2020 Georgia Code
Title 34 - Labor and Industrial Relations
Chapter 9 - Workers' Compensation
Article 4 - Insurance of Compensation Liability Generally
§ 34-9-133. Apportionment and Assignment of Rejected Risks; Workers' Compensation Assigned Risk Insurance Plan; Merit Rating Plan
- The board shall prescribe the rules and regulations for apportioning rejected workers' compensation policies and may establish an equitable assignment of such policies and enforce such provisions; provided, however, the Commissioner of Insurance is authorized to establish or approve a method to apportion on a pro rata basis any rejected workers' compensation policy where four insurers duly authorized to write workers' compensation insurance refused, in writing, to issue the workers' compensation policy to cover said risk or where the agent for the applicant for such insurance confirms in writing to the four insurers their refusal to cover said risk. In formulating this method of assignment, a minimum loss ratio will be considered by the Commissioner of Insurance. Then, such established or approved method shall immediately assign an insurer to write such risk. The Commissioner of Insurance shall establish separate categories of risks rejected as the result of insufficient prior workers' compensation experience, risks rejected for factors other than workers' compensation loss experience, and risks rejected as the result of poor workers' compensation experience. Where such assignment has been made under the aforementioned method, the board shall not make the assignment.
- The method of apportioning and assigning rejected workers' compensation insurance policies provided in subsection (a) of this Code section shall include the assignment and apportionment of such policies covering vendors who provide logging services to a named insured or covering an association of such vendors.
- The method of apportioning and assigning rejected workers' compensation insurance policies provided in subsections (a) and (b) of this Code section shall be known as the "Workers' Compensation Assigned Risk Insurance Plan" or "Plan." All policies issued under the Plan shall have the words "Georgia Workers' Compensation Assigned Risk Plan" placed in bold letters on the policy declarations page to ensure that rejected risks know that the policy has been issued in the Plan.
- For Plan policies with effective dates on or after January 1, 1996, the Commissioner of Insurance shall approve and implement a plan which establishes rates adequate to eliminate any Plan operating deficit by January 1, 1999.
- Such Plan shall be revised annually by the Plan administrator and presented to the Commissioner of Insurance for approval.
- Such Plan shall include, to the extent adequate to reduce the Plan operating deficit:
- Rating plans, procedures, and requirements placed on Plan policyholders; and
- Procedures and requirements placed on Plan insurers and the Plan administrator.
- Such Plan shall also include, but not be limited to:
- Plan policy assessments and surcharges;
- Credits for policyholders who have had no lost-time claims;
- A system of credits against assessment or participation of insurers for the voluntary writing of a risk or risks which are currently insured through the Plan;
- Provisions that the type or level of services by an insurer for Plan policyholders shall be no less than such type or level of services of such insurer for its policyholders not in the Plan; and
- Provisions for safety programs to be implemented by policyholders in cooperation with their insurer.
- The Plan required by subsection (c) of this Code section shall be structured, to the extent possible, so as to reduce the operating deficit of the Plan proportionately each year from January 1, 1996, through January 1, 1999.
- Notwithstanding anything to the contrary provided in subsection (c) or (d) of this Code section, the Commissioner of Insurance shall have the discretion to waive all or any portion of the Plan policy assessments and surcharges described in subsection (c) of this Code section if the operating deficit of the Plan for a respective Plan policy year improves by at least 15 percent as compared to the deficit for such Plan policy year calculated based upon rates in effect for the immediately preceding Plan policy year.
- For Plan policies with effective dates on or after January 1, 1999, the aggregate of all revenues received from rates and rating plans charged to participants who are insured under the Plan shall be set so that the amount received in premiums, together with reasonable investment income earned on those premiums, shall be sufficient to pay claims and reasonable expenses of providing coverage under the Plan and to establish appropriate levels of loss reserves, all in accordance with actuarial standards, including consideration of the effects of subsection (c) of this Code section. For purposes of this Code section, the term "actuarial standards" means standards adopted by the Casualty Actuarial Society in its Statement of Principles Regarding Property and Casualty Insurance Ratemaking and the Standards of Practice adopted by the Actuarial Standards Board. Any premium or surcharge collected by the Plan in excess of the amount necessary to fund the projected ultimate losses and expenses of the Plan shall be refunded to the policyholders or applied to reduce premiums.
- Notwithstanding Code Sections 33-9-8 and 33-9-21, the Commissioner of Insurance shall cause the implementation of rates for policies issued pursuant to the Plan which are sufficient to conform with the requirements of paragraphs (1) and (2) of subsection (c) of this Code section.
