COMMITTEE SUBSTITUTE
FOR
Senate Bill No. 595
(By Senator Minard)
____________
[Originating in the Committee on the Judiciary;
reported February 26, 2007.]
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A BILL to amend and reenact §23-1-1 and §23-1-1f of the Code of
West Virginia, 1931, as amended; to amend and reenact §23-2-9
of said code; to amend and reenact §23-2C-3, §23-2C-8, §23-2C-
15, §23-2C-18 and §23-2C-19 of said code; to amend said code
by adding thereto a new section, designated §23-2C-18a; and to
amend and reenact §23-5-9 of said code, all relating to the
transition to a private workers' compensation insurance
system; expressing legislative intent; permitting the
Insurance Commissioner to hire additional exempt employees;
exempting the Insurance Commissioner from purchasing rules in
some circumstances; changing requirements for approval of
self-insured status and for reports from self-insured
employers; making various technical changes necessitated by
the transition to a private workers' compensation insurance
system; reducing frequency of certain payments from self-
insured employers and private carriers; authorizing the Insurance Commissioner to assess self-insured employers for
certain funds; making certain assessments against self-insured
employers discretionary with the Insurance Commissioner;
clarifying how disputes related to claims against the
Uninsured Employer Fund are resolved; increasing time that
employers must report certain changes in coverage to the
Insurance Commissioner; authorizing the Insurance Commissioner
to promulgate exempt legislative rules; revising rate-making
process; defining terms; providing for the designation of a
single rating organization; deleting provisions regarding
private carrier premium collection; requiring agencies to
terminate or revoke licenses, permits or certifications of
employers in default to the state; clarifying persons subject
to certain liens; providing for stay of award pending appeal;
and removing requirement that the record of proceedings
before the office of judges include certain documents.
Be it enacted by the Legislature of West Virginia:
That §23-1-1 and §23-1-1f of the Code of West Virginia, 1931,
as amended, be amended and reenacted; that §23-2-9 of said code be
amended and reenacted; that §23-2C-3, §23-2C-8, §23-2C-15, §23-2C-
18 and §23-2C-19 of said code be amended and reenacted; that said
code be amended by adding thereto a new section, designated §23-2C-
18a; and that §23-5-9 of said code be amended and reenacted, all to
read as follows:
CHAPTER 23. WORKERS' COMPENSATION.
ARTICLE 1. GENERAL ADMINISTRATIVE PROVISIONS.
§23-1-1. Workers' Compensation Commission created; findings.
(a) The Legislature finds that a deficit exists in the
Workers' Compensation Fund of such critical proportions that it
constitutes an imminent threat to the immediate and long-term
solvency of the fund and constitutes a substantial deterrent to the
economic development of this state. The Legislature further finds
that addressing the workers' compensation crisis requires the
efforts of all persons and entities involved and resolution of the
crisis is in the best interest of the public. Modification to the
rate system, alteration of the benefit structure, improvement of
current management practices and changes in perception must be
merged into a unified effort to make the workers' compensation
system viable and solvent through the mutualization of the system
and the opening of the market to private workers' compensation
insurance carriers. It was and remains the intent of the
Legislature that the amendments to this chapter enacted in the year
two thousand three be applied from the date upon which the
enactment was made effective by the Legislature. The Legislature
finds that an emergency exists as a result of the combined effect
of this deficit, other state budgetary deficits and liabilities and
other grave social and economic circumstances currently confronting
the state and that unless the changes provided by the enactment of
the amendments to this chapter, as well as other legislation
designed to address the problem are made effective immediately, the
fiscal stability of this state will suffer irreparable harm.
Accordingly, the Legislature finds that the need of the citizens of this state for the protection of the State Treasury and the
solvency of the Workers' Compensation Funds requires the
limitations on any expectations that may have arisen from prior
enactments of this chapter.
(b) It is the further intent of the Legislature that this
chapter be interpreted so as to assure the quick and efficient
delivery of indemnity and medical benefits to injured workers at a
reasonable cost to the employers who are subject to the provisions
of this chapter. It is the specific intent of the Legislature that
workers' compensation cases shall be decided on their merits and
that a rule of "liberal construction" based on any "remedial" basis
of workers' compensation legislation shall not affect the weighing
of evidence in resolving such cases. The workers' compensation
system in this state is based on a mutual renunciation of common
law rights and defenses by employers and employees alike.
Employees' rights to sue for damages over and above medical and
health care benefits and wage loss benefits are to a certain degree
limited by the provisions of this chapter and employers' rights to
raise common law defenses such as lack of negligence, contributory
negligence on the part of the employee, and others, are curtailed
as well. Accordingly, the Legislature hereby declares that any
remedial component of the workers' compensation laws is not to
cause the workers' compensation laws to receive liberal
construction that alters in any way the proper weighing of evidence
as required by section one-g, article four of this chapter.
(c) The "Workers' Compensation Division of the Bureau of Employment Programs" is, on or after the first day of October, two
thousand three, reestablished, reconstituted and continued as the
Workers' Compensation Commission, an agency of the state. The
purpose of the commission is to ensure the fair, efficient and
financially stable administration of the workers' compensation
system of the State of West Virginia. The powers and duties
heretofore imposed upon the Workers' Compensation Division and the
Commissioner of the Bureau of Employment Programs as they relate to
workers' compensation are hereby transferred to and imposed upon
the Workers' Compensation Commission and its executive director in
the manner prescribed by this chapter.
(d) It is the intent of the Legislature that the transfer of
the administration of the workers' compensation system of this
state from the Workers' Compensation Division under the
Commissioner of the Bureau of Employment Programs to the Workers'
Compensation Commission under its executive director and the
workers' compensation board of managers is to become effective the
first day of October, two thousand three. Any provisions of the
enactment of Enrolled Senate Bill No. 2013 in the year two thousand
three relating to the transfer of the administration of the
workers' compensation system of this state that conflict with the
intent of the Legislature as described in this subsection shall, to
that extent, become operative on the first day of October, two
thousand three, and until that date, prior enactments of this code
in effect on the effective date of Enrolled Senate Bill No. 2013
relating to the administration of the workers' compensation system of this state, whether amended and reenacted or repealed by the
passage of Enrolled Senate Bill No. 2013, have full force and
effect. All provisions of the enactment of Enrolled Senate Bill
No. 2013 in the year two thousand three relating to matters other
than the transfer of the administration of the workers'
compensation system of this state shall become operative on the
effective date of that enactment, unless otherwise specifically
provided in that enactment.
(e) It is the intent of the Legislature, expressed through its
enactment of legislation to transfer the regulation of the workers'
compensation system to the Insurance Commissioner. By proclamation
of the Governor, as authorized by article two-c of this chapter,
the Workers' Compensation Commission was terminated on the thirty-
first day of December, 2005. To further the transition from the
state operated workers' compensation system to a system of private
insurance, the duties and responsibilities of the Workers'
Compensation Commission and the Board of Managers, including, but
not limited to, rate-making and adjudication of claims now reside
with the Insurance Commissioner.
§23-1-1f. Authority of Insurance Commission to exempt employees
from classified service; exemption from purchasing
rules.
