CHAPTER
Lab 400 WORKERS' COMPENSATION
SELF-INSURANCE
Statutory
Authority: RSA 281-A:5, III and RSA
281-A:60
PART
Lab 401 PURPOSE
Lab 401.01 Statement of Purpose. This chapter sets forth the procedures and forms
for carrying out the provisions of RSA 281-A pertaining to workers'
compensation self-insurance.
Source. #2264, eff 1-6-83; ss by #2935, eff 12-27-84,
EXPIRED: 12-27-90
New. #5235, eff 9-27-91, EXPIRED: 9-27-97
New. #6631, INTERIM, eff 11-16-97, EXPIRED:
3-16-98
New. #6806, eff 7-18-98; ss by #8682, INTERIM, eff
7-15-06, EXPIRED: 1-11-07
New. #9019, eff 11-1-07; ss by #11066, eff 4-1-16
PART
Lab 402 DEFINITIONS
Lab 402.01 "Aggregate excess" means coverage
which applies once within each specified policy term or portion thereof.
Source. #2264, eff 1-6-83; ss by #2935, eff 12-27-84,
EXPIRED: 12-27-90
New. #5235, eff 9-27-91, EXPIRED: 9-27-97
New. #6631, INTERIM, eff 11-16-97, EXPIRED:
3-16-98
New. #6806, eff 7-18-98; ss by #8682, INTERIM, eff
7-15-06, EXPIRED: 1-11-07
New. #9019, eff 11-1-07; ss by #11066, eff 4-1-16
Lab 402.02 "Attachment point" means the dollar
amount at which the risk retention for the self-insurer ends and at which the involvement of the carrier begins.
Source. #2264, eff 1-6-83; ss by #2935, eff 12-27-84,
EXPIRED: 12-27-90
New. #5235, eff 9-27-91, EXPIRED: 9-27-97
New. #6631, INTERIM, eff 11-16-97, EXPIRED:
3-16-98
New. #6806, eff 7-18-98; ss by #8682, INTERIM, eff
7-15-06, EXPIRED: 1-11-07
New. #9019, eff 11-1-07; ss by #11066, eff 4-1-16
Lab 402.03 "Carrier" means a legal entity, or
group thereof, which has been lawfully authorized by the state's insurance
department to market insurance in this state.
Source. #2264, eff 1-6-83; ss by #2935, eff 12-27-84,
EXPIRED: 12-27-90
New. #5235, eff 9-27-91, EXPIRED: 9-27-97
New. #6631, INTERIM, eff 11-16-97, EXPIRED:
3-16-98
New. #6806, eff 7-18-98; ss by #8682, INTERIM, eff
7-15-06, EXPIRED: 1-11-07
New. #9019, eff 11-1-07; ss by #11066, eff 4-1-16
(from Lab 402.04)
Lab 402.04 "Certificate" means the documentary
evidence of insurance to be filed with the department as proof of coverage by a
carrier.
Source. #2264, eff 1-6-83; ss by #2935, eff 12-27-84,
EXPIRED: 12-27-90
New. #5235, eff 9-27-91, EXPIRED: 9-27-97
New. #6631, INTERIM, eff 11-16-97, EXPIRED:
3-16-98
New. #6806, eff 7-18-98; ss by #8682, INTERIM, eff
7-15-06, EXPIRED: 1-11-07
New. #9019, eff 11-1-07; ss by #11066, eff 4-1-16
(from Lab 402.05)
Lab 402.05 "Coverage" means the full amount of
insurance.
Source. #2264, eff 1-6-83; ss by #2935, eff 12-27-84,
EXPIRED: 12-27-90
New. #5235, eff 9-27-91, EXPIRED: 9-27-97
New. #6631, INTERIM, eff 11-16-97, EXPIRED:
3-16-98
New. #6806, eff 7-18-98; ss by #8682, INTERIM, eff
7-15-06, EXPIRED: 1-11-07
New. #9019, eff 11-1-07; ss by #11066, eff 4-1-16
(from Lab 402.06)
Lab 402.06 "Excess per
Loss" means the amount above the attachment point on each work injury
incident.
Source. #2264, eff 1-6-83; ss by #2935, eff 12-27-84,
EXPIRED: 12-27-90
New. #5235, eff 9-27-91, EXPIRED: 9-27-97
New. #6631, INTERIM, eff 11-16-97, EXPIRED:
3-16-98
New. #6806, eff 7-18-98; ss by #8682, INTERIM, eff
7-15-06, EXPIRED: 1-11-07
New.
#9019, eff 11-1-07; ss by #11066, eff 4-1-16 (from Lab 402.07)
Lab 402.07 “Financial
Ability” means having the resources and willingness to make direct payment of
compensation in amounts, manner, and when due.
Source. #2264, eff 1-6-83; ss by #2935, eff 12-27-84,
EXPIRED: 12-27-90
New. #5235, eff 9-27-91, EXPIRED: 9-27-97
New. #6631, INTERIM, eff 11-16-97, EXPIRED:
3-16-98
New. #6806, eff 7-18-98; ss by #8682, INTERIM, eff
7-15-06, EXPIRED: 1-11-07
New. #9019, eff 11-1-07; ss by #11066, eff 4-1-16
(from Lab 402.08)
Lab 402.08 "Guarantee"
means surety bond, security, or cash that is deposited with the department and
available for self-insurer retention if the self-insurer fails to pay directly.
