following any changes made to the self-insured employer's account
				and, if necessary, make an appropriate recommendation to the Industrial Council
				for an adjustment to the security requirements.
9.4. If the modification of business requires
				processing that includes any type of an actuarial analysis, a $2,500.00
				processing fee shall be assessed.
9.5. If the modification causes a
				self-insured employer to no longer qualify for the privilege of self-insured
				status, the Commissioner, with the approval of the Industrial Council, may
				terminate the self-insured employer's status in accordance with the provisions
				of section 14 of this rule. Settlement of estimated liability at the time of
				revocation shall be determined in accordance with 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 85-18 - Self Insurance, Self Administration And Third Party Administrators › Section 85-18-10 - Voluntary Termination of Self-Insured Status

Current through Register Vol. XLI, No. 28, July 12, 2024
10.1. A self-insured employer may terminate
				its self-insured status with the following conditions:
a. The employer shall remain forever liable
				for all accrued and contingent liabilities which the employer has incurred as a
				result of being self-insured;
b.
				The employer shall provide written notice to the Commissioner a minimum of
				thirty (30) days prior to the termination of its status. Upon the expiration of
				the thirty (30) days of notice, self-insured status shall terminate the first
				day of the succeeding calendar quarter.
c. The employer shall post bond or security
				in an amount estimated sufficient to cover the costs of all future accrued and
				contingent liabilities resulting from the period of self-insured status. The
				security or bond is subject to the Commissioner's approval of the form, type
				and amount of the security or bond.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-18 - Self Insurance, Self Administration And Third Party Administrators › Section 85-18-11 - Self-Administration of Claims

Current through Register Vol. XLI, No. 28, July 12, 2024
11.1. All
				self-insured employers shall administer their own claims consistent with the
				provisions of chapter twenty-three of the West Virginia Code and the rules
				promulgated thereunder. An injured worker who is an employee of a self-insured
				employer is entitled to all of the workers' compensation benefits, pursuant to
				chapter twenty-three of the West Virginia Code and the rules promulgated
				thereunder, as those afforded to injured workers whose claims are paid and
				administered by private workers' compensation insurance carriers. These same
				benefits include the proper and timely payment of medical bills and
				compensation.
11.2. Notifications.
a. Each new self-insured employer shall
				within five (5) working days notify, in writing, the following persons,
				entities or adjudicatory bodies involved in active claims matters that the
				self-insured employer is self-administering its claims:
1. Claimants;
2. Claimant representatives;
3. All parties to the claim;
4. All adjudicatory bodies that are currently
				proceeding in the claim; and
5.
				Vendors who are rendering services in the claim.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-18 - Self Insurance, Self Administration And Third Party Administrators › Section 85-18-12 - Payroll Reports, Assessments and Surcharges

Current through Register Vol. XLI, No. 28, July 12, 2024
12.1. Upon filing an application for
				self-insured status, an employer acknowledges its obligation to continue to
				make all payments and file all reports required by chapter twenty-three of the
				West Virginia Code and the rules promulgated thereunder.
12.2. On or before the last day of the first
				month of each quarter, for the preceding quarter, each self-insured employer
				shall file with the Commissioner a sworn statement of the total payroll of all
				of its employees subject to chapter twenty-three of the West Virginia Code for
				the preceding quarter.
12.3. In
				addition to properly and timely administering and paying workers' compensation
				claims, self-insured employers are also responsible for timely remittance of
				debt reduction and regulatory surcharges pursuant to W. Va. Code §
									23-2C-3
				and W. Va. CSR §
									85-6-1 et seq.
				and, if applicable, remission of self-insured pool assessments pursuant to W.
				Va. CSR §
									85-19-1 et
				seq. Failure to timely remit the surcharges and assessments will result in
				delinquency and, if the delinquency is not cured, default, which can subject
				the self-insured employer to penalties, including revocation of self-insured
				status.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-18 - Self Insurance, Self Administration And Third Party Administrators › Section 85-18-13 - Auditing, Monitoring and Inspections; Record Keeping