The workers' compensation division shall continue to exist
pursuant to article ten, chapter four of this code through the
thirtieth day of September, two thousand three, at which time all powers and duties are transferred to the workers' compensation
commission. The workers' compensation commission shall continue to
exist, pursuant to said article until the first day of July, two
thousand six, unless sooner terminated, continued or reestablished
pursuant to the provisions of that article. Notwithstanding any
other provision of this code, upon termination of the commission,
the Insurance Commissioner may:
(1) Exempt no more than twenty positions of the offices of the
Insurance Commissioner from the classified service of the state,
the employees of which positions shall serve at the will and
pleasure of the commissioner: Provided, That such exempt positions
shall be in addition to those positions in classified-exempt
service under the classification plan adopted by the Division of
Personnel. The Insurance Commissioner shall report all exemptions
made under this section to the Director of the Division of
Personnel no later than the first day of July, two thousand seven,
and thereafter as the commissioner determines to be necessary; and
(2) Expend such sums for professional services as he or she
determines are necessary to perform those duties transferred to the
Insurance Commissioner upon the termination of the commission. The
provisions of article three, chapter five-a of this code relating
to the Purchasing Division of the Department of Administration
shall not apply to these contracts, and the Insurance Commissioner
shall award the contract or contracts on a competitive basis.
ARTICLE 2. EMPLOYERS AND EMPLOYEES SUBJECT TO CHAPTER;
EXTRATERRITORIAL COVERAGE.
§23-2-9. Election of employer or employers' group to be
self-insured and to provide own system of
compensation; exceptions; self administration; rules;
penalties; regulation of self-insurers.
(a) Notwithstanding any provisions of this chapter to the
contrary, the following types of employers or employers' groups may
apply for permission to self-insure their workers' compensation
risk.
including their risk of catastrophic injuries.
(1) The types of employers are:
(A) Any employer who is of sufficient capability and financial
responsibility to ensure the payment to injured employees and the
dependents of fatally injured employees of benefits provided
for in
this chapter at least equal in value to the compensation provided
for in this chapter;
(B) Any employer or group of employers as provided
for
subdivision (c) in paragraph (A) of such capability and financial
responsibility
who that maintains its own benefit fund or system of
compensation to which its employees are not required or permitted
to contribute and whose benefits are at least equal in value to
those provided
for in this chapter; or
(C) Any employer who is signatory to a collective bargaining
agreement that allows for participation in a group workers'
compensation insurance program may join with any other employer or
employers that are signatory to a collective bargaining agreement
or agreements that allow for participation in a group workers' compensation program and jointly apply to the
commission Insurance
Commissioner to collectively self-insure their obligations under
this chapter. The employers must collectively meet the conditions
set forth in paragraph (A) or (B) of this subdivision. There shall
be joint and several liability for all employers who choose to
jointly self-insure under the provisions of this article.
(2) In order to be approved for self-insurance status, the
employer shall:
(A)
Have an effective health and safety program at its
workplaces; and Submit all information requested by the Insurance
Commissioner;
(B) Provide security or bond in an amount and form determined
by the
executive director with the approval of the board of
managers Insurance Commissioner which shall balance the employer's
financial condition based upon an analysis of its audited financial
statements and the full accrued value of current liability for
future claim payments based upon generally accepted actuarial and
accounting principles of the employer's existing and expected
liability;
(C) Meet the financial responsibility requirements set forth
in rules promulgated by the board of managers or industrial
council;
(D) Obtain and maintain a policy of excess insurance if
required to do so by the Insurance Commissioner; and
(E) Have an effective health and safety program at its
workplaces.
(3) Any employer whose record upon the books of the commission
shows a liability, as determined on an accrued basis against the
workers' compensation fund incurred on account of injury to or
death of any of the employer's employees, in excess of premiums
paid by the employer, shall not be granted the right, individually
and directly or from the benefit funds or system of compensation,
to be self-insured until the employer has paid into the workers'
compensation fund the amount of the excess of liability over
premiums paid, including the employer's proper proportion of the
liability incurred on account of catastrophes or second injuries as
defined in section one, article three of this chapter and charged
against such fund.
(4) (3) Upon a finding that the employer has met all of the
requirements of this section
and any rules promulgated thereunder,
the employer may be permitted self-insurance status. An annual
review of each self-insurer's continuing ability to meet its
obligations and the requirements of this section shall be made by
the
workers' compensation commission Insurance Commissioner. At
the time of such review, the Insurance Commissioner may require
that the self-insured employer post a bond or security or obtain
and maintain an excess insurance policy. This review shall
also
include a
redetermination recalculation of the amount of
any
security,
or bond,
which shall be provided by the employer or
policy of excess insurance previously required to be posted or
obtained under any provision of this chapter or any rules
promulgated thereunder. Failure to provide
any new the required amount or form of security or bond
or to obtain or maintain the
required excess insurance policy may cause the employer's
self-insurance status to be terminated by the
workers' compensation
commission Insurance Commissioner. The security or bond provided
by employers prior to the second day of February, one thousand nine
hundred ninety-five, shall continue in full force and effect until
the performance of the employer's annual review and the entry of
any appropriate decision on the amount or form of the employer's
security or bond.
(5) (4) Whenever a self-insured employer furnishes security
or bond, including replacement and amended bonds and other
securities, as surety to ensure the employer's or guarantor's
payment of all obligations under this chapter for which the
security or bond was furnished, the security or bond shall be in
the most current form or forms approved and authorized by the
commission
or Insurance Commissioner for use by the employer or its
guarantors, surety companies, banks, financial institutions or
others in its behalf for that purpose.
(b) (1) Notwithstanding any provision in this chapter to the
contrary, self-insured employers shall, effective the first day of
July, two thousand four, administer their own claims. The
executive director Insurance Commissioner shall, pursuant to rules
promulgated by the board of managers
or industrial council,
regulate the administration of claims by employers granted
permission to self-insure their obligations under this chapter.
Such rules shall be promulgated at least thirty days prior to the first day of July, two thousand four. A self-insured employer
shall comply with rules promulgated by the board of managers
or
industrial council governing the self-administration of its claims.
(2) An employer or employers' group
who that self-insures its
risk and self-administers its claims shall exercise all authority
and responsibility granted to the
commission Insurance Commissioner
or private carriers in this chapter and provide notices of action
taken to effect the purposes of this chapter to provide benefits to
persons who have suffered injuries or diseases covered by this
chapter. An employer or employers' group granted permission to
self-insure and self-administer its obligations under this chapter
shall at all times be bound and shall comply fully with all of the
provisions of this chapter. Furthermore, all of the provisions
contained in article four of this chapter pertaining to disability
and death benefits are binding on and shall be strictly adhered to
by the self-insured employer in its administration of claims
presented by employees of the self-insured employer. Violations of
the provisions of this chapter and such rules relating to this
chapter as may be approved by the board of managers
or industrial
council may constitute sufficient grounds for the termination of
the authority for any employer to self-insure its obligations under
this chapter.
Claim notices currently generated by the commission
on behalf of self-insured employers must be generated and sent by
the self-insured employer or its third-party administrator.