Source. #2264, eff 1-6-83; ss by #2935, eff 12-27-84,
EXPIRED: 12-27-90
New. #5235, eff 9-27-91, EXPIRED: 9-27-97
New. #6631, INTERIM, eff 11-16-97, EXPIRED:
3-16-98
New. #6806, eff 7-18-98; ss by #8682, INTERIM, eff
7-15-06, EXPIRED: 1-11-07
New. #9019, eff 11-1-07; ss by #11066, eff 4-1-16
(from Lab 402.09)
Lab 402.09 "Parent company support" means a
written agreement filed with the department on behalf of a subsidiary for the
purpose of guarantying payment of workers' compensation benefits in a specified
amount in the event the self-insured subsidiary defaults.
Source. #2264, eff 1-6-83; ss by #2935, eff 12-27-84,
EXPIRED: 12-27-90
New. #5235, eff 9-27-91, EXPIRED: 9-27-97
New. #6631, INTERIM, eff 11-16-97, EXPIRED:
3-16-98
New. #6806, eff 7-18-98; ss by #8682, INTERIM, eff
7-15-06, EXPIRED: 1-11-07
New. #9019, eff 11-1-07; ss by #11066, eff 4-1-16
(from Lab 402.10)
Lab 402.10 "Permit" means the documentary
evidence that an employer, or an association or group of employers, has been
authorized by the commissioner to be self-insured.
Source. #2264, eff 1-6-83; ss by #2935, eff 12-27-84,
EXPIRED: 12-27-90
New. #5235, eff 9-27-91, EXPIRED: 9-27-97
New. #6631, INTERIM, eff 11-16-97, EXPIRED:
3-16-98
New. #6806, eff 7-18-98; ss by #8682, INTERIM, eff
7-15-06, EXPIRED: 1-11-07
New. #9019, eff 11-1-07; ss by #11066, eff 4-1-16
(from Lab 402.11)
Lab 402.11 "Principal" means the self-insured.
Source. #2264, eff 1-6-83; ss by #2935, eff 12-27-84,
EXPIRED: 12-27-90
New. #5235, eff 9-27-91, EXPIRED: 9-27-97
New. #6631, INTERIM, eff 11-16-97, EXPIRED:
3-16-98
New. #6806, eff 7-18-98; ss by #8682, INTERIM, eff
7-15-06,
EXPIRED:
1-11-07
New. #9019, eff 11-1-07; ss by #11066, eff 4-1-16
(from Lab 402.12)
Lab 402.12 "Security" means an evidence of
property, as a stock certificate or bond, which is negotiable and transferable.
Source. #2264, eff 1-6-83; ss by #2935, eff 12-27-84,
EXPIRED: 12-27-90
New. #5235, eff 9-27-91, EXPIRED: 9-27-97
New. #6631, INTERIM, eff 11-16-97, EXPIRED:
3-16-98
New. #6806, eff 7-18-98; ss by #8682, INTERIM, eff
7-15-06, EXPIRED: 1-11-07
New.
#9019, eff 11-1-07; ss by #11066, eff 4-1-16 (from Lab 402.13)
Lab 402.13 “Self-insurer retention” means the amount
below the attachment point on each work injury incident.
Source. #2264, eff 1-6-83; ss by #2935, eff 12-27-84,
EXPIRED: 12-27-90
New. #5235, eff 9-27-91, EXPIRED: 9-27-97
New. #6631, INTERIM, eff 11-16-97, EXPIRED:
3-16-98
New. #6806, eff 7-18-98; ss by #8682, INTERIM, eff
7-15-06, EXPIRED: 1-11-07
New. #9019, eff 11-1-07; ss by #11066, eff 4-1-16
(from Lab 402.14)
Lab 402.14
"Self-insurer" means an employer, or association or group of
employers, which has been authorized by the commissioner to be self-insured.
Source. #2264, eff 1-6-83; ss by #2935, eff 12-27-84,
EXPIRED: 12-27-90
New. #5235, eff 9-27-91, EXPIRED: 9-27-97
New. #6631, INTERIM, eff 11-16-97, EXPIRED:
3-16-98
New. #6806, eff 7-18-98; ss by #8682, INTERIM, eff
7-15-06, EXPIRED: 1-11-07
New. #9019, eff 11-1-07; ss by #11066, eff 4-1-16
(from Lab 402.15)
Lab 402.15 "Surety" means a company licensed
in this state to furnish surety bonds.
Source. #2264, eff 1-6-83; ss by #2935, eff 12-27-84,
EXPIRED: 12-27-90
New. #5235, eff 9-27-91, EXPIRED: 9-27-97
New. #6631, INTERIM, eff 11-16-97, EXPIRED:
3-16-98
New. #6806, eff 7-18-98; ss by #8682, INTERIM, eff
7-15-06, EXPIRED: 1-11-07
New. #9019,
eff 11-1-07 (from Lab 402.14); ss by #11066, eff 4-1-16 (from Lab 402.16)
Lab 402.16 “Surety Bond” means a contract among three
parties, the self-insurer as principal, a financial institution as surety, and
the commissioner as obligee, using the wording of
“Surety Bond” form WCSI-2 (8/1994), contained in appendix II.
