Ala. Admin. Code r. 480-5-2-.02 - Requirements Of Qualification For Self-Insurance
(1) Self-Insurance under the Alabama Workers'
Compensation Law is authorized by Code of Ala. 1975,
§
25-5-8,
as last amended. The following rules and regulations are adopted pursuant to
the authority contained therein.
(2) Definitions as used herein:
(a)
Director - the Director of
the Department of Industrial Relations or the Director's official
designee.
(b)
Division
- the Department of Industrial Relations, Workers' Compensation Division,
Montgomery, Alabama, 36131, phone number (334) 242-2868.
(c)
Guaranty Association - the
Alabama Workers' Compensation Self- Insurer's Guaranty Association, created by
Act 89-533.
(d)
Security
Amount - the monetary amount of Guaranty Association coverage, or any
other security amount determined by the Director of the Department of
Industrial Relations to constitute adequate security to insure the payment of
any and all Alabama workers' compensation claims which an individual
self-insured employer may be reasonably expected to incur.
(e)
Certificate - a certificate
of Self-Insurance issued by the Alabama Department of Industrial Relations to
an employer pursuant to Code of Ala. 1975,
25-5-8(d),
as last amended.
(f)
Insolvency - A self-insurer is insolvent for workers' compensation
purposes under any of the following circumstances:
1. When a determination of insolvency has
been made by a court of competent jurisdiction.
2. Upon institution of bankruptcy proceedings
by or regarding the self-insured or its parent company which renders the
company unable to pay its workers' compensation claims.
3. When the Director has determined that the
self-insured is not financially able to pay its Alabama workers' compensation
claims liability.
(3) Certificate of Self Insurance. The
Director may issue to each employer who has made application for
self-insurance, and is deemed qualified to operate as a self-insurer and who
has met all requirements contained herein, a Certificate of Self-Insurance
which shall evidence the Director's authorization for the employer to operate
as a self insurer.
(a) If the Director deems
that it is not in the best interest of the Alabama workers' compensation scheme
for a self-insurance applicant to operate as a self-insured entity in Alabama,
then the Director may, for good cause, at his or her discretion, deny the
application for self-insurance.
(b)
The certificate of self-insurance, once issued, shall become effective on the
date the certificate is issued or on the date requested on the application and
shall remain in force until cancelled or revoked or otherwise suspended by the
Director. Applications cannot be approved retroactively.
(c) A certificate shall be valid only to that
entity to which it is issued.
(d)
No self-insured employer has the authority to extend use of its certificate to
any other person, firm or corporation, and the unauthorized extension of said
use shall constitute good cause for revocation of the certificate.
(e) Any self-insured employer that amends its
articles, charter or agreement of incorporation, association or copartnership,
or partnership, or merges or attempts to merge with another entity so as to
change its identity or business structure or in any other manner materially
alters its status as it existed at the time the certificate was issued, shall
within thirty (30) days notify the Director in writing of such action and
provide the Director with a copy of such amendments. Failure to comply with
this provision may be grounds for revocation of the certificate of
self-insurance at the discretion of the Director.
(f) Any self-insured employer that proposes
to cease doing business in Alabama, or proposes to dispose of, by sale,
transfer, convey, sell, or otherwise, the controlling interest of the business
for which the certificate was issued, or proposes to dispose of, by sale or
otherwise, a significant portion of the in-state assets of the business, or
transfer of its workers' compensation liability, for which the certificate was
issued, shall immediately notify the Director in writing of the proposed
action. Failure to comply with this provision shall be grounds for revocation
of the certificate of self insurance at the discretion of the
Director.
(4)
Application - Every employer seeking authority to operate as a self-insured
shall make application to the Department of Industrial Relations, Workers'
Compensation Division, Montgomery, Alabama, 36131, at least thirty (30) days
prior to the requested effective date. The application shall be made on WCSI
Form No. 1, and shall include as attachments current, certified, independently
audited financial statements prepared in conformity with generally accepted
accounting principles using either the historical cost balance sheet, statement
of income, retained earnings and cash flows, or financial statements presented
on an income tax basis complete with all schedules, notes and such other
supporting financial information as may be deemed necessary by the Director.
(a) If required by the Director, each
application must include an actuarially certified summary of the dollar amount
of Alabama premiums paid, and losses paid and incurred, including IBNR claims,
incurred by the business operations for which the certificate is being sought
for the three (3) years preceding the requested effective date. The actuarial
certification must also verify that each worker is properly classified in the
proper job classification code and that loss reserves are adequately
established in accordance with acceptable actuarial practices and
procedures.