(c) Each self-insured employer shall, on or before the last
day of the first month of each quarter or other assigned reporting period, file with the
commission Insurance Commissioner a certified
statement of the total gross wages and earnings of all of the
employer's employees subject to this chapter for the preceding
quarter or other assigned reporting period.
Each self-insured
employer shall pay into the workers' compensation fund as portions
of its self-insured employer premium tax:
(1) A sum sufficient to pay the employer's proper portion of
the expense of the administration of this chapter;
(2) A sum sufficient to pay the employer's proper portion of
the expense of claims for those employers who are in default in the
payment of premium taxes or other obligations;
(3) A sum sufficient to pay the employer's fair portion of
the expenses of the disabled workers' relief fund;
(4) A sum sufficient to maintain as an advance deposit an
amount equal to the previous quarter or other assigned reporting
period's payment of each of the foregoing three sums;
(5) A sum as determined by the commission to be sufficient to
pay the employer's portion of rates, surcharges or deficit
management and deficit reduction assessments; and
(6) A sum as determined by the commission to pay the
employer's portion of self-insured catastrophic injury benefits,
and second injury payments on all self-insured second injury claims
other than second injury claims for those employers self-insured
for second injury. Any employer previously self-insured for second
injury benefits shall continue to be responsible for payment of
those benefits.
(d) The required payments to the employer's injured employees
or dependents of fatally injured employees as benefits provided for
by this chapter including second injury benefits and catastrophic
injury benefits, if applicable, shall constitute the remaining
portion of the self-insurer's premium tax.
(e) Notwithstanding any provision of subsection (d) of this
section to the contrary, except for those increases made effective
for fiscal year two thousand four by action of the compensation
programs performance council heretofore established in article
three, chapter twenty-one-a of this code taken prior to the
effective date of the amendment and reenactment of this section,
the portion of the premium taxes for each self-insured employer as
determined under subdivisions (1) through (6), inclusive,
subsection (c) of this section shall not be increased during fiscal
years two thousand four, two thousand five and two thousand six.
(f) (d) (1) If
an a self-insured employer defaults in the
payment of any portion of
its self-insured employer premium taxes,
surcharges or assessments
required under this chapter or rules
promulgated thereunder, or in any payment required to be made as
benefits provided by this chapter to the employer's injured
employees or dependants of fatally injured employees, the
commission Insurance Commissioner shall, in an appropriate case,
determine the full accrued value based upon generally accepted
actuarial and accounting principles of the employer's liability,
including the costs of all awarded claims and of all incurred but
not reported claims. The amount determined may, in an appropriate case, be assessed against the employer. The
commission Insurance
Commissioner may demand and collect the present value of the
defaulted
tax liability. Interest shall accrue upon the demanded
amount as provided
for in section thirteen of this article until
the
premium tax liability is fully paid. Payment of all amounts
then due to the
commission Insurance Commissioner and to the
employer's employees is a sufficient basis for reinstating the
employer to good standing with the fund.
In addition, any self-
insured employer who, without good cause, ceases to make required
payments to the employer's injured employees or dependents of
fatally injured employees as benefits provided for by this chapter
including second injury benefits and catastrophic injury benefits,
if applicable, is in default. The board of managers shall establish
by rule the procedures by which the existence or nonexistence of
good cause is to be determined by the commission.
(2)
Premium tax The assessments
and surcharges required to be
paid by self-insured employers pursuant to the provisions of this
chapter and the rules promulgated thereunder are special revenue
taxes under and according to the provisions of state workers'
compensation law and are considered to be tax claims, as priority
claims or administrative expense claims according to those
provisions under the law provided in the United States bankruptcy
code, Title 11 of the United States Code. In addition, as the same
was previously intended by the prior provisions of this section,
this amendment and reenactment is for the purpose of clarification
of the taxing authority of the
workers' compensation commission Insurance Commissioner.
(g) Each self-insured employer shall elect whether or not to
self-insure its catastrophic injury risk as defined in subsection
(c), section one, article three of this chapter. A self-insured
employer who elects to insure its catastrophic risk through a
policy of excess insurance obtained through a private insurance
carrier approved by the commission shall provide a copy of the
policy to the commission. Upon termination of the commission, self-
insured employers shall either self-insure their catastrophic risk
or insure their catastrophic risk through a policy of excess
insurance obtained through a private insurance carrier approved by
the insurance commissioner. Self-insured employers shall also
reinsure their catastrophic risks.
(1) If the employer does not elect to self-insure its
catastrophic risk, the employer shall pay premium taxes for this
coverage in the same manner as is provided for in section four of
this article and in rules adopted to implement that section. As
stated in this subsection, this option shall expire upon
termination of the commission. If the employees of that employer
suffer injury or death from a catastrophe, the payment of the
resulting benefits shall be made from the catastrophe reserve of
the surplus fund provided for in subsection (b), section one,
article three of this chapter. Any portion of an employer's
catastrophic liability insured and paid under a policy of insurance
purchased by the employer shall not be included in the liabilities
upon which the employer's security or bond is determined in subsection (a) of this section.
(2) If an otherwise self-insured employer elects to self-
insure its catastrophic risk, the security or bond required in
subsection (a) of this section shall include the liability for the
catastrophic risk.
(h) For those employers previously permitted to self-insure
their second injury risks, the amount of the security or bond
required in subsection (a) of this section shall include the
liability for that risk. All benefits provided for by this chapter
which are awarded to the employer's employees which constitute
second injury life awards shall be paid by the employer and not the
commission.
(I) (e) The commission may create, implement, establish and
administer a perpetual self-insurance security risk pool of funds,
sureties, securities, insurance provided by private insurance
carriers or other states' programs, and other property, of both
real and personal properties, to secure the payment of obligations
of self-insured employers. If a pool is created, the board of
managers shall adopt rules for the organizational plan,
participation, contributions and other payments which may be
required of self-insured employers under this section. The board
of managers may adopt a rule authorizing the commission to assess
each self-insured employer in proportion according to each
employer's portion of the unsecured obligation and liability or to
assess according to some other method provided
for by rule which
shall properly create and fund the risk pool to serve the needs of employees, employers and the Workers' Compensation Fund by
providing adequate security. The board of managers establishing a
security risk pool, may authorize the executive director to use any
assessments, premium taxes and revenues and appropriations as may
be made available to the commission. Effective upon termination of
the commission, all statutory and regulatory authority provided to
the commission and board of managers over pools created pursuant to
this section,
as such pools are defined in section two, article
two-c of this chapter, shall transfer to the Insurance
Commissioner.
Provided, That the funds contained in the security
pool shall be deposited into the old fund and the funds contained
in the guaranty pool shall be deposited in the self-insured
employer guaranty risk pool created in article two-c of this
chapter. All assets held by the commission for security pursuant to
85 CSR §19 (2004) shall transfer to the insurance commissioner.
(j) (f) Any self-insured employer which has had a period of
inactivity due to the nonemployment of employees which results in
its reporting of no wages on reports to the
commission Insurance
Commissioner for a period of four or more consecutive quarters
shall may have its status
at the commission inactivated and shall
apply for reactivation to status as a self-insured employer prior
to its reemployment of employees. Despite the inactivation, the
self-insured employer shall continue to make payments on all awards
for which it is responsible. Upon application for reactivation of
its status as an operating self-insured employer, the employer
shall document that it meets the eligibility requirements needed to maintain self-insured employer status under this section and any
rules adopted to implement it. If the employer is unable to
requalify and obtain approval for reactivation, the employer shall,
effective with the date of employment of any employee,
become a
subscriber to the workers' compensation fund and, upon termination
of the commission, shall purchase workers' compensation insurance
as provided
for in article two-c of this chapter, but shall
continue to be a self-insurer as to the prior period of active
status and to furnish security or bond and meet its prior
self-insurance obligations.