Source. #2264, eff 1-6-83; ss by #2935, eff 12-27-84,
EXPIRED: 12-27-90
New. #5235, eff 9-27-91, EXPIRED: 9-27-97
New. #6631, INTERIM, eff 11-16-97, EXPIRED:
3-16-98
New. #6806, eff 7-18-98; ss by #8682, INTERIM, eff
7-15-06, EXPIRED: 1-11-07
New. #9019, eff 11-1-07; ss by #11066, eff 4-1-16
PART
Lab 403 SELF-INSURANCE AUTHORIZATION
Lab 403.01 Purpose of Rules. No employer, or association of employers,
shall be self-insured without the commissioner's authorization. Authorization
shall be evidenced by a permit. No permit shall be issued by the commissioner unless an employer, or association or
group of employers, has furnished satisfactory proof of financial ability
through submission of a surety bond, parent company agreement, certified
financial statements, proof of excess insurance, and willingness to make direct
payment of workers' compensation benefits in accordance with Lab 405.
Source. #2264, eff 1-6-83; ss by #2935, eff 12-27-84,
EXPIRED: 12-27-90
New. #5235, eff 9-27-91, EXPIRED: 9-27-97
New. #6631, INTERIM, eff 11-16-97, EXPIRED:
3-16-98
New. #6806, eff 7-18-98; ss by #8682, INTERIM, eff
7-15-06, EXPIRED: 1-11-07
New. #9019, eff 11-1-07; ss by #11066, eff 4-1-16
Lab 403.02 Duration. A permit shall remain in effect indefinitely,
except that it shall be subject
to voluntary termination and to revocation for good and sufficient reason as
defined in Lab 403.03. The self-insurer shall be issued a self-insurance permit
by the commissioner.
Source. #2264, eff 1-6-83; ss by #2935, eff 12-27-84,
EXPIRED: 12-27-90
New. #5235, eff 9-27-91, EXPIRED: 9-27-97
New. #6631, INTERIM, eff 11-16-97, EXPIRED:
3-16-98
New. #6806, eff 7-18-98; ss by #8682, INTERIM, eff
7-15-06, EXPIRED: 1-11-07
New.
#9019, eff 11-1-07; ss by #11066, eff 4-1-16
Lab 403.03 Revocation. Permits shall be revoked by reason of:
(a) Failure to cooperate with the department;
(b) Failure to make payment of compensation
benefits;
(c) Failure to demonstrate proof of
financial ability; or
(d) Any other condition which demonstrates that the
self-insurer is unable to meet the requirements of RSA chapter 281-A.
Source. #2264, eff 1-6-83; ss by #2935, eff 12-27-84,
EXPIRED: 12-27-90
New. #5235, eff 9-27-91, EXPIRED: 9-27-97
New. #6631, INTERIM, eff 11-16-97, EXPIRED:
3-16-98
New. #6806, eff 7-18-98; ss by #8682, INTERIM, eff
7-15-06, EXPIRED: 1-11-07
New. #9019, eff 11-1-07; ss by #11066, eff 4-1-16
Lab 403.04 Voluntary Termination. All self-insurers shall notify the department
in writing at least 30 days prior to ceasing to be self-insured, and in
addition to filing “Termination Notice”, form WC-100 (10/1991), in accordance with Lab 307 & 308.
Source. #2264, eff 1-6-83; ss by #2935, eff 12-27-84,
EXPIRED: 12-27-90
New. #5235, eff 9-27-91, EXPIRED: 9-27-97
New. #6631, INTERIM, eff 11-16-97, EXPIRED:
3-16-98
New. #6806, eff 7-18-98; ss by #8682, INTERIM, eff
7-15-06, EXPIRED: 1-11-07
New. #9019, eff 11-1-07; ss by #11066, eff 4-1-16
PART Lab 404 ASSOCIATION OR GROUP SELF-INSURANCE
Lab 404.01 Homogenous Self-Insured Groups. Employers as defined by RSA 281-A:2, VIII and
IX who have similar trades, businesses, occupations, professions, or functions
may become self-insured as an association or group upon meeting the applicable
requirements of this part, subject to the following provisions:
(a) Such employers shall form or join an association or group;
(b) Upon receipt of a self-insurance permit, an
association or group shall complete and file with the department “Notice of
Workers Compensation Insurance Coverage” form 6WC (4/2008) and “Supplemental Notice of Information Regarding Workers'
Compensation Insurance Coverage” form 6WC-S (3/2013) specifying all members, and shall update these filings upon each
new membership, in accordance with Lab chapter 300;
(c) Associations or groups shall provide proof of financial ability in accordance
with Lab 405;
(d) Group self-insurance shall not relieve a
member of any obligation under the statute or related rules of the department;
(e) Notice or knowledge of a work injury incident by a member shall be deemed conclusively
to be constructive notice or knowledge on the part of an association or group;
(f) The insolvency, bankruptcy, or disassociation
of a member shall not relieve
the association or group from liability under the statute;
(g) When the membership of an employer ceases, an association or group shall
complete and file written notice with the department, not less than 30 days
prior to the effective date, in addition to filing with respect to such
employer a “Termination Notice”
form WC-100, (10/1991) in accordance with Lab 307; and
(h) When the membership of an employer ceases,
but is then reinstated prior to the effective date of termination, an
association or group shall file with the department a “Reinstatement Notice”
form WC-100 R (9/2015) in accordance with Lab 307.02.
Source. #2264, eff 1-6-83; ss by #2935, eff 12-27-84,
EXPIRED: 12-27-90
New. #5235, eff 9-27-91, EXPIRED: 9-27-97
New. #6631, INTERIM, eff 11-16-97, EXPIRED:
3-16-98
New. #6806, eff 7-18-98; ss by #8682, INTERIM, eff
7-15-06, EXPIRED: 1-11-07
New. #9019, eff 11-1-07; ss by #11066, eff 4-1-16
PART Lab 405 SATISFACTORY PROOF OF FINANCIAL ABILITY
Lab 405.01 Proof of Financial Ability. Proof of financial ability and willingness to
make direct payment of compensation in amounts, manner, and when due as
required by RSA 281-A:5, III,
shall be given to the commissioner as provided in this part.