(b) An application fee
in the amount of $500.00 made payable to the Department of Industrial Relations
Worker's Compensation Administrative Trust Fund for deposit to said Fund shall
accompany each application. Any application received without the $500.00
application fee cannot be considered and will be returned.
(c) If the audited financial statements,
actuarial reports or any other required reports or documents submitted with the
application are dated more than six (6) months prior to the date of the
application, the Director may require interim certified financial statements or
other interim reports as deemed appropriate.
(d) A separate application must be filed for
each subsidiary corporation seeking authority to operate as a self-insurer. A
subsidiary corporation may submit with its application the consolidated
financial statement of its parent corporation in lieu of its own along with a
Parental Guarantee. In addition to the consolidated financial statements of the
parent corporation, the Director may require statements and reports relating to
the subsidiary's financial condition be certified and submitted by the
appropriate financial officers. In the event that a subsidiary corporation is
unable to furnish its own certified independently audited financial statements
or in the event that the financial reports of a subsidiary do not
satisfactorily evidence sufficient financial strength, it will be necessary for
the subsidiary to submit with its application documentary evidence,
satisfactory to the Director, that the parent corporation has undertaken an
obligation to guarantee the payment of all workers' compensation claims which
may be made against the subsidiary. Such a guarantee may be in the form of an
indemnification agreement (sample attached) or a resolution of the board of
directors of the parent company authorizing the guarantee of workers'
compensation liabilities. The parent corporation must meet the financial
qualification standards. The parent corporation must also maintain these
standards.
(e) Upon request, an
applicant may be required to supplement the application by providing accident
statistics, records or other documents, reports, or any other information
deemed appropriate relating to the applicant's claims liability and claims
paying ability.
(f) The Director
may request any other documents deemed necessary for the determination of the
self-insured's workers' compensation claims paying ability and/or financial
condition.
(g) Each application
shall include a complete outline of the manner in which the applicant intends
to administer its self-insured program. If claims are to be self-administered
by the applicant's in-house resources, the personnel involved should be
identified and their qualifications and the procedures to be utilized outlined.
If a service company or third party administrator is to be utilized, the
company or administrator should be identified and the procedures to be utilized
outlined.
(h) All financial
statements, reports, or information submitted to the Director by any
self-insured employer or by any applicant for authority to self-insure shall be
considered confidential, and as such, shall not be disclosed to any
unauthorized person or business entity without written authority, subpoena, or
other order of an appropriate court.
(i) Any application for a certificate of
self-insurance must identify or include as an attachment, a listing of the
excess coverage, specifying the insurance company, the policy or contract
number and the limits of liability and the retention amount. Each policy must
be properly endorsed to require a minimum of sixty (60) days prior notice to
the Director of any material changes, cancellation or nonrenewal, before the
existence of such coverage will be considered in determining the applicant's
financial ability to pay its workers' compensation claims. Any self-insured
employer must notify the Division of any change in the retention amount of
excess coverage within thirty (30) days after the effective date of the
change.
(j) The Director may
require, at his or her discretion, any other documents or reports as deemed
necessary to determine the financial condition of the self-insurance
applicant.
(5) Financial
Qualification Standards - To qualify for a certificate of authority to
self-insure, an applicant must furnish satisfactory proof of sufficient
financial resources to pay all workers' compensation claims and benefits and
costs for which it may become liable under the provisions of the Alabama
Workers' Compensation Act.
(a) An applicant
for a certificate of authority to self-insure, other than municipalities or
political subdivisions, must have a net worth of not less than $5,000,000, a
current assets to current liabilities ratio of at least 1.0, and a positive net
income for the past three years, shown on the submitted audited financial
statements. After applicant is approved for self-insurance, the applicant must
maintain a net worth of not less than $5,000,000, a current assets to current
liabilities ratio of at least 1.0, and a positive net income.
(b) Additionally, each five years after the
effective date of this amended rule, the minimum net worth requirement may be
adjusted for inflation by the annual cost of living as reflected by the U.S.
Department of Labor consumer price index.
(c) A self-insured entity that is operating
under an approved certificate of self-insurance prior to the effective date of
this amended rule is exempted from the increased net worth
requirement.
(d) A self-insured
must have and maintain specific excess insurance coverage for its workers'
compensation liability. The retention amount shall be $250,000 or greater.
Excess coverage must be underwritten by an insurance carrier properly licensed
or approved by the Alabama Department of Insurance to write workers'
compensation insurance. Reinsurance may not be substituted for excess coverage.