Current through Register Vol. XLI, No. 28, July 12, 2024
13.1. Preservation of records. Every
				self-insured employer shall keep, preserve and maintain complete records
				showing in detail all expenditures for payroll and the separation of such
				expenditures in the various classifications of the employer's business. The
				employer shall keep such additional information necessary to determine
				classification of the employer's activities as well as other information
				necessary for a risk assessment. Records shall be preserved for not less than
				ten (10) years after the respective times of the transaction upon which the
				records are based. The employer shall retain all records for periods in excess
				of ten (10) years in matters involving possible fraud or failure to report or
				disputes with the Commissioner until the Commissioner or appropriate
				administrative, judicial or appellate body finally resolves the matter and the
				time for appeal has been exhausted.
13.2. Pursuant to W. Va. Code §
									23-2-2(a),
				each self-insured employer shall furnish to the Commissioner, upon request, all
				information required to determine risk assessment, the amount of surcharges and
				assessments owed, or to carry out any other duties under chapter twenty-three
				of the West Virginia Code and the rules promulgated thereunder. This
				information may include, but is not limited to, the number of employees
				employed by the employer during a pertinent period and the names, social
				security numbers, payroll during relevant periods, occupations and
				classification information of the self-insured employer's employees,.
13.3. Preservation of claims records. Every
				self-insured employer is required to keep, preserve and maintain all records
				relevant to workers' compensation claims.
13.4. Inspections of records; failure to
				maintain records.
a. The self-insured
				employer shall keep available for inspection at any reasonable time by the duly
				authorized representatives of the Commissioner:
1. All accounting records, books, records,
				papers and documents, whether in hard copy or electronic form, reflecting the
				amount and the classifications of the payroll expenditures of an employer, as
				well as the nature of the business operation; and
2. All records relevant to workers'
				compensation claims, whether in hard copy or electronic from.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-18 - Self Insurance, Self Administration And Third Party Administrators › Section 85-18-14 - Maintaining Self-Insured Status; Annual Review

Current through Register Vol. XLI, No. 28, July 12, 2024
14.1. The employer's status as a self-insured
				employer shall continue on a year-to-year basis so long as the employer
				continues to maintain the requisite financial standing and continues to satisfy
				the other requirements imposed by chapter twenty-three of the West Virginia
				Code and the rules promulgated thereunder, and any order of the
				Commissioner.
14.2. Annual review.
				The Commissioner will perform a comprehensive claims, financial, compliance and
				security review of each self-insured employer on an annual basis. The
				Commissioner may conduct an audit of all claims records, accounting records,
				books, records, papers, operations and documents deemed relevant by the
				Commissioner in the possession or control of the employer.
a. The Commissioner shall notify each
				self-insured employer of their annual review.
b. Upon notice of the Commissioner, each
				self-insurer shall file or make available for inspection, by whichever method
				specified by the Commissioner, all documents and information requested to
				perform an annual review on the self-insured employer. If any employer fails to
				make such records and information available for inspection, the Commissioner
				may recommend to the Industrial Council that the employer's self-insurance
				status be revoked or, in the Commissioner's discretion, impose penalties on the
				self-insured employer.
c. The
				Commissioner shall notify the employer of the results of the annual review or
				interim reviews if such reviews reflect a deteriorating financial
				condition.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-18 - Self Insurance, Self Administration And Third Party Administrators › Section 85-18-15 - Involuntary revocation of self-insurance status

Current through Register Vol. XLI, No. 28, July 12, 2024
15.1. Notification.
a. Prior to recommending to the Industrial
				Council that the self-insured employer's status of self-insurance be revoked,
				the Commissioner shall:
1. Notify the
				self-insured employer regarding the forthcoming recommendation;
2. Provide to the employer the reasons for
				recommending revocation of self-insured status;
3. Provide to the employer fifteen (15) days
				for written response to the Commissioner's reasons for recommending revocation
				of self-insurance status;
4. Inform
				the self-insured employer that failure to respond in writing to the
				notification will result in the Commissioner's recommendation to the Industrial
				Council that the employer's self-insured status be revoked; and
5. Provide the notification to the
				self-insured in writing and by certified United States mail, return receipt
				requested.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-18 - Self Insurance, Self Administration And Third Party Administrators › Section 85-18-16 - Name and Address of Employer; Legal Notice; Publications; Employer Correspondence