Source. #2264, eff 1-6-83; ss by #2935, eff 12-27-84,
EXPIRED: 12-27-90
New. #5235, eff 9-27-91, EXPIRED: 9-27-97
New. #6631, INTERIM, eff 11-16-97, EXPIRED:
3-16-98
New. #6806, eff 7-18-98; ss by #8682, INTERIM, eff
7-15-06, EXPIRED: 1-11-07
New. #9019, eff 11-1-07; ss by #11066, eff 4-1-16
Lab 405.02 Application for Self-Insurance. Application for self-insurance shall be made
as follows:
(a) A first time applicant shall complete and
file with the department a “Workers Compensation Self-Insurance Application”
form WSCI-1 (2/2016), contained in appendix II if the applicant is a single
employer, or a “Workers Compensation Self-Insurance Application-Group” form
WSCI-1A (2/2016) contained in appendix II if the applicant is an association or
group of employers , together with balance sheet data or the most recent annual
report containing such data, payroll data, and an “Annual Financial Statement”
form WCSI-11 (3/1975) contained in appendix II .
(b) Annually after first receipt of a
self-insurance permit, the self – insurer shall complete and file with the
department an “Annual Financial Statement” form WCSI-11, a “Report of
Outstanding Liabilities” form WCSI-9 (3/1975), contained in appendix II, a
“Workers’ Compensation Self-Insurance Questionnaire” form WCSI-16 (9/2015),
contained in appendix II, a full report of actuarial analysis and opinion, and
the “Actuarial Opinion Summary Sheet” form WCSI-7 (9/2015), contained in appendix
II.
Source. #2264, eff 1-6-83; ss by #2935, eff 12-27-84,
EXPIRED: 12-27-90
New. #5235, eff 9-27-91, EXPIRED: 9-27-97
New. #6631, INTERIM, eff 11-16-97, EXPIRED:
3-16-98
New. #6806, eff 7-18-98; ss by #8682, INTERIM, eff
7-15-06, EXPIRED: 1-11-07
New. #9019, eff 11-1-07; ss by #11066, eff 4-1-16
Lab 405.03 Self-Insured Retention.
(a)
A self-insurer shall identify to the commissioner the dollar amount of the attachment point, up to which the self-insurer will
be responsible for the payment of workers’ compensation benefits for each work
injury incident.
(b)
In support of this identification of amount, the self- insurer shall
submit:
(1)
The dollar amount of the proposed self-insurer retention;
(2) Five
years of loss history;
(3) A financial
statement of the self-insured; and
(4)
Any other factor that may impact the self-insurer’s ability to pay
claims.
(c) The commissioner shall review the submission
and approve an amount for the self-insurer retention based on his or her
discretion.
Source. #2264, eff 1-6-83; ss by #2935, eff 12-27-84,
EXPIRED: 12-27-90
New. #5235, eff 9-27-91; amd by #5501, eff
11-12-92; ss by #6631, INTERIM, eff 11-16-97, EXPIRED: 3-16-98
New. #6806, eff 7-18-98; ss by #8682, INTERIM, eff
7-15-06, EXPIRED: 1-11-07
New. #9019, eff 11-1-07; ss by #11066, eff 4-1-16
Lab 405.04 Supplemental Guarantee of Payment.
(a) The self-insurer shall provide to the commissioner
a supplemental guarantee of payment of the self-insurer retention. The supplemental guarantee of payment shall
be in the form of a surety bond or securities or cash.
(b) A surety bond shall use the wording of
“Surety Bond”, form WCSI-2 (8/1994) contained in Appendix II and shall name the State of New
Hampshire Commissioner of Labor as beneficiary, and shall be in a penal sum not
to exceed the 90-percent confidence level determined by the actuary of the
self-insured and reported to the department on the “Actuarial Opinion Summary
Sheet”, form WCIS-7 (9/2015) contained in Appendix II.
(c) The commissioner shall require a surety bond
exceeding the amount of self-insurer retention upon application or annual
review under any of the following circumstances:
(1) Lack of financial history;
(2) Fluctuating financial statements;
(3) Litigation pending in other jurisdictions;
(4) Any negative change in the financial picture
of a self-insurer; or
(5) The confidence levels determined in “Actuarial
Opinion Summary Sheet” form WCSI-7.
(d) Such surety bond shall remain in full force and effect unless terminated by the
surety by written notice of its intention to do so filed in the office of the
labor commissioner, and by giving written notice thereof to the principal.
After proper notice, the surety’s liability shall terminate at the
expiration of 90 days from the date of such filing and not earlier. However, such termination shall not relieve
the surety of its continual liability under this bond for obligations that
occurred prior to the effective date of such termination.
(e)
If the self-insurer ceases to be an employer subject to the statute, or if it obtains coverage pursuant to RSA 281-A:5,I, then the liability of the self-insurer and
of the surety shall cease, except as to
such liability which has accrued during the life of the obligation. The surety shall be liable to the full extent
of the penal sum in the event the self-insurer defaults.
(f) Should the financial circumstances of the
self-insurer change, the commissioner shall order an additional surety bond or
supplemental guarantee or both or permit
a reduction in the penal sum of an existing bond or the substitution of a new
bond. Increases or reductions of the
penal sum of a bond may be done by endorsement.