(k) (g) In any case under the provisions of this section that
require requires the payment of compensation or benefits by an
employer in periodical payments and the nature of the case makes it
possible to compute the present value of all future payments, the
commission may, in its discretion, at any time compute and permit
to be paid into the Workers' Compensation Fund an amount equal to
the present value of all unpaid future payments on the award or
awards for which liability exists in trust. Thereafter, the
employer shall be discharged from any further portion of premium
tax liability upon the award or awards and payment of the award or
awards shall be assumed by the commission. Upon termination of the
commission,
those self-insured the process herein described will no
longer be permitted. Self-insured employers may thereafter
withdraw from self-insured status and purchase workers'
compensation insurance as provided
for in article two-c of this
chapter, but said self-insured employers shall remain liable for their self-insured employer claims liabilities
for each claim with
a date of injury or last exposure prior to the effective date of
insurance coverage.
(l) (h) Any employer subject to this chapter, who elects to
carry the employer's own risk by being
a self-insured employer and
who has complied with the requirements of this section and of any
applicable rules, shall not be liable to respond in damages at
common law or by statute for the injury or death of any employee,
however occurring, after the election's approval and during the
period that the employer is allowed to carry the employer's own
risk.
(m) (I) An employer may not hire any person or group to self-
administer claims under this chapter as a third-party administrator
unless the person or group has been determined to be qualified to
be a third-party administrator by the
commission Insurance
Commissioner pursuant to rules adopted by the board of managers
or
industrial council. Any person or group whose status as a
third-party administrator has been revoked, suspended or terminated
by the
commission Insurance Commissioner shall immediately cease
administration of claims and shall not administer claims unless
subsequently authorized by the
commission Insurance Commissioner.
(n) (j) All regulatory, oversight and document gathering
authority provided to the commission under
this section
nine,
article two, chapter twenty-three shall transfer to the Insurance
Commissioner and the industrial council upon termination of the
commission.
ARTICLE 2C. EMPLOYERS' MUTUAL INSURANCE COMPANY.
§23-2C-3. Creation of employer mutual as successor organization of
the West Virginia Workers' Compensation Commission.
(a) On or before the first day of June, two thousand five, the
executive director may take such actions as are necessary to
establish an employers' mutual insurance company as a domestic,
private, nonstock, corporation to:
(1) Insure employers against liability for injuries and
occupational diseases for which their employees may be entitled to
receive compensation pursuant to chapter twenty-three of this code
and federal Longshore and Harbor Workers' Compensation Act, 33
U.S.C. § 901, et seq.;
(2) Provide employer's liability insurance incidental to and
provided in connection with the insurance specified in
paragraph
subdivision (1), including coal-workers pneumoconiosis coverage and
employer excess liability coverage as provided in this chapter; and
(3) Transact such other kinds of property and casualty
insurance for which the company is otherwise qualified under the
provisions of this code.
(4) The company shall not sell, assign or transfer substantial
assets or ownership of the company.
(b) If the executive director establishes a domestic mutual
insurance company pursuant to subsection (a) of this section:
(1) As soon as practical, the company established pursuant to
the provisions of this article shall, through a vote of a majority of its provisional board, file its corporate charter and bylaws
with the Insurance Commissioner and apply for a license with the
Insurance Commissioner to transact insurance in this state.
Notwithstanding any other provision of this code, the Insurance
Commissioner shall act on the documents within fifteen days of the
filing by the company.
(2) In recognition of the workers' compensation insurance
liability insurance crisis in this state at the time of enactment
of this article and the critical need to expedite the initial
operation of the company, the Legislature hereby authorizes the
Insurance Commissioner to review the documentation submitted by the
company and to determine the initial capital and surplus
requirements of the company, notwithstanding the provisions of
section five-b, article three of chapter thirty-three. The company
shall furnish the Insurance Commissioner with all information and
cooperate in all respects necessary for the Insurance Commissioner
to perform the duties set forth in this section and in other
provisions of this chapter and chapter thirty-three. The Insurance
Commissioner shall monitor the economic viability of the company
during its initial operation on not less than a monthly basis,
until such time as the commissioner in his or her discretion,
determines that monthly reporting is not necessary. In all other
respects the company shall be subject to comply with the applicable
provisions of chapter thirty-three of this code.
(3) Subject to the provisions of
subsection subdivision (4) of
this
section subsection, the Insurance Commissioner may waive other requirements imposed on mutual insurance companies by the
provisions of chapter thirty-three as the Insurance Commissioner
determines is necessary to enable the company to begin insuring
employers in this state at the earliest possible date.
(4) Within forty months of the date of the issuance of its
license to transact insurance, the company shall comply with the
capital and surplus requirements set forth in subsection (a),
section five-b, article three, chapter thirty-three of this code in
effect on the effective date of this enactment, unless said
deadline is extended by the Insurance Commissioner.
(c) For the duration of its existence, the company is not and
shall not be considered a department, unit, agency or
instrumentality of the state for any purpose. All debts, claims,
obligations and liabilities of the company, whenever incurred,
shall be the debts, claims, obligations and liabilities of the
company only and not of the state or of any department, unit,
agency, instrumentality, officer or employee of the state.
(d) The moneys of the company are not and shall not be
considered part of the General Revenue Fund of the state. The
debts, claims, obligations and liabilities of the company are not
and shall not be considered a debt of the state or a pledge of the
credit of the state.
(e) The company is not subject to provisions of article
nine-a, chapter six of this code; the provisions of chapter
twenty-nine-b of this code; the provisions of article three,
chapter five-a of this code; the provisions of article six, chapter twenty-nine of this code; the provisions of article six-a of said
chapter; or the provisions of chapter twelve of this code.