Current through Register Vol. XLI, No. 28, July 12, 2024
16.1.
				General. Self-insured employers are required to provide the Commissioner with
				the name, telephone number, fax number and e-mail address of its designated
				primary contact person responsible for workers' compensation matters. Except as
				hereinafter provided, the name and address given by the employer on the
				application for coverage shall be used by the Commissioner for giving any
				notice required by the statute or by this rule, unless a formal request for a
				change of name or address is made by the employer as hereinafter
				provided.
16.2. Change of name or
				address. Any self-insured employer changing the name or the address of its
				business must promptly notify the Commissioner, in writing, and request that
				the name or address be changed on the Commissioner's records. Every employer
				required to register with the Office of the Secretary of State shall provide
				evidence of any name change from that office.
a. In case of the appointment of a
				receivership, the full name of the receivership shall be reported.
b. If the employer wishes to have certain
				notices and correspondence directed to a subsidiary, a branch office or agent,
				the employer must notify the Commissioner in writing of the name and address of
				said subsidiary, branch office or representative and specify the circumstances
				under which said notice is to be given. The representative shall notify the
				Commissioner when such representation ceases and provide a current address to
				which the employer's notices and correspondence are to be sent.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-18 - Self Insurance, Self Administration And Third Party Administrators › Section 85-18-17 - Third Party Administrators

Current through Register Vol. XLI, No. 28, July 12, 2024
Self-insured employers may hire third party administrators
				  to administer claims if the third party administrator is licensed to perform
				  workers' compensation claims services for the self-insured employer, consistent
				  with the provisions of W. Va. Code §
									23-2C-17(c).
				  Additionally, any third-party administrator performing services for
				  self-insured employers shall comply with relevant provisions of chapters
				  twenty-three and thirty-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 85-18 - Self Insurance, Self Administration And Third Party Administrators › Section 85-18-18 - Administrative Protests and Hearings

Current through Register Vol. XLI, No. 28, July 12, 2024
Any self-insured employer who wishes to contest a decision
				  made by the Commissioner, under the provisions of chapter twenty-three, article
				  two of the West Virginia Code, may do so under the provisions of W. Va. Code,
				  §
									23-2-17
				  and 85 CSR 7, "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 85-19 - Self Insurance Risk Pools › Section 85-19-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This
				exempt legislative rule provides for the creation of risk pools for the benefit
				of self-insured employers to secure the payment of obligations of self-insured
				employers.
1.2. Authority. -- W.
				Va. Code §§
									23-2-9(e),
				23-2C-2(p),
				23-2C-2(q),
				23-2C-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-3-9
				through
				29A-3-16,
				inclusive. Public notice requirements of that chapter and article, however,
				must be followed.
1.3. Filing Date.
				-- October 22, 2008.
1.4. Effective
				Date. -- November 21, 2008.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-19 - Self Insurance Risk Pools › Section 85-19-2 - Purpose of Rule