Bonds shall remain in the possession of the department, even subsequent
to their termination, except that the effective date of the termination shall
be acknowledged in writing by the department to both the principal and the
surety.
(g) In
lieu of the surety bond referred to in Lab 405.04 (b) through (f), the self-insurer shall deposit and
keep on deposit with a New Hampshire bank cash, securities, or both in trust for the benefit of a
self-insurer's employees. Such
guarantees shall be used, liquidated and disbursed exclusively upon the
self-insurer's default and upon the commissioner's order, for the purpose of
making direct payment of compensation benefits as provided by the statute and
administrative rule of the department.
(h) The self-insured and its fiduciary shall
complete and file a “Securities
Deposit Agreement” form WCSI-3 (1/1992), contained in appendix II, if the
self-insured is using securities or cash as a supplemental guarantee.
(i) The commissioner
shall order additional guarantees if an annual actuary opinion indicates such change is prudent or permit a reduction or substitution if an annual actuary opinion indicates such change is prudent. Income from such deposit shall accrue to the
self-insurer.
(j) The
agreement evidencing and governing a deposit of securities shall be executed by
the self-insurer as principal, the bank's trust officer as fiduciary, and the
commissioner as administrator of the statute, and shall remain in full force
and effect until other guarantees provided by this section are substituted.
(k) If the self-insurer ceases to be an employer
subject to the statute or insures pursuant to RSA 281-A:5, I, the liability of
the principal and the fiduciary shall cease except with respect to liability
which has accrued during the life of the agreement. The bank and the fiduciary shall be liable to
the full extent of the sum of cash or the market value of the securities on
deposit.
(l) No such deposit of securities may be withdrawn by anyone, without prior authorization
of the commissioner. No guarantees
deposited pursuant to this section shall be assignable, or subject to
attachment, or liable in any way for the debt of the self-insurer unless such
liability is incurred under RSA 281-A.
(m) The self-insurer shall obtain a completed
“Certificate of Insurance” form WCSI-4 (1/1992) contained in appendix II,
executed by a carrier for excess insurance. The excess coverage shall include
the
(n) The certificate shall remain in full force
and effect until it has been replaced or other guarantees have been substituted,
or until a written notice of termination has been on file with the department
for a minimum period of 45 days. If the
self-insurer ceases to be an employer subject to the statute or insures
pursuant to RSA 281-A: 5, I, the liability of the carrier shall cease except as
to such liability which has accrued during the life of the certificate.
(o) If the self-insurer is a subsidiary to a
parent entity the self-insurer shall file evidence of a parent company support,
guaranteeing payment of compensation benefits under the statute up to a
specific sum. This guarantee invests the
commissioner with the power to order the manner and amount of payment upon
default of the self-insurer. Termination
of such agreement shall require a 60-day written notice to be filed with the
department. “The Parent Company
Agreement” form WCSI-6 (1/1992) contained in appendix II shall be used.
Source. #9019, eff 11-1-07 (from Lab 405.03); ss by
#11066, eff 4-1-16
PART Lab 406 SELF-INSURED PUBLIC EMPLOYERS - REPLEALED
Lab 406.01
Application and Permit. - REPEALED
Source. #2264, eff 1-6-83; ss by #2935, eff 12-27-84,
EXPIRED: 12-27-90
New. #5235, eff 9-27-91, EXPIRED: 9-27-97
New. #6631, INTERIM, eff 11-16-97, EXPIRED:
3-16-98
New. #6806, eff 7-18-98; ss by #8682, INTERIM, eff
7-15-06, EXPIRED: 1-11-07
New. #9019, eff 11-1-07; rpld
by #11066, eff 4-1-16
PART Lab 407 INSTRUCTIONS FOR THE COMPLETION OF
SELF-INSURANCE FORMS - REPEALED
Lab
407.01 - 407.08
- REPEALED
Source. #5235, eff 9-27-91, EXPIRED: 9-27-97
New. #6631, INTERIM, eff 11-16-97, EXPIRED:
3-16-98
New. #6806, eff 7-18-98; ss by #8682, INTERIM, eff
7-15-06, EXPIRED: 1-11-07
New. #9019, eff 11-1-07; rpld
by #11066, eff 4-1-16
PART
Lab 408 REGULATION OF THIRD PARTY
ADMINISTRATORS
Statutory
Authority: RSA 281-A:5-d
Lab 408.01 Purpose. The purpose of this part is to provide for the
regulation and licensing of third party administrators who perform services for
employers self-insuring their workers’ compensation and to set forth procedural
requirements which the commissioner deems necessary to carry out the provisions
of RSA 281-A:5-d.
Source. #7142, eff 11-24-99, EXPIRED: 11-24-07
New. #9878-A eff 2-25-11, EXPIRED: 2-25-19
New. #12815, eff 6-26-19
Lab 408.02 Definitions.
(a)
“Third party administrator (TPA)” means “third party administrator” as
defined in RSA 281-A:5-d.
(b)
“Department” means the department of labor.
(c)
“Commissioner” means the commissioner of labor or the commissioner’s
authorized representative.
(d)
“Self-insurer” means a person, partnership, association, limited
liability company, corporation, or
legal representative of a person, partnership, association, limited liability company, or corporation who employs
one or more persons whether in one or more trades, businesses, professions, or
occupations and whether in one or more locations who is approved by the
department of labor to assume the responsibility for providing workers’
compensation for wage loss, remedial care, and rehabilitation as provided by
RSA 281-A.
