COMPENSATION RATING AND INSPECTION BUREAU

Transcription

1 OMPENSTION RTING ND INSPETION BUREU GROVER E. ZEH, ESQ. Executive Director STTE OF NEW JERSEY DEPRTMENT OF BNKING ND INSURNE 60 PRK PLE, NEWRK, NJ (973) FREDERIK. HUBER ssociate Executive Director MNUL MENDMENT BULLETIN #427 June 13, 2005 To ll Bureau Members and Subscribers: Re: hanges to Manual Rules The ommissioner of Banking and Insurance has approved the following changes to the New Jersey Workers ompensation and Employers Liability Insurance Manual (Manual). The changes are effective July 1, 2005 on a new and renewal basis. FORMS mend 3:2 to include an amended New Jersey Limited Other States Insurance Endorsement (W ). This endorsement, which is attached as Exhibit I, is amended to clarify wording in the previous version of this endorsement that was deemed to be confusing or not sufficiently clear as to its intent. The Index Policy Forms and Endorsements has been revised to include the amended endorsement. The revised Index is attached as Exhibit II. With respect to policy forms, your attention is called to 3:2-1 of the Manual wherein it is stipulated that they must be filed in duplicate with the Rating Bureau before being placed in use. PREPRTION ND UDITING OF POLIIES mend 3: as follows: PRESENT 40.1 Spouse of Individual Proprietor or Partner. The payroll of a spouse of an individual proprietor or spouse of a partner in a partnership employed to perform work in connection with the business operations of the insured shall be included in the statement of payroll and a premium charged thereon subject to a maximum average individual payroll of one thousand eight hundred fifty ($1,850) per week and a minimum average of four hundred sixty ($460) per week. The maximum average and minimum average payroll required by this rule shall be subject to pro rata adjustment where the spouse does not devote full time to the risk subject to audit. PROPOSED 40.1 Spouse of Individual Proprietor or Partner. The payroll of a spouse of an individual proprietor, a spouse of a partner in a partnership or a spouse of a principal owner of a Limited Liability ompany employed to perform work in connection with the business operations of the insured shall be included in the statement of payroll and a premium charged thereon subject to a maximum average individual payroll of one thousand eight hundred fifty ($1,850) per week and a minimum average of four hundred sixty ($460) per week. The maximum average and minimum average payroll required by this rule shall be subject to pro rata adjustment where the spouse does not devote full time to the risk subject to audit.

2 .R.I.B. -2- Effective July 1, 2005 Manual mendment Bulletin #427 Similar to an individual proprietor or a partner in a partnership, owners of Limited Liability ompanies have the option of including or excluding themselves from the policy coverage. Presently, the Manual rule in 3: provides for inclusion of payroll, subject to the payroll limitations applying to Executive Officers of corporations, of an actively working spouse of an individual proprietor or partner for premium determination purposes. The Manual rule in 3: must be amended to provide for the inclusion of payroll of an actively working spouse of a principal owner of a Limited Liability ompany for premium determination, subject to the payroll limitations to Executive Officers of corporations. PPROVED MNGED RE PROGRM mend 3:10B as follows: PRESENT 4. Notification in Writing. member carrier utilizing an approved managed care program shall notify the Rating Bureau in writing on the form prescribed for that purpose if it intends to apply a premium reduction. copy of the form is shown in 8. below. The form and attachments stipulated therein, where applicable, must be completed and signed. 8. Forms Required PPLITION FOR N PPROVED MNGED RE PROGRM PREMIUM REDUTION (pplication Form not shown) PROPOSED 4. Notification in Writing. member carrier utilizing an approved managed care program shall notify the Rating Bureau in writing on the form prescribed for that purpose if it intends to apply a premium reduction. copy of the form is shown in 9. below. The form and attachments stipulated therein, where applicable, must be completed and signed. 8. New Jersey Workers ompensation Insurance Plan. n pproved Managed are Program Premium Reduction shall not be offered or available to any risk written through the New Jersey Workers ompensation Insurance Plan. 9. Forms Required PPLITION FOR N PPROVED MNGED RE PROGRM PREMIUM REDUTION (See Exhibit III) This section of the Manual has been amended to provide for a new rule and revisions to two current rules. The new rule is included in 3:10B-8. This rule prohibits the use of an pproved Managed are Program Premium Reduction in policies written through the New Jersey Workers ompensation Insurance Plan (Plan). The pplication for an pproved Managed are Program Premium Reduction form, that was previously included in 3:10B-8, has been revised and is now included in 3:10B-9. The pplication form, filed with the Bureau by insurers that opt to offer pproved