Current through Register Vol. XLI, No. 28, July 12, 2024
This rule provides for the continued maintenance and funding
				  of two risk pools to secure the obligations of self-insured
				  employers.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-19 - Self Insurance Risk Pools › Section 85-19-3 - 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. "Default" means the
				failure by a self-insured employer to make a payment (including but not limited
				to payment of a claim, regulatory surcharge, debt reduction assessment or
				guaranty pool assessment), maintain required surety pursuant to the provisions
				of W. Va. Code St. R. §
									85-18-1 et
				seq. and this rule, or file a report due by it under the provisions of chapter
				twenty-three of the West Virginia Code or the rules promulgated thereunder
				within the time period specified by a notice regarding such failure.
3.2. "Employee" has the meaning ascribed to
				that term by W. Va. Code §§
									23-2-1
				and
				23-2-1a.
3.3. "Employer" has the meaning ascribed to
				that term by W. Va. Code §
									23-2-1,
				which includes, but is not limited to, any individual, sole proprietor, firm,
				partnership, limited partnership, limited liability company, joint venture,
				association, corporation, company, organization, receiver, estate, trust,
				guardian, executor, administrator, government entity or any other entity
				regularly employing another person or persons for the purpose of carrying on
				any form of industry, service or business in this state.
3.4. "Guaranty Pool", as the term is used in
				this rule means the Self-insured employer guaranty risk pool as established by
				W. Va. Code §§
									23-2-9(e)
				and
				23-2C-2(p).
3.5. "Industrial Council" means the
				Industrial Council created within the office of the Insurance Commissioner
				pursuant to W. Va. Code §
									23-2C-5.
3.6. "Commissioner" means the Insurance
				Commissioner of West Virginia.
3.7.
				"Security Pool", as the term is used in this rule means the Self-insured
				employer security risk pool as established by W. Va. Code §§
									23-2-9(e)
				and
				23-2C-2(q).
3.8. "Self-insurer" and "self-insured
				employer" mean employers who have been granted self-insured status under the
				provisions of W. Va. Code §
									23-2-9.
3.9. "Insured Employer" means an employer who
				obtains coverage under any of the workers' compensation insurance plans offered
				by an insurer licensed by the Commissioner to provide such coverage in this
				State.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-19 - Self Insurance Risk Pools › Section 85-19-4 - Self Insurance Pools; Establishment; Application of Funds

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. The Commissioner shall maintain the
				Self-insured Employer Security Pool established pursuant to W. Va. Code
				§§
									23-2-9(e)
				and
				23-2C-2(q)
				to make payments for bankrupt and default self-insured employers for claims
				with dates of injury prior to July 1, 2004.
a. The Commissioner shall segregate all
				contributions to the Security Pool, including all investment income earned from
				Security Pool proceeds.
b. The
				Commissioner shall not expend proceeds from the Security Pool corpus or its
				earnings for any other purposes than for obligations of the security
				pool.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-19 - Self Insurance Risk Pools › Section 85-19-5 - Participation

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1. All
				self-insured employers, whether active or inactive, which have any claims
				arising during the period of self-insurance and which are open or subject to
				being re-opened shall participate in the Security Pool.
5.2. All active self-insured employers shall
				participate in the Guaranty Pool. Active self-insured employers that become
				inactive on or after July 1, 2004, shall be required to participate in the
				Guaranty Pool under the provisions of section 10. of this rule.
5.3. Former self-insured employers who have
				voluntarily bought out their liability prior to December 31, 2005, or have
				entered into an agreement for an involuntary buy out are not required to
				participate in either the security or guaranty pools.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-19 - Self Insurance Risk Pools › Section 85-19-6 - Surety Requirements

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1.
				All employers who participate in the Security Pool are required to fully secure
				their claims liabilities for all claims with dates of injury prior to July 1,
				2004.
a. All employers who are fully secured
				for their claims liabilities as of the effective date of this rule shall
				maintain and increase their security as necessary to remain fully secured for
				their claims liabilities.
b. The
				failure by an employer to fully secure and maintain security on their claims
				liabilities in accordance with this rule may result in revocation of
				self-insurance status pursuant to the provisions of W. Va. Code St. R. §
										85-18-1 et
				seq. An employer who receives a notification of a recommendation by the
				Commissioner of revocation of self-insured status for failure to fully secure
				or maintain security on their claims liability may file a petition with the
				Industrial Council to be granted a six (6) month grace period to obtain
				security.
1. The employer shall file its
				petition for grace period with the Commissioner who will distribute the
				petition to the Industrial Council.
2. The Industrial Council shall consider the
				petition for grace period at such time as is convenient to the Industrial
				Council. The Industrial Council shall consider the petition in an executive
				session. The Industrial Council may consider the written petition only or
				request the employer, the Commissioner or both to make an oral presentation.
				The Industrial Council shall make any decision regarding the petition for grace
				period in an open meeting.
3. The
				Industrial Council shall only grant a petition for grace period upon a
				unanimous vote of the Industrial Council.
4. An employer may only be granted one grace
				period.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-19 - Self Insurance Risk Pools › Section 85-19-7 - Security Pool Funding