Source. #7142, eff 11-24-99, EXPIRED: 11-24-07
New. #9878-A eff 2-25-11, EXPIRED: 2-25-19
New. #12815, eff 6-26-19
Lab 408.03 Application.
(a)
A TPA shall not operate as a TPA in this state without a certificate of
authority from the department which will be issued only following review of the
information supplied by the applicant as described in Lab 408.18.
(b) Any amendment to the application shall be
filed in the same manner as the application.
If an application is amended, such amendment shall be considered, and
subject to approval or denial, in the same manner as the original application.
(c) A TPA shall notify the commissioner in
writing of any change in the information required to be filed under these rules
including, but not limited to, a change of address or name, no later than 30
days after the change. If a change
occurs but notification is not provided, the certificate of registration shall
be terminated following notice and an opportunity for hearing.
Source. #7142, eff 11-24-99, EXPIRED: 11-24-07
New. #9878-A eff 2-25-11, EXPIRED: 2-25-19
New. #12815, eff 6-26-19
Lab 408.04 Surety Bond.
(a)
All applicants shall provide
financial assurance as
follows:
(1) The applicant shall attempt in good faith to
obtain a surety bond issued by an insurance company licensed to do business in
the State of New Hampshire in a minimum amount of $100,000; and
(2) If the applicant cannot obtain such a bond, then another form of security,
including, but not limited to, cash or negotiable securities in an amount equal
to $100,000 shall be set aside in an
escrow account with a financial institution licensed to do business in the
state of New Hampshire.
(b)
The surety bond or escrow account
shall be payable to the commissioner to ensure the financial protection of
the TPA’s customers, subject to the dollar limitation of the surety bond or escrow account.
Source. #7142, eff 11-24-99, EXPIRED: 11-24-07
New. #9878-A eff 2-25-11, EXPIRED: 2-25-19
New. #12815, eff 6-26-19
Lab 408.05 Audited Financial Statement.
(a)
Each applicant for a certificate of authority or renewal of a
certificate of authority shall provide the applicant’s current audited
financial statement. An audited
financial statement, for the purposes of this rule, shall consist of a
financial statement that is prepared in a manner consistent with generally
accepted accounting principles (GAAP), and shall be accompanied by an opinion
by an independent accounting firm.
(b)
The audited financial statement shall reflect a positive net worth in
order to be acceptable as proof of the applicant’s financial responsibility.
Source. #7142, eff 11-24-99, EXPIRED: 11-24-07
New. #9878-A eff 2-25-11, EXPIRED: 2-25-19
New. #12815, eff 6-26-19
Lab 408.06 Written Agreement Necessary.
(a)
A TPA shall not act on behalf of a self-insurer without a written
agreement with that self-insurer.
(b)
A TPA shall complete and submit “Notice of Contract Between Third Party
Administrator and Self-Insurer” form WC-TPA-CBP (3/2019). The form may be
obtained at https://www.nh.gov/labor/documents/tpa-contract.pdf.
(c)
In addition to the “Notice of Contract Between Third Party Administrator
and Self-Insurer” form, a TPA shall submit the following documents to the
department:
(1) A copy of the contract between the
administrators and insurers; and
(2) A copy of the notification which will be sent
to policyholders informing them of this arrangement.
Source. #7142, eff 11-24-99, EXPIRED: 11-24-07
New. #9878-A eff 2-25-11, EXPIRED: 2-25-19
New. #12815, eff 6-26-19
Lab 408.07 Fiduciary Obligation.
(a)
Each TPA shall establish a premium trust account if the TPA expects to
receive premiums or return premiums on New Hampshire business.
(b)
If the account is interest bearing, the TPA shall comply with Lab
408.11.
(c)
Fiduciary funds on New Hampshire business shall at all times be
maintained in the premium trust account separate from any other account of
depository. Such account shall be in an
amount at least equal to the premiums and return premiums, net of commission,
received by the TPA.
(d) The TPA’s New Hampshire premium trust account
signature card shall contain the following notation: “This is an insurance premium trust account
maintained under the provisions of RSA 281-A:5-d.”
(e)
Checks drawn on the premium trust account shall bear the notation
“Premium Trust Account”.
Source. #7142, eff 11-24-99, EXPIRED: 11-24-07
New. #9878-A eff 2-25-11, EXPIRED: 2-25-19
New. #12815, eff 6-26-19
Lab 408.08 Commingling of Funds Prohibited.
(a)
Under no circumstances shall a TPA place fiduciary funds in a personal
or business operating account. The TPA
may retain commission income or other funds in the TPA’s premium trust account
in order to advance premiums, establish reserves for paying return commissions
or for such contingencies as may arise in his business of receiving and
transmitting premiums or return premium funds.
(b)
The TPA may retain a portion of the TPA’s unearned commissions in the
premium trust account in order to avoid being short in the event of a policy
cancellation. When a policy is canceled
and the return premium is received by the TPA by means of a credit or
otherwise, those funds shall be placed in the premium trust account until remitted
to the self-insured entitled thereto.
(c)
Cash premium payments shall not be deposited into the TPA’s personal or
business operating account in order to draw a personal check in the amount of
net premium payment to the self-insurer.
The use of personal checks to transit fiduciary funds shall be
prohibited in any situation that results in commingling the fiduciary funds
with the TPA’s personal funds.