3 .R.I.B. -3- Effective July 1, 2005 Manual mendment Bulletin #427 Managed are Program Premium Reductions, was revised to include a statement indicating that an pproved Managed are Premium Reduction is not applicable to policies written through the Plan. Finally, the rule in 3:10B-4 has been revised to account for the renumbering of the pplication form. GE:njl tt. Grover E. zech, Esq. Executive Director

4 .R.I.B. -4- Effective July 1, 2005 Manual mendment Bulletin #427 Exhibit I WORKERS OMPENSTION ND EMPLOYERS LIBILITY INSURNE POLIY W NEW JERSEY LIMITED OTHER STTES INSURNE ENDORSEMENT Part Three - Other States Insurance is amended to read:. How This Insurance pplies 1. We will pay promptly, when due, the benefits required of you by the workers' compensation law of any state not listed in Item 3.. of the Information Page, if all of the following conditions are met: a. The employee claiming benefits was employed under a contract of hire made in a state listed in Item 3.. of the Information Page and was, at the time of injury, principally employed in a state listed in Item 3.. of the Information Page; and b. The employee claiming benefits is not claiming benefits in a state where, at the time of injury, (i) you have other workers' compensation coverage, or (ii) you were, by virtue of the nature of your operations in that state, required by that state's law to have obtained separate workers' compensation insurance coverage, or (iii) you are an authorized self-insurer or participant in a self-insured group plan; and c. The duration of the work being performed by the employee claiming benefits in a state other than those listed in item 3.. of the Information Page is temporary. 2. If we are not permitted to pay the benefits directly to persons entitled to them under circumstances described in item 1 above, we will reimburse you for the benefits required to be paid. 3. This insurance does not apply to fines or penalties arising out of your failure to comply with the requirements of the workers' compensation law. IMPORTNT NOTIE! If you hire any employees outside of New Jersey to work principally outside of New Jersey or you begin operations in any state other than New Jersey, you must obtain insurance coverage in that state and do whatever else may be required under that state s law, as this Limited Other States Endorsement does not satisfy the requirements of that state s workers compensation law. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Policy No. Endorsement No. Insured Premium $ Insurance ompany ountersigned by Notes: 1. Servicing carriers and direct assignment carriers must attach this endorsement to all policies issued through the New Jersey Workers ompensation Insurance Plan. Voluntary carriers may, as an option, elect to attach this endorsement to any policy showing New Jersey in Item 3.. of the Information Page. 2. Enter See Endorsement W in Item 3.. of the Information Page. ompensation Rating and Inspection Bureau