Upon request by the Director, a self-insured must identify or include as an
attachment a listing of the excess coverage, specifying the name of the
insurance company, the policy or contract number and the limits of liability
and the retention amount. Each policy must be properly endorsed to require a
minimum of sixty (60) days prior notice to the Director of any material
changes, cancellation or nonrenewal, before the existence of such coverage will
be considered in determining the applicant's financial ability to pay its
workers' compensation claims. Any self-insured employer must notify the
Division of any change in the retention amount of excess coverage within thirty
(30) days after the effective date of the change. A self-insured entity that is
operating under an approved certificate of self-insurance prior to the
effective date of this amended rule is exempted from the excess insurance
requirement.
(e) The amount of
excess insurance and the amount of coverage provided by the excess carrier will
be considered in determining an employer's financial ability to pay the claims
it incurs. and in determining the Guaranty Association security amount required
of the self-insured employer.
(6) Security Amount - Each self-insured
employer, other than municipalities and political subdivisions, shall maintain
security in an amount determined by the Director, in the form of membership in
the Alabama Workers' Compensation Self-Insurer's Guaranty Association. Public
utilities are eligible for membership in the Alabama Workers' Compensation
Self-Insurer's Guaranty Association or shall furnish and maintain security in
any amount determined by the Director in the form of a cash deposit with the
Alabama State Treasury or other approved securities.
(a) The Director shall determine the Guaranty
Association security amount for each employer authorized to operate as a
self-insured at the time of the issuance of the certificate, and the security
amount required of each self-insured employer will be reviewed throughout the
period during which the certificate remains in effect. The Guaranty Association
security amount shall be predicated on the self-insured's satisfactory proof to
the Department of the self-insurer's financial strength and ability to pay all
benefits and costs as required by the provisions of the Alabama Workers'
Compensation Act. The security amount required of any individual self-insurer
may be increased for good cause at the Director's discretion, at any
time.
(b) The minimum Guaranty
Association security amount required of each self-insured employer shall be an
amount which is deemed by the Director to be sufficient to pay any and all
workers' compensation claims which may reasonably be expected to be incurred
but in no event will it be less than the greater of the following:
1. The sum total of the two (2) highest years
of workers' compensation insurance premiums paid by the applicant during the
preceding three (3) years, or
2.
The sum total of the two (2) highest years of incurred workers' compensation
claims losses during the preceding three (3) years, or
3. The excess insurance retention amount,
or
4. $500,000.
(c) The Director may, for good
cause, at his or her discretion, require a self-insured entity to post an
additional security in the form of a cash deposit with the Alabama State
Treasury, or other security subject to the approval of the Director, to secure
the payment of workers' compensation claims in Alabama. Any additional security
would be in addition to the Guaranty Association security amount.
(d) Each five years after the effective date
of this amended rule, the minimum security of $500,000 stated herein, may be
adjusted for inflation by the annual increase in the cost of living as
reflected by the U.S. Department of Labor consumer price index.
(e) A self-insured entity that is operating
under an approved certificate of self-insurance prior to the effective date of
this amended rule is exempt from the $500,000 minimum security
amount.
(7)
Administration of Self-Insured Claims - Every self-insured employer shall
conduct the administration of its self-insured claims program through the
services of a competent administrator or administrative agency or company
located in Alabama. Upon a showing of good cause and upon proof of the
competency of the person, company or agency responsible for the administration
of the claims, the Director may, within his or her discretion, permit such
administration from locations outside Alabama. In the event that a change in
the administrative company or agency is desired, notice must be given to and
approved by the Director prior to the date on which the change is to occur.
Failure to notify the Director of the proposed change shall constitute good
cause for revocation of the certificate of self-insurance.
(a) Self-insured employers are required to
set reserves for claims in an amount deemed to be sufficient to pay any and all
claims expense which may reasonably be expected to be incurred. Those reserves
are to be independently verified by an independent actuary once every three (3)
years. The actuary's report must be submitted to the workers' compensation
division for review accompanied by a letter, signed by an officer of the
company, verifying that reserves have been set up in the liabilities section of
the balance sheet.
(b) The
actuarial report must verify the Alabama workers' compensation claims
liability, adequacy of loss reserves for incurred and IBNR claims.
(c) The Director may, for good cause, at any
time, at his or her discretion, require an independent actuarial verification
of the proper classification of workers and/or payroll to further ascertain the
adequacy of the claims reserves and claims liability.
(d) Failure to comply with this provision
shall be grounds for revocation of the certificate of self insurance at the
discretion of the Director.