- On or before December 15, 1995, and each subsequent year, the Commissioner of Insurance shall submit a report to the appropriate standing committees of the General Assembly concerning the status and results of operation of the Plan. Such report shall include but not be limited to a report on the Plan deficit, burden and trends in reducing such deficit, number of policies and amount of premium underwritten by the Plan, rating of such policies based upon the three-tier rating program, his or her estimate of the effect of policyholder safety committees on policyholder loss experience, operation of workers' compensation insurance specialty markets in this state, impact of the servicing carrier remedial program and results of servicing carrier incentives and disincentives, review of the efficiency of the servicing carrier bid program, and any other information the Commissioner of Insurance or the respective chairpersons of such standing committees deem necessary to evaluate the Plan and the workers' compensation insurance market in this state.
- On or before July 1, 1995, the Commissioner of Insurance shall promulgate rules and regulations to implement this Code section. Such rules and regulations shall include the system of credits required by subparagraph (c)(5)(C) of this Code section, which credits shall not be less than the following:
- For policies with an annual premium of $7,500.00 or less, a credit of four times the amount of such annual premium;
- For policies with an annual premium of at least $7,501.00, but not exceeding $15,000.00, a credit of three times the amount of such annual premium;
- For policies with an annual premium of at least $15,001.00, but not exceeding $25,000.00, a credit of two times the amount of such annual premium;
- For policies with an annual premium of at least $25,001.00, but not exceeding $200,000.00, a credit of one and one-half times the amount of such annual premium; or
- For policies with an annual premium of $200,001.00 or greater, a credit of the amount of such annual premium.
- A merit rating plan shall be implemented by the Plan administrator and the Commissioner of Insurance in compliance with subparagraph (c) (5) (B) of this Code section to establish credits for policyholders who have had no lost-time claims and debits for a specified number of lost-time claims to include the following:
- A policyholder who is not experience rated, whose annual premium is less than $5,000.00, and who is subject to a merit rating plan of credits and debits to be applied to the Georgia manual premium for the policyholder in the Plan;
- The merit rating plan shall be based upon the number of lost-time claims of the policyholder during the most recent one-year period for which statistics are available. This one-year period is that which would otherwise be used for experience rating purposes;
- The credits and debits under such plan shall be as follows:
- No lost-time claims for the most recent year, a 12 1/2 percent credit;
- One lost-time claim for the most recent year, no credit or debit; and
- Two or more lost-time claims for the most recent year, a 5 percent debit;
- The insurer shall obtain the claims information of the policyholder and shall notify the policyholder of the credit or debit premium adjustment and the reason for same in writing within 90 days of the effective date of the policy. The insurer, upon request, shall provide additional safety plan information to a policyholder who develops a debit merit rating adjustment; and
- Debits and credits used in this merit rating plan shall not apply to the Georgia minimum premium for a risk.
(Code 1933, § 114-620, enacted by Ga. L. 1935, p. 146, § 1; Ga. L. 1982, p. 644, § 7; Ga. L. 1990, p. 781, § 1; Ga. L. 1992, p. 1322, § 1; Ga. L. 1992, p. 1942, § 13; Ga. L. 1993, p. 91, § 34; Ga. L. 1995, p. 1365, § 1; Ga. L. 1996, p. 1527, § 1.)Code Commission notes.
- Pursuant to Code Section 28-9-5, in 1986, "Commissioner of Insurance" was substituted for "Insurance Commissioner" in two places.Law reviews.
- For note on the 1992 amendment of this Code section, see 9 Ga. St. U.L. Rev. 285 (1992).
Independent investigation not required.
- In an action by a workers' compensation insurer based on negligent misrepresentations by an agent and the insured that the insured qualified for coverage through the assigned risk pool, the trial court did not err in failing to charge that an insurer may rely on representations in an insurance application as true without conducting an independent investigation. United States Fid. & Guar. Co. v. Paul Assocs., 230 Ga. App. 243, 496 S.E.2d 283 (1998).
Cited in National Council on Compensation Ins., Inc. v. Strickland, 241 Ga. App. 504, 526 S.E.2d 924 (1999).
OPINIONS OF THE ATTORNEY GENERAL
Required participation of companies providing alternative insurance coverage.
- Companies providing alternative insurance coverage in lieu of workers' compensation insurance may be required to participate in the Workers' Compensation Assigned Risk Insurance Plan by a rule properly promulgated under the Administrative Procedure Act. 1995 Op. Att'y Gen. No. 95-33.