Source. #7142, eff 11-24-99, EXPIRED: 11-24-07
New. #9878-A eff 2-25-11, EXPIRED: 2-25-19
New. #12815, eff 6-26-19
Lab 408.09 Interest-Bearing Accounts. A TPA shall utilize only interest-bearing accounts
that require no advance notice for the withdrawal of funds, and the TPA shall
arrange all such interest-bearing accounts so that funds therein contained
shall be immediately available during normal business hours.
Source. #7142, eff 11-24-99, EXPIRED: 11-24-07
New. #9878-A eff 2-25-11, EXPIRED: 2-25-19
New. #12815, eff 6-26-19
Lab 408.10 Return Premiums. The TPA shall
hold the return premiums as a fiduciary.
The TPA shall retain the return premium in
the trust account until remittance to the client is made. Remittance to
the client shall occur no later than 45 days from the date the return premium
is determined. If the return
premium cannot be delivered to the insured entitled thereto, the TPA shall
retain the funds. The
TPA shall report the unclaimed funds to the State of New Hampshire, in
accordance with RSA 471-C.
Source. #7142, eff 11-24-99, EXPIRED: 11-24-07
New. #9878-A eff 2-25-11, EXPIRED: 2-25-19
New. #12815, eff 6-26-19
Lab 408.11 Recordkeeping Requirements.
(a)
The TPA shall maintain the following records relative to the premium
trust account:
(1) Periodic
statements of account supplied by the bank for all premium trust accounts
maintained pursuant to this part;
(2) Records of all
deposits made into each premium trust account;
(3) Canceled checks drawn
on, or records of withdrawal of funds from, such premium trust accounts; and
(4) An accounts
receivable listing or similar record.
(b)
All records described above shall be kept in the principal office of the
TPA.
Source. #7142, eff 11-24-99, EXPIRED: 11-24-07
New. #9878-A eff 2-25-11, EXPIRED: 2-25-19
New. #12815, eff 6-26-19
Lab 408.12 Responsibilities of the Self Insurer.
(a)
The self-insurer shall be responsible for determining benefits, premium
rates, underwriting criteria and claims payment procedures and for securing
reinsurance.
(b)
The standards pertaining to these matters shall be provided in writing
by the self-insurer to the TPA.
(c)
If the TPA has any responsibility for the development or formula of the
items in (a) above, that responsibility shall
be set forth in the written agreement between the TPA and the self-insurer.
Source. #7142, eff 11-24-99, EXPIRED: 11-24-07
New. #9878-A eff 2-25-11, EXPIRED: 2-25-19
New. #12815, eff 6-26-19
Lab 408.13 Approval of Advertising. All advertising conducted by the TPA on the behalf
of the self-insurer shall be approved in writing by the self-insurer in advance
of its use.
Source. #7142, eff 11-24-99, EXPIRED: 11-24-07
New. #9878-A eff 2-25-11, EXPIRED: 2-25-19
New. #12815, eff 6-26-19
Lab 408.14 Grounds for Denial, Nonrenewal, or
Revocation of Certificate. Following
notice and an opportunity for hearing, the commissioner or the commissioner’s
representative shall deny, nonrenew,
or revoke a TPA’s certificate if it is found that the TPA is not competent,
trustworthy, financially responsible, or of good personal and business
reputation, based on the following factors.
(a)
Failure to comply with any provisions of RSA 281-A:5-d, or these rules;
(b)
Failure to comply with any lawful order of the commissioner;
(c)
Failure to comply with the workers’ compensation claims processing
responsibilities established by Lab 500;
(d)
Committing an unfair or deceptive act or practice;
(e)
Deterioration of financial condition adversely affecting the certificate
holder’s ability to operate as a TPA;
(f)
Filing an application or any required form with the department which
contains fraudulent information or omissions;
(g)
Misappropriation, conversion, illegal withholding, or refusal to pay on
proper demand any monies that belong to a person otherwise entitled to them;
(h)
That an owner, principal, officer, partner, manager, director,
stockholder, trustee, employee of the TPA, or the TPA itself has:
(1) Had a TPA
license or an application for a TPA license in any state denied, suspended, or
revoked;
(2) Been the subject
of a fine, penalty, order, withdrawal, or informal settlement with any state
regulatory agency; or
(3) Pled guilty or
no contest to any felony or misdemeanor;
Source. #7142, eff 11-24-99, EXPIRED: 11-24-07
New. #9878-A eff 2-25-11, EXPIRED: 2-25-19
New. #12815, eff 6-26-19
Lab 408.15 Inquiry by Commissioner.
(a)
The TPA shall respond, in writing, within 30 days to any inquiry by the
commissioner made pursuant to these rules.
(b)
A TPA shall keep all complaints on file for a period of 5 years. Complaint information shall be made available
to the department by the TPA upon the commissioner’s request.
Source. #7142, eff 11-24-99, EXPIRED: 11-24-07
New. #9878-A eff 2-25-11, EXPIRED: 2-25-19
New. #12815, eff 6-26-19
Lab 408.16 Hearing and Appeal. Prior to denying or revoking a certificate
issued under this part, a certificate holder shall be provided with written
notice of the commissioner’s allegations and provided an opportunity for a
hearing in accordance with Lab 200.
Source. #7142, eff 11-24-99, EXPIRED: 11-24-07
New. #9878-A eff 2-25-11, EXPIRED: 2-25-19
New. #12815, eff 6-26-19
Lab 408.17 Violations and Penalties.