(f) If the commission has been terminated, effective upon said
termination, private carriers, including the company, shall not be
subject to payment of premium taxes, surcharges and credits
contained in article three of chapter thirty-three of this code on
premiums received for coverage under this chapter. In lieu
thereof, the workers' compensation insurance market shall be
subject to the following:
(1) Each fiscal year, the Insurance Commissioner shall
calculate a percentage surcharge to be collected by each private
carrier from its policy holders. The surcharge percentage shall be
calculated by dividing the previous fiscal year's total premiums
collected plus deductible payments by all employers into the
portion of the Insurance Commissioner's budget amount attributable
to regulation of the private carrier market. This resulting
percentage shall be applied to each policy holder's premium payment
and deductible payments as a surcharge and remitted to the
Insurance Commissioner. Said surcharge shall be remitted within
ten (10) ninety (90) days of receipt of premium payments;
whenever
said payments are made by its insureds;
(2) Each fiscal year, the Insurance Commissioner shall
calculate a percentage surcharge to be remitted on a
monthly
quarterly basis by self-insured employers and said percentage shall
be calculated by dividing previous year's self-insured payroll in
the state into the portion of the Insurance Commissioner's budget amount attributable to regulation of the self-insured employer
market. This resulting percentage shall be applied to each
self-insured employer's
monthly payroll and the resulting amount
shall be remitted as a regulatory surcharge by each self-insured
employer. The Workers' Compensation Board of Managers
or
industrial council may promulgate a rule for implementation of this
section. The company, all other private carriers and all
self-insured employers shall furnish the Insurance Commissioner
with all required information and cooperate in all respects
necessary for the Insurance Commissioner to perform the duties set
forth in this section and in other provisions of this chapter and
chapter thirty-three. The surcharge shall be calculated so as to
only defray the costs associated with the administration of chapter
twenty-three of this code and the funds raised shall not be used
for any other purpose.
(3) Upon termination of the commission, the company and all
other private carriers shall collect a premiums surcharge from
their policy holders equal to ten percent, or such higher or lower
rate as annually determined, by the first day of May of each year,
by the Insurance Commissioner to produce forty-five million dollars
annually, of each policy holder's periodic premium amount for
workers' compensation insurance. Additionally, by the first day of
May each year, the self-insured employer community shall be
assessed a cumulative total of nine million dollars. The
methodology for the assessment shall be fair and equitable and
determined by exempt legislative rule issued by the workers' compensation board of managers
or industrial council. The amount
collected shall be remitted to the Insurance Commissioner for
deposit in the Workers' Compensation Debt Reduction Fund created in
section five, article two-d of this chapter.
(g) The new premiums surcharge imposed by subdivision
(2) (3),
subsection (f) of this section shall sunset and not be collectible
with respect to workers' compensation insurance premiums paid when
the policy is renewed on or after the first day of the month
following the month in which the Governor certifies to the
Legislature that the revenue bonds issued pursuant to article
two-d, chapter twenty-three of this code have been retired and that
the unfunded liability of the old fund has been paid or has been
provided for in its entirety, whichever occurs last.
§23-2C-8. Workers' Compensation Uninsured Employer Fund.
(a) The
West Virginia Workers' Compensation Uninsured Employer
Fund shall be governed by the following:
(1) All money and securities in the fund must be held by the
State Treasurer as custodian thereof to be used solely as provided
in this article.
(2) The State Treasurer may disburse money from the fund only
upon written requisition of the Insurance Commissioner.
(3)
Assessments. -- The Insurance Commissioner shall assess
each private carrier and
all may assess self-insured employers an
amount to be deposited in the fund. The assessment may be collected
by each private carrier from its policy holders in the form of a
policy surcharge. To establish the amount of the assessment, the Insurance Commissioner shall determine the amount of money
necessary to maintain an appropriate balance in the fund for each
fiscal year and shall allocate a portion of that amount to be
payable by
private carriers, a portion to be payable by self-
insured employers and a portion to be paid by any other appropriate
group each of the groups subject to the assessment. After
allocating the amounts payable
by each group, the Insurance
Commissioner shall apply an assessment rate to:
(A) Private carriers that reflects 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;
(B) Self-insured employers,
if assessed, that results in an
equitable distribution of costs among the self-insured employers
and is based upon expected annual expenditures for claims; and
(C) Any other
categories of payees groups assessed that
results in an equitable distribution of costs among them and is
based upon expected annual expenditures for claims or premium to be
received.
(4) The Workers' Compensation Board of Managers
or industrial
council may adopt rules for the establishment and administration of
the assessment methodologies, rates, payments and any penalties
that
the workers' compensation board of managers it determines are
necessary to carry out the provisions of this section.
(b)
Payments from the fund. -- shall be governed by the
following:
(1) Except as otherwise provided in this subsection, an
injured
worker employee of any employer required to be covered
under this chapter who has failed to obtain coverage may receive
compensation from the uninsured employers' fund if
such employee
(A) He or she meets all jurisdictional and entitlement provisions
of this chapter,
(B) He or she files a claim with the Insurance
Commissioner, and
(C) He or she makes an irrevocable assignment to
the Insurance Commissioner
of a right to be subrogated to the
rights of the injured employee.
(2)
If the Insurance Commissioner receives a claim, it shall
immediately notify the employer of the claim. For the purposes of
this section, the employer has the burden of proving that it
provided mandatory workers' compensation insurance coverage for the
employee or that it was not required to maintain workers'
compensation insurance for the employee. If the employer meets this
burden, benefits shall not be paid from the fund. Employees who
are injured while employed by a self-insured employer are
ineligible for benefits from the Workers' Compensation Uninsured
Employer Fund.
(3) Any employer who has failed to provide mandatory coverage
required by the provisions of this chapter is liable for all
payments made on its behalf, including any benefits, administrative
costs and attorney's fees paid from the fund or incurred by the
Insurance Commissioner.
(4) The Insurance Commissioner:
(A) May recover from the employer the payments made by it, any accrued interest and attorney fees and costs by bringing a civil
action in a court of competent jurisdiction.
(B) May enter into a contract with any person, including the
third-party administrator of the Uninsured Employer Fund, to assist
in the collection of any liability of an uninsured employer.
(C) In lieu of a civil action, may enter into an agreement or
settlement regarding the collection of any liability of an
uninsured employer.
(5) The Insurance Commissioner shall:
(A) Determine whether the employer was insured within five
days after receiving notice of the claim from the employee.
(B) Assign the claim to the third-party administrator of the
fund for administration and, if appropriate, payment of
compensation.
(C) Initial determination upon receipt of a claim. --
(1) If the Insurance Commissioner determines that the
claimant's employer maintained a policy of Workers' Compensation
insurance pursuant to this chapter on the date of injury or last
exposure or that the employer was not required to maintain such a
policy on such date, then the claim shall not be accepted into the
fund; if the commissioner determines that the employer was required
to maintain such a policy but failed to do so, the claim will be
accepted into the fund and the Insurance Commissioner may assign
such a claim to the third-party administrator of the fund for
administration.
(6) (2) Upon determining whether the claim is accepted or denied, the third-party administrator The Insurance Commissioner
shall notify the injured employee and the named employer of
it's
the determination
made pursuant to subdivision (1) of this
subsection and any party aggrieved thereby shall be entitled to
protest such determination in a hearing before the Insurance
Commissioner: Provided, That in any such proceeding, the employer
has the burden of proving that it either provided mandatory
workers' compensation insurance coverage or that it was not
required to maintain workers' compensation insurance.
(d) Employer liability. --
(1) Any employer who has failed to provide mandatory coverage
required by the provisions of this chapter is liable for all
payments made and to be made on its behalf, including any benefits,
administrative costs and attorney's fees paid from the fund or
incurred by the Insurance Commissioner, plus interest calculated in
accordance with the provisions of section thirteen, article two of
this chapter.