(8) Reports - In addition to all reports
required by the Workers' Compensation Act, and required elsewhere in these
rules, each employer authorized to operate as a self-insurer must file with the
Division a loss summary for the year giving totals for compensation and medical
expenses paid during the year regardless of injury date and reserves, and a
copy of the most recent, certified, independently audited financial statement
with accompanying financial notes for the financial year then ended.
(a) The Director, or the designee of the
Director, or any contract designee of the Director, may, for good cause, at any
time, examine, review, audit, or inspect all books and records of any
self-insured or self insured applicant to determine the claims liability, the
workers' compensation claims paying ability, the financial condition in
relation to the claims paying ability, and to ascertain the workers'
compensation administrative trust fund assessment liability. Any self-insurer
that refuses to allow the Director, or his or her designee, to examine or audit
any books or records shall be subject to revocation of the certificate of
self-insurance, and to any other penalty allowed by law or regulation. Any
applicant for self-insurance who refuses to provide any reports or
documentation requested by the Director, or who refuses to allow the Director
or his or her designee to examine, inspect, or audit any books or records so
requested by the Director shall be denied a certificate of
self-insurance.
(b) All required
reports, documents or requested information must be received by the division no
later than ninety (90) days after the close of a self-insured's financial year.
A self-insured employer may ask for a ninety (90) day extension in which to
file a required report or document. Failure to submit a required report within
ninety (90) days after the close of the self-insured's financial year, or
within one hundred eighty (180) days if a ninety (90) day extension is granted,
will subject the self-insured entity to an administrative penalty of $50.00 per
day for each day the required report is late for a maximum of thirty (30) days,
at which time revocation proceedings will begin. This paragraph applies to all
current and future self-insured entities.
(9) Cancellation or Revocation of Authority
to Self-Insure: - The Director may revoke a certificate of self-insurance or
may deny an application for self-insurance for failure to comply with any
provision of this regulation, or for failure to comply with any other laws or
regulations, or for other good cause.
(a) The
Director may revoke the certificate of self-insurance for any self-insured that
fails to meet its workers' compensation claims obligations or for failure or
inability to pay its workers' compensation claims, or that is deemed to be
unable to pay its workers' compensation claims, or is otherwise deemed
insolvent.
(b) The Director may
revoke the certificate of self-insurance for failure to pay any Guaranty
Association fees, assessments, or security amounts, within the time
prescribed.
(c) The Director may
revoke the certificate of self-insurance for any self-insured that submits
false information regarding the workers' compensation administrative trust fund
assessment, or that hinders the Departments determination or verification of
the trust fund assessment amount, including the failure to file a first report
of injury.
(d) Any self- insured
employer who is required by these rules or who desires to have its authority to
self-insure cancelled, may do so by furnishing to the Director, at least thirty
(30) days prior to the proposed date on which the cancellation is to become
effective, notice of the desired action. Upon cancellation of self-insurance
status, an employer, if legally required to do so, must have and maintain
workers' compensation insurance in accordance with the Alabama workers'
compensation laws.
(e) The
authority to self-insure may be revoked by the Director for financial reasons
or for failure of the employer to faithfully discharge his obligations
according to the agreements contained in his application for authority to
self-insure, or for continued violations of these rules or the workers'
compensation laws or other regulations as prescribed by the Director in
accordance with Code of Ala. 1975, §
25-5-8(d) as last amended. Any such employer shall provide the Director with any and all
assistance, material and information, documentation or claims files or claims
information which may be reasonably required to enable the Director to
determine the total amount of claims liability, including IBNR claims, and
outstanding future liabilities incurred by the employer. The cancellation or
revocation of the authority to self-insure will be ineffective as to any claims
which were incurred by an employer during the period in which the Certificate
remained in effect.
(f) Upon
cancellation, voluntary or otherwise, or revocation of a self-insurance
certificate, any security held by the Director will continue to be held by the
director until all Alabama workers' compensation claims have been paid or
settled.
(10) Notice -
Any notice required to be given by these rules and regulations to the Director
shall be deemed proper if made in writing, addressed to Director, Department of
Industrial Relations, Workers' Compensation Division, Montgomery, Alabama,
36131. Any notice required by these rules and regulations to be given to a
self-insured employer shall be deemed properly given if in writing and
addressed to the employer at the address shown on either the application or the
last annual report.
Author: W. Scottie Spates, Workers' Compensation Director
Notes
Statutory Authority: Code of Ala. 1975, § 25-2-2(6)
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.