(a)
Any TPA who violates any of the provisions of this part shall have civil
penalties imposed as provided in RSA 281-A:60, I(r), as follows:
(1) A violation of
Lab 408.03(a) shall result in a civil penalty of up to $2,500.00; and
(2) Each individual
violation of the other provisions of these rules shall result in a civil
penalty of up to $500.00 for the first violation, and each subsequent violation
shall result in the civil penalty increasing by $500.00 per violation up to a
maximum civil penalty of $2,500.00 for each violation.
Source. #7142, eff 11-24-99, EXPIRED: 11-24-07
New. #9878-A eff 2-25-11, EXPIRED: 2-25-19
New. #12815, eff 6-26-19
Lab 408.18 Application Form.
(a)
TPAs wishing to do business in this state shall complete and submit
“Application for Certificate of Authority Third Party Administrators” form
WC-TPA-COA (06/2019). The “Application
for Certificate of Authority Third Party Administrators” form may be obtained
at https://www.nh.gov/labor/documents/tpa-certificate-authority.pdf.
(b)
In addition to the “Application for Certificate of Authority Third Party
Administrators”, TPA’s shall include the following documentation with their
submission:
(1)
The last 3 years of federal tax returns;
(2)
The last 2 years of audited financial statements;
(3)
Certified copies of organizational documents;
(4)
Certified copies of by-laws;
(5)
Current adjusters licenses for workers’ compensation in NH;
(6)
Business plan statement;
(7)
Summary of insurance policies; and
(8)
Evidence of a toll-free telephone number.
(c)
The “Application for Certificate of Authority Third Party
Administrators” form shall be completed and signed by an officer or authorized
representative of the TPA. The complete
application form shall be verified and filed with the department on initial
application and annually thereafter. The
filing fee of $200.00 shall accompany the initial application, and a filing fee
of $100.00 shall accompany a renewal application.
(d)
The “Application for Certificate of Authority Third Party
Administrators” form shall not be deemed to be filed until the commissioner has
received all of the information necessary to properly process the application.
(e)
The “Application for Certificate of Authority Third Party
Administrators” form completed by a corporation, limited partnership, or
limited liability company shall be accompanied by a current certificate of good
standing, from the secretary of state of New Hampshire.
(f)
In addition to “The Application for Certificate of Authority Third Party
Administrators” form the officer or authorized representative of the TPA shall
complete and submit the “Biographical Affidavit” form WC-TPA-BA (3/2019). The
“Biographical Affidavit” form may be obtained at https://www.nh.gov/labor/documents/tpa-affadavit.pdf.
(g)
The “Biographical Affidavit” form must be signed before a notary
public/justice of the peace in order to be considered properly submitted.
(h)
Upon receipt of a completed application in accordance with (a) through
(g) the commissioner shall make a determination on approval.
Source. #7142, eff 11-24-99, EXPIRED: 11-24-07
New. #9878-B,
eff 2-25-11; ss by #12815, eff 6-26-19
APPENDIX
|
Rule |
|
|
Lab 401.01 |
RSA 281-A:5,
III; RSA 281-A:5-a |
|
Lab 402.01 |
RSA 281-A:5-a |
|
Lab 402.02 |
RSA 281-A:5-a |
|
Lab 402.03 |
RSA 281-A:5, III;
RSA 281-A:5-a |
|
Lab 402.04 |
RSA 281-A:2, XII |
|
Lab 402.05 |
RSA 281-A:5-a |
|
Lab 402.06 |
RSA 281-A:5 |
|
Lab 402.07 |
RSA 281-A:5-b |
|
Lab 402.08 |
RSA 281-A:5-a;
RSA 281-A:5-b |
|
Lab 402.09 |
RSA 281-A:5-a;
RSA 281-A:5-b |
|
Lab 402.10 |
RSA 281-A:5; RSA
281-A:5-a; RSA 281-A:5-b |
|
Lab 402.11 |
RSA 281-A:5 |
|
Lab 402.12 |
RSA 281-A:5; RSA
281-A:11 |
|
Lab 402.13 |
RSA 281-A:5-a;
RSA 281-a:5-b |
|
Lab 402.14 |
RSA 281-A:5-a;
RSA 281-A:5-b |
|
Lab 402.15 |
RSA 281-A:5-a;
RSA 281-A:5-b; RSA 281-A:5-c |
|
Lab 402.16 |
RSA 281-A:5-a;
RSA 281-A:5-b |
|
Lab 403.01 |
RSA 281-A:5,
III; RSA 281-A:5-a; RSA 281-A:5-b; RSA 281-A:5-c |
|
Lab 403.02 |
RSA 281-A:5-c |
|
Lab 403.03 |
RSA 281-A:5-a;
RSA 281-A:5-b; RSA 281-A:5-c |
|
Lab 403.04 |
RSA 281-A:7 |
|
Lab 404 |
RSA 281-A:2, VIII,
XI; RSA 281-A:5-a; RSA 281-A:5-c; RSA 281-A:5,
III; RSA 281-A:7 |
|
Lab 405.01 |
RSA 281-A:5,
III; RSA 281-A:5-a |
|
Lab 405.02 |
RSA 281-A:5,
III; RSA 281-A:5-a; RSA 281-A:5-b; RSA 281-A:5 –c |
|
Lab 405.03-Lab
405.04 |
RSA 281-A:5, I,
III; RSA 281-A:5-a; RSA 281-A:5-b; RSA 281-A:5-c |
|
Lab 406-407 |
Repealed |
|
Lab 408 |
RSA 281-A:5-d,
RSA 281-A:60, I (r). |