5 .R.I.B. -5- Effective July 1, 2005 Manual mendment Bulletin #427 EXHIBIT II INDEX POLIY FORMS ND ENDORSEMENTS PPLIBLE IN NEW JERSEY STNDRD IDENTIFIER VERSION IDENTIFIER± Workers ompensation and Employers Liability Insurance Policy...W Information Page (With New Jersey Requirements)...W B FEDERL OVERGES ND EXLUSIONS Defense Base ct overage Endorsement...W Federal Employers' Liability ct overage Endorsement...W Longshore and Harbor Workers' ompensation ct overage Endorsement...W Outer ontinental Shelf Lands ct overage Endorsement...W Notification Endorsement of Pending Law hange to Terrorism Risk Insurance ct of W New Jersey Voluntary ompensation Federal Employers' Liability ct overage Endorsement...W MRITIME OVERGES ND EXLUSIONS Maritime overage Endorsement...W Voluntary ompensation Maritime overage Endorsement...W OTHER OVERGE ND EXLUSIONS lternate Employer Endorsement...W Designated Workplaces Exclusion Endorsement...W Insurance ompany as Insured Endorsement...W Joint Venture as Insured Endorsement...W Rural Electrification dministration Endorsement...W New Jersey Workers ompensation and Employers Liability overage for Residence Employees Endorsement...W New Jersey Employee Leasing Labor ontractor Endorsement...W New Jersey Employee Leasing lient Exclusion Endorsement...W New Jersey Employee Leasing Labor ontractor Exclusion Endorsement...W New Jersey Part Two Employers Liability Endorsement...W New Jersey Sole Proprietor and Partners overage Endorsement...W New Jersey Limited Other States Insurance Endorsement...W New Jersey Workers ompensation Insurance Plan Eligibility Endorsement...W PREMIUM nniversary Rating Date Endorsement...W Experience Rating Modification Factor Endorsement...W Pending Rate hange Endorsement...W Policy Period Endorsement...W Rate hange Endorsement...W Premium Due Date Endorsement...W Terrorism Risk Insurance ct Endorsement...W New Jersey Premium Discount Endorsement: Schedule Y...±±W New Jersey Premium Discount Endorsement: Schedule X...±±W New Jersey pproved Managed are Program Endorsement...W New Jersey onstruction lassification Premium djustment Endorsement...W R RETROSPETIVE PREMIUM Retrospective Premium Endorsement - One Year Plan...W Retrospective Premium Endorsement - Three Year Plan...W Retrospective Premium Endorsement viation Exclusion...W Retrospective Premium Endorsement hanges...w Retrospective Premium Endorsement Non-Ratable atastrophe Element or Surcharge...W Retrospective Premium Endorsement Short Form...W New Jersey Retrospective Premium Endorsement Part Two Employers Liability Insurance Excess Exclusion...W New Jersey Retrospective Premium Endorsement - Long Term onstruction Project...W New Jersey Retrospective Premium Endorsement - Large Risk lternative Rating Option - One Year Rating Period...W New Jersey Retrospective Premium Endorsement - Large Risk lternative Rating Option - Three Year Rating Period...W New Jersey Retrospective Premium Endorsement - Large Risk lternative Rating Option Long Term onstruction Project...W New Jersey Large Risk - Large Deductible Endorsement...W New Jersey Large Risk - Large Deductible Retrospective djustment Endorsement...W New Jersey Large Risk Large Deductible ggregate Limit Endorsement...W New Jersey Large Risk - Large Deductible Retrospective Per Person Basis...W B OTHER Policy Information Page Endorsement...W New Jersey Participating Provisions Endorsement...W B NEW JERSEY NOTIES New Jersey Notice of ancellation...form 116-B New Jersey Notice of Reinstatement...Form 117- New Jersey Posting Notice...Form 16NJ New Jersey Posting Notice (Spanish)...Form 17NJ New Jersey Notice of Election Proprietors and Partners Workers ompensation and Employers Liability Insurance...Form PP-1 ± bsence of a version identifier denotes original printing ±± The version identifier for these endorsements will be governed by revisions in verbiage or change in the Discount Percentages/Table of Rating Values forming a part of the endorsements New or revised forms

6 .R.I.B. Manual mendment Bulletin # Effective July 1, 2005 Exhibit III SETION 10B. PPROVED MNGED RE PROGRM 9. Form Required. PPLITION FOR N PPROVED MNGED RE PROGRM PREMIUM REDUTION The has Name of Insurer entered into a written agreement with the pproved Managed are Organization to process claims under policies providing New Jersey workers compensation coverage. The managed care organization has been approved by the ommissioner of Insurance and a copy of the written agreement with the managed care organization together with the approval document of the managed care organization are enclosed. received approval by the ommissioner of Insurance for its in-house managed care program for processing claims under policies providing New Jersey workers compensation coverage. opy of the approval document is enclosed. specimen copy of the written agreement which will be executed by the insured is enclosed. Such agreement contains the stipulation that the use of the managed care program is an exercise of the insured s right of choice of medical provider under the New Jersey Workers ompensation Law. Premium reductions will be applied uniformly to each insured at a percentage rate of %. The effective date of the program is The program will be applicable to individual policies on a: new and renewal basis only new, renewal and outstanding basis other If Other is stipulated, a complete explanation by separate attachment is required. n pproved Managed are Program Premium Reduction is not applicable to policies written through the New Jersey Workers ompensation Insurance Plan. copy of the New Jersey pproved Managed are Program Endorsement W is enclosed. The program and procedures included in this form and any accompanying attachments have been reviewed by the management of the insurer and have been found to provide fair and equitable treatment to workers compensation insurance policyholders of the insurer. Signature Date Form #Req 11:6-2.3(d) ompensation Rating and Inspection Bureau