(2) The Insurance Commissioner:
(A) May bring a civil action in a court of competent
jurisdiction to recover from the employer the amounts set forth in
subdivision (1) of this subsection. In any such action, the
Insurance Commissioner may also recover the present value of the
estimated future payments to be made on the employer's behalf and
the costs and attorney's fees attributable to such claim:
Provided, That the failure of the Insurance Commissioner to include
a claim for future payments shall not preclude one or more subsequent actions for such amounts;
(B) May enter into a contract with any person, including the
third-party administrator of the Uninsured Employer Fund, to assist
in the collection of any liability of an uninsured employer; and
(C) In lieu of a civil action, may enter into an agreement or
settlement regarding the collection of any liability of an
uninsured employer.
(3) In addition to any other liabilities provided in this
section, the Insurance Commissioner may impose an administrative
penalty of not more than ten thousand dollars against an employer
if the employer fails to provide mandatory coverage required by
this chapter. All penalties and other moneys collected pursuant to
this section shall be deposited into the Workers' Compensation
Uninsured Employer Fund.
(7) (e) Protests to claims decisions. -- Any party aggrieved
by a
determination claims decision made by the Insurance
Commissioner or the third-party administrator
regarding the claims
decisions made pursuant to this section in a claim that has been
accepted into the fund may
appeal object to that
determination
decision by filing a protest with the office of judges as set forth
in article five of this chapter.
(8) An uninsured employer is liable for the interest on any
amount paid on his or her claims from the fund. The interest must
be calculated at a rate set in accordance with the provisions of
section thirteen, article two of this chapter, compounded monthly,
from the date the claim is paid from the account until payment is received by the Insurance Commissioner or third-party administrator
from the employer.
(9) Attorney's fees recoverable by the Insurance Commissioner
or third-party administrator pursuant to this section must be paid
at the usual and customary rate for that attorney.
(10) In addition to any other liabilities provided in this
section, the Insurance Commissioner or the third-party
administrator may impose an administrative fine of not more than
ten thousand dollars against an employer if the employer fails to
provide mandatory coverage required by this chapter. All fines and
other moneys collected pursuant to this section shall be deposited
into the Uninsured Employer Fund.
(c) Employees of self-insured employers who are injured while
employed by a self-insured employer are ineligible for benefits
from the West Virginia Uninsured Employer Fund.
§23-2C-15. Mandatory coverage; changing of coverage.
(a) Effective upon termination of the commission, all
subscriber policies with the commission shall novate to the company
and all employers otherwise shall purchase workers' compensation
insurance from the company unless permitted to self-insure their
obligations. The company shall assume responsibility for all new
fund obligations of the subscriber policies which novate to the
company or which are issued thereafter. Each subscriber whose
policy novates to the company shall also have its advanced deposit
credited to its account with the company. Employers purchasing
workers' compensation insurance from the company shall have the right to designate a representative or agent to act on its behalf
in any and all matters relevant to coverage and claims as
administered by the company.
(b) Effective the first day of July, two thousand eight, an
employer may elect to: (1) Continue to purchase workers'
compensation insurance from the company; (2) purchase workers'
compensation insurance from another private carrier licensed and
otherwise authorized to transact workers' compensation insurance in
this state; or (3) self-insure its obligations if it satisfies all
requirements of this code to so self-insure and is permitted to do
so:
Provided, That all state and local governmental bodies,
including, but not limited to, all counties and municipalities and
their subdivisions and including all boards, colleges, universities
and schools, shall continue to purchase workers' compensation
insurance from the company through the thirtieth day of June, two
thousand twelve. The company and other private carriers shall be
permitted to sell workers' compensation insurance through licensed
agents in the state. To the extent that a private carrier markets
workers' compensation insurance through a licensed agent, it shall
be subject to all applicable provisions of chapter thirty-three of
this code.
All employers' must immediately notify the Insurance
Commissioner of its private carrier and any change thereto.
(c) An employer may elect to change its private insurer
carrier on or after the first day of July, two thousand eight, if
the employer has:
(1) Given at least thirty days' notice to the Insurance Commissioner of the change of insurer; and
(2) Furnished evidence satisfactory to the Insurance
Commissioner that the payment of compensation has otherwise been
secured.
(d) Each private carrier and employer shall notify the
Insurance Commissioner if an employer has changed his or her
insurer or has allowed his or her insurance to lapse within twenty-
four hours or by the end of the next working day, whichever is
later, after the insurer has notice of the change or lapse.
(c) Every employer shall post a notice upon its premises in a
conspicuous place identifying its
industrial workers' compensation
insurer. The notice must include the insurer's name, business
address and telephone number and the name, business address and
telephone number of its nearest adjuster in this state. The
employer shall at all times maintain the notice provided
for the
information of his or her employees. Release of employer policy
information and status by the industrial council and the Insurance
Commissioner shall be governed by section four, article one of this
chapter. The Insurance Commissioner shall collect and maintain
information related to officers, directors and ten percent or more
owners of each carrier's policy holders,
The and each private
carrier shall provide said information to the Insurance
Commissioner
within sixty days of the issuance of a policy and any
changes to the information shall thereafter be reported within
sixty days of such change.
(e) (d) Any rule promulgated by the
workers' compensation board of managers
or industrial council empowering agencies of this
state to revoke or refuse to grant, issue or renew any contract,
license, permit, certificate or other authority to conduct a trade,
profession or business to or with any employer whose account is in
default
with the commission with regard to any liability under this
chapter shall be fully enforceable by the Insurance Commissioner
against
the any such employer
in policy default with a private
carrier.
(f) (e) Effective the first day of January, two thousand nine,
the company may decline to offer coverage to any applicant.
Effective the first day of January, two thousand nine, the company
and private carriers may cancel a policy or decline to renew a
policy upon the issuance of sixty days' written advance notice to
the policyholder:
Provided, That cancellation of the policy by the
carrier for failure of consideration to be paid by the policyholder
is effective after fifteen days advance written notice of
cancellation to the policyholder.
(f) Every private carrier shall notify the Insurance
Commissioner or his or her designee of: (i) The issuance or
renewal of insurance coverage, within ten calendar days of the
effective date of coverage; and (ii) a termination of coverage due
to lapse, refusal to renew or cancellation, within three business
days of the effective date of the termination; such notifications
shall be on forms developed by the Insurance Commissioner.
§23-2C-18. Ratemaking; Insurance Commissioner.
(a) For the fiscal year beginning the first day of July, two thousand six, the company shall charge the actuarially determined
base rates for the fiscal year. The base rates shall be calculated
by the company and submitted for approval by the insurance
commissioner.
(b) For the fiscal year beginning the first day of July, two
thousand seven, the company shall charge the actuarially determined
base rates for said fiscal year. The base rates shall be calculated
by the company and submitted for approval by the insurance
commissioner.
(c) Effective for the fiscal year beginning the first day of
July, two thousand eight, all private carriers' rates shall be
governed by the following:
(1) For the period beginning on first day of July, two
thousand eight, and ending on the thirtieth day of June, two
thousand nine, no more than five percent variance from the base
rates established by the insurance commissioner.
(2) For the period beginning on the first day of July, two
thousand nine, and ending on the thirtieth day of June, two
thousand ten, no more than ten percent variance from the base rates
established by the insurance commissioner.
