SENATE
HOUSE
JOINT
BILL STATUS
STATE LAW
REPORTS
EDUCATIONAL
CONTACT
home
home
Introduced Version Senate Bill 595 History

OTHER VERSIONS  -  Enrolled Version - Final Version  |  Committee Substitute (1)  |     |  Email
Key: Green = existing Code. Red = new code to be enacted
Senate Bill No. 595

(By Senator Minard)

____________

[Introduced February 15, 2007; referred to the Committee on the Judiciary.]

____________




A BILL to amend and reenact §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; 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; authorizing the Insurance Commissioner to reduce certain claims against employers to present value; reducing frequency of certain payments from self-insured employers; 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; and removing the requirement that the record of proceedings before the office of judges include certain documents.

Be it enacted by the Legislature:
That §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:
ARTICLE 1. GENERAL ADMINISTRATIVE PROVISIONS.
§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 employees 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 employees shall be in addition to those employees 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 © 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
© 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;
© 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.
© 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 © 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 ©, 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.
© 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. Worker's Compensation Uninsured Employer Fund.

(a) The West Virginia Worker's 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
© 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 © 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 Worker's 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.
© 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.
© 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 employers' 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
© 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 Worker's 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.
© 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.
© 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.
© 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.
(e) Any payment, interest and penalty due and owing to any fund created pursuant to this article is a personal obligation of the employer, its officers and its directors, 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 shall be considered by the circuit court to be a judgment lien for this purpose.
(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.
(f) (g) 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.
§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.
© 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.
(3) "Noncommercial lines," as defined in subsection (e), section eight, article six, chapter thirty-three of this code, shall include workers' compensation insurance.
(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) © 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;
© (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
© 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 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.
© 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) © 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.
ARTICLE 5. REVIEW.
§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.
© 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 the decision is subsequently appealed and reversed in accordance with the procedures set forth in this article.

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.
This Web site is maintained by the West Virginia Legislature's Office of Reference & Information.  |  Terms of Use  |   Email WebmasterWebmaster   |   © 2024 West Virginia Legislature **


X

Print On Demand

Name:
Email:
Phone:

Print