Current through Register Vol. XLI, No. 28, July 12, 2024
7.1. The
				Security Pool shall be funded by the following sources:
a. Proceeds received from the draw-down on
				surety documents in the event of a self-insured employer's default;
b. All graduated premium tax payments made by
				participating self-insured employers for periods through the quarter ending
				June 30, 2004;
c. Assessments to
				fund the Security Pool pursuant to W. Va. Code §
										23-2-9(e);
				and d. Proceeds received from any alternative funds identified and made
				available through legislative enactment.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-19 - Self Insurance Risk Pools › Section 85-19-8 - Security Pool Assessments Pursuant to W. Va. Code Section 23-2-9(e)

Current through Register Vol. XLI, No. 28, July 12, 2024
Beginning January 1, 2006, Security Pool assessments to
				  self-insured employers shall be made as follows:
8.1. The Commissioner shall determine the
				projected claims payments to be made in the fiscal year.
8.2. The Commissioner shall determine the
				amount necessary to fund the Security Pool through assessments.
8.3. The Commissioner shall determine the
				methodology employed to allocate to each self-insured employer, based upon the
				self-insured employer's claims reserves and financial strength, a fair and
				equitable portion of the projected claims payments.
8.4. In accordance with the methodology
				employed, the Commissioner shall determine the amount of each Security Pool
				assessment.
8.5. Notification. The
				Commissioner shall notify every employer who is assessed under this provision
				the amount of the assessment and the methodology employed to determine the
				assessment. The Commissioner shall provide notice to each affected employer at
				least sixty (60) days prior to the period for which the assessment is
				applicable.
8.6. Payments required
				under this provision shall be pro-rated and made on a quarterly
				basis.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-19 - Self Insurance Risk Pools › Section 85-19-9 - Guaranty Pool Funding

Current through Register Vol. XLI, No. 28, July 12, 2024
9.1. Beginning
				July 1, 2006, and in order to fund the Guaranty Pool, the Commissioner shall,
				except with respect to those self-insured employers and former self-insured
				employers required to make payments in accordance with subdivision b. of this
				subsection and section 10. of this rule, respectively, assess self-insured
				employers, as follows:
a. The annual
				assessment shall be equal to two percent (2%) of the self-insured employer's
				preceding fiscal year's annual claims indemnity payments [excluding payments to
				settle claims on a full and final basis] or a minimum of five thousand dollars
				($5,000), whichever is greater. For example, a self-insured employer has paid
				one million dollars ($1,000,000.00) in indemnity payments in the preceding
				fiscal year. Of the one million dollars ($1,000,000.00), two hundred thousand
				dollars ($200,000.00) has been paid to settle claims on a full and final basis.
				The self-insured employer would be assessed two percent (2%) of eight hundred
				thousand dollars ($800,000.00), which yields sixteen thousand dollars
				($16,000.00) as an assessment to the self-insured employer; and
b. Any employer who becomes self-insured on
				or after July 1, 2004, will be assessed an amount equal to five percent (5%) of
				the preceding year's premium, or a minimum of five thousand dollars ($5,000),
				whichever is greater, for a period of 3 years, beginning with the quarter in
				which self-insured status was made effective and regardless of whether such
				employer becomes an insured employer within such 3-year period: Thereafter,
				assessments shall be made in accordance with the same methodology utilized for
				other self-insured employers, as set forth in subdivision a. of this
				subsection. An employer's liability for the assessments imposed pursuant to
				this subsection is not subject to suspension under subsection 9.2. of this
				section.
c. Payments made under
				this section and section 10. of this rule shall be pro-rated and made on a
				quarterly basis.