(d) For the period beginning on the first day of July, two
thousand six through the thirtieth day of June, two thousand ten,
the company and, when applicable, a private carrier, may continue
to calculate experience modification factors and other related
rating modification methodologies to adequately insure individual
employer risks.
(e) The variances provided in this section are only
applicable to base rates and shall be exclusive of experience
modification and other related adjustments, including surcharges
imposed by this chapter.
(f) For the period beginning the first day of July, two
thousand ten, and thereafter, the insurance commissioner shall set
base rates for approved classifications and thereafter in
accordance with rules established in accordance with subsection
nine of this section. Said rates shall be released to the public at
least ninety days prior to the first day of July each year. Within
thirty days from this release date, private carriers shall submit
to the insurance commissioner their proposed rates, which may be
higher than the base rates established by the insurance
commissioner. The insurance commissioner retains authority to
disapprove rates in effect if it is determined that the rates are
not in compliance with the following:
(a) (1) The rate-making provisions and premium provisions
contained in article two of this chapter shall not be applicable to
the company or other private carriers. Rates for workers'
compensation insurance are subject to the provisions of this
section, section eighteen-a of this article and article twenty,
chapter thirty-three of this code.
(2) In the event of any conflict, the provisions of this
article shall have paramount effect, but the provisions in chapters
twenty-three and thirty-three of this code shall be construed as
complementary and harmonious unless so clearly in conflict that they cannot reasonably be reconciled.
(1) (b) Rates must not be excessive, inadequate or unfairly
discriminatory, nor may an insurer charge any rate which if
continued will have or tend to have the effect of destroying
competition or creating a monopoly.
(2) (c) The Insurance Commissioner may disapprove rates if
there is not a reasonable degree of price competition at the
consumer level with respect to the class of business to which they
apply. In determining whether a reasonable degree of price
competition exists, the Insurance Commissioner shall consider all
relevant tests, including:
(A) (1) The number of insurers actively engaged in the class
of business and their shares of the market;
(B) (2) The existence of differentials in rates in that class
of business;
(C) (3) Whether long-run profitability for private carriers
generally of the class of business is unreasonably high in relation
to its risk;
(D) (4) Consumers' knowledge in regard to the market in
question; and
(E) (5) Whether price competition is a result of the market
or is artificial. If competition does not exist, rates are
excessive if they are likely to produce a long-run profit that is
unreasonably high in relation to the risk of the class of business,
or if expenses are unreasonably high in relation to the services
rendered.
(3) (d) Rates are inadequate if they are clearly insufficient,
together with the income from investments attributable to them, to
sustain projected losses and expenses in the class of business to
which they apply.
(4) (e) One rate is unfairly discriminatory in relation to
another in the same class if it clearly fails to reflect equitably
the differences in expected losses and expenses. Rates are not
unfairly discriminatory because different premiums result for
policyholders with similar exposure to loss but different expense
factors, or similar expense factors but different exposure to loss,
so long as the rates reflect the differences with reasonable
accuracy. Rates are not unfairly discriminatory if they are
averaged broadly among persons insured under a group, franchise or
blanket policy.
(g) The rate-making provisions and premium provisions
contained in article two of this chapter shall not be applicable to
the company or other private carriers. The workers' compensation
board of managers, in consultation with the insurance commissioner
shall issue an exempt legislative rule to govern ratemaking and
premium collection by the company and other private carriers.
§23-2C-18a. Designation of rating organization.
(a) For the purposes of this section:
(1) "Classification system" or "classification" means the
plan, system or arrangement for grouping risks with similar
characteristics or a specified class of risk by recognizing
differences in exposure to hazards.
(2) "Experience rating" means a statistical procedure
utilizing past risk experience to produce a prospective premium
credit, debit or unity modification.
(3) "Prospective loss costs" means historical aggregate losses
and loss adjustment expenses projected through development to their
ultimate value and through trending to a future point in time.
Prospective loss costs do not include provisions for profit or
expenses other than loss adjustment expenses.
(4) "Statistical plan" means the plan, system or arrangement
used in collecting data for rate making or other purposes.
(b) The Insurance Commissioner shall designate one rating
organization to:
(1) Assist the commissioner in gathering, compiling and
reporting relevant statistical information on an aggregate basis;
(2) Develop and administer, subject to approval by the
commissioner, the uniform statistical plan, uniform classification
plan and uniform experience rating plan;
(3) Develop and file manual rules, subject to the approval of
the commissioner, that are reasonably related to the recording and
reporting of data pursuant to the uniform statistical plan, uniform
experience rating plan and the uniform classification plan; and
(c) Each workers' compensation insurer shall:
(1) Record and report its workers' compensation experience to
the designated rating organization as set forth in the uniform
statistical plan approved by the 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.
(d) The commissioner may promulgate exempt legislative rules
to implement the provisions of this section, including a rule
providing for the equitable sharing and recovery of the expense of
the designated rating organization in performing the functions set
forth in subsection (b) of this section.
§23-2C-19. Special provisions as to private carrier premium
collection.
(a) Each employer who is required to purchase and maintain
workers' compensation insurance or who elects to purchase workers'
compensation insurance shall pay a premium to a private carrier.
Each carrier shall notify its policy holders of the mandated
premium payment methodology and under what circumstances a policy
holder will be found to be in policy default.
(b) An employer who is required to purchase and maintain
workers' compensation insurance but fails to do so or otherwise
enters policy default shall be deprived of the benefits and
protection afforded by this chapter, including section six, article
two of this chapter, and the employer is liable as provided in
section eight of said article. The policy defaulted employer's
liability under these sections is retroactive to the day the policy
default occurs. The private carrier shall notify the policy
defaulted employer of the method by which the employer may be
reinstated with the private carrier.
(c) A private carrier is authorized to commence a civil action against an employer who, after due notice, defaults on any payment.
If judgment is against the employer, the employer shall pay the
costs of the action. Upon prevailing in a civil action, the private
carrier is entitled to recover its attorneys' fees and costs of
action from the employer.
(d) In addition to the provisions of subsection (a) of this
section, any payment, interest and penalty due and unpaid under
this chapter is a personal obligation of the employer, its officers
and its directors, immediately due and owing to the private carrier
and shall, in addition, be a lien enforceable against all the
property of the employer: Provided, That the lien shall not be
enforceable as against a purchaser (including a lien creditor) of
real estate or personal property for a valuable consideration
without notice, unless docketed as provided in section one, article
ten-c, chapter thirty-eight of this code: Provided, however, That
the lien may be enforced as other judgment liens are enforced
through the provisions of said chapter and the same is considered
deemed by the circuit court to be a judgment lien for this purpose.
(e) The secretary of state of this state shall withhold the
issuance of any certificate of dissolution or withdrawal in the
case of any corporation organized under the laws of this state or
organized under the laws of any other state and admitted to do
business in this state, until notified by its private carrier that
all payments, interest and penalties thereon against the
corporation which is an employer under this chapter have been paid
or that provision satisfactory to the private carrier has been made for payment.
(f) (c) In addition to any other liabilities provided in this
section, the Insurance Commissioner may impose an administrative
fine of not more than ten thousand dollars against an employer if
the employer fails to provide mandatory coverage required by this
chapter. Further, prior to providing an applicant employer with
coverage mandated in this chapter, all private carriers shall
exercise reasonable due diligence to ensure that an employer
applicant has not been in policy default with another carrier or in
default with the commission. If it is discovered that the employer
applicant remains in policy default with another carrier or the
commission, the company or new carrier shall not provide the
coverage mandated by this chapter until such time as the
preexisting policy default is cured. Any provider violating this
provision may be fined not more than ten thousand dollars by the
insurance commissioner.
(g) (d) The company and the Insurance Commissioner shall be
provided extraordinary powers to collect any premium amounts
payable to the workers' compensation fund or the new fund and due
from the first day of July, two thousand five, through the
thirtieth day of June, two thousand eight. Those powers shall
include: (1) Withholding of coverage effective the first day of
January, two thousand six. Employers without coverage shall
immediately be deprived of the benefits and protection afforded by
this chapter, including section six, article two of this chapter
and the employer is liable as provided in section eight of said article; (2) the right to maintain a civil action against all
officers and directors of the employer individually for collection
of the premium owed; and (3) the right to immediately report the
employers to the State Tax Department and other state agencies to
secure suspension of any and all licenses, certificates, permits,
registrations and other similar approval documents necessary for
the employer to conduct business in this state.
(e) Every agency shall, upon notification of employer default
by the Insurance Commissioner, immediately begin the process to
revoke or terminate any contract, license, permit, certificate or
other authority to conduct a trade, profession, or business in this
state and shall refuse to issue, grant or renew any such contract,
license, permit, certificate or authority.
(1) The term "employer default" means having an outstanding
balance or liability to the old fund or to the uninsured employers'
fund or being in policy default, as defined in section two, of this
article, or failure to maintain mandatory workers' compensation
coverage. An employer is not in default if it has entered into a
repayment agreement with the Insurance Commissioner and remains in
compliance with the obligations under the repayment agreement.
(2) The term "agency" includes any unit of state government
such as officers, agencies, divisions, departments, boards,
commissions, authorities or public corporations.
(f)
Employer default
is a personal liability of the employer,
its officers, owners, partners and directors
and is immediately due
and owing and shall, in addition, be a lien enforceable against all the property of the employer, its officers, owners, partners and
directors: Provided, That the lien shall not be enforceable as
against a purchaser, including a lien creditor, of real estate or
personal property for a valuable consideration without notice,
unless docketed as provided in section one, article ten-c, chapter
thirty-eight of this code: Provided, however, That the lien may be
enforced as other judgment liens are enforced through the
provisions of said chapter and the same is considered by the
circuit court to be a judgment lien for this purpose.
(g) The Insurance Commissioner shall propose rules for
adoption by the industrial council to effectuate the purposes of
this section including the conditions under which agencies shall
comply with the provisions of subsection (e) of this section and
specifying how notice of default shall be given by the
commissioner.
§23-5-9. Hearings on objections to Insurance Commissioner; private
carrier or self-insured employer decisions; mediation;
remand.
a) Objections to a decision of the Workers' Compensation
Commission, the successor to the commission, other Insurance
Commissioner, private insurance carriers and carrier or self-
insured employers employer, whichever is applicable, made pursuant
to the provisions of section one of this article shall be filed
with the office of judges. Upon receipt of an objection, the
office of judges shall notify the commission, the successor to the commission, other Insurance Commissioner, private insurance
carriers and carrier or self-insured employers employer, whichever
is applicable, and all other parties of the filing of the
objection. The office of judges shall establish by rule
promulgated in accordance with the provisions of subsection (e),
section eight of this article an adjudicatory process that enables
parties to present evidence in support of their positions and
provides an expeditious resolution of the objection. The employer,
the claimant, and the commission, the successor to the commission,
other Insurance Commissioner, private insurance carriers and
carrier or self-insured employers employer, whichever is are
applicable, shall be notified of any hearing at least ten days in
advance. The office of judges shall review and amend, or modify,
as necessary its procedural rules by the first day of July, two
thousand seven.
(b) The office of judges shall establish a program for
mediation to be conducted in accordance with the requirements of
rule twenty-five of the West Virginia Trial Court Rules. The
parties may agree that the result of the mediation is binding. A
case may be referred to mediation by the administrative law judge
on his or her own motion, on motion of a party or by agreement of
the parties. Upon issuance of an order for mediation, the office
of judges shall assign a mediator from a list of qualified
mediators maintained by the West Virginia State Bar.
(c) The office of judges shall keep full and complete records
of all proceedings concerning a disputed claim. Subject to the rules of practice and procedure promulgated pursuant to section
eight of this article, the record upon which the matter shall be
decided shall include any evidence submitted by a party to the
office of judges and evidence taken at hearings conducted by the
office of judges. and any documents in the claim files which relate
to the subject matter of the objection. The record may include
evidence or documents submitted in electronic form or other
appropriate medium in accordance with the rules of practice and
procedure. The office of judges is not bound by the usual common
law or statutory rules of evidence.
(d) All hearings shall be conducted as determined by the chief
administrative law judge pursuant to the rules of practice and
procedure promulgated pursuant to section eight of this article.
Upon consideration of the designated record, the chief
administrative law judge or other authorized adjudicator within the
office of judges shall, based on the determination of the facts of
the case and applicable law, render a decision affirming, reversing
or modifying the action protested. The decision shall contain
findings of fact and conclusions of law and shall be mailed to all
parties.
(e) The rule authorized by subsection (a) of this section
shall be promulgated on or before the first day of October, two
thousand three. Until the rule is promulgated, any rules
previously promulgated shall remain in full force and effect.
(f) (e) The office of judges may remand a claim to the
commission, the successor to the commission, other Insurance Commissioner, private insurance carriers and carrier or self-
insured employers employer, whichever is applicable, for further
development of the facts or administrative matters as, in the
opinion of the administrative law judge, may be necessary for a
full and complete disposition of the case. The administrative law
judge shall establish a time within which the commission, the
successor to the commission, other Insurance Commissioner, private
insurance carriers and carrier or self-insured employers employer,
whichever is applicable, must report back to the administrative law
judge.
(g) (f) The decision of the workers' compensation office of
judges regarding any objections to a decision of the workers'
compensation commission, the successor to the commission, other
Insurance Commissioner private insurance carriers and carrier or
self-insured employers employer, whichever is applicable, is final
and benefits shall be paid or denied in accordance with the
decision, unless an order staying the payment of benefits is
specifically entered by the workers' compensation board of review
created in section eleven of this article or by the administrative
law judge who granted the benefits. No stay with respect to any
medical treatment or rehabilitation authorized by the office of
judges may be granted. If the decision is subsequently appealed and
reversed in accordance with the procedures set forth in this
article, and any overpayment of benefits occurs as a result of such
reversal, any such overpayment may be recovered pursuant to the
provisions of subsection (d), section one-d, article four, chapter twenty-three of this code.
NOTE: The purpose of this bill is to revise various sections
of the workers' compensation statutes in light of the recent
transition to a private insurance system.
Strike-throughs indicate language that would be stricken from
the present law, and underscoring indicates new language that would
be added.
§23-2C-18a is new; therefore, underscoring and strike-throughs
have been omitted.