Ga. Comp. R. & Regs. R. 120-2-36-.06 - Insurers Required to Provide Statistics, Data and Information to Statistical Agent and Insured

(1) As a condition to continuing to transact insurance in the State of Georgia, every Insurer authorized to transact Worker's Compensation insurance shall provide to the authorized statistical agent worker's compensation data, statistics including loss ratios and all other relevant information. The foregoing shall be submitted in such a manner (including statistical plan and data collection procedures) as is required by the current statistical plan filed with and approved by the Commissioner by that authorized statistical agent.

(2) The Insurer shall verify with the Insured, the data to be submitted to the Statistical Agent who shall determine the experience modification factor. Verification of such data shall be accomplished in accordance with this regulation:

(a) The Insurer shall provide the Insured with a copy of the statistical data being submitted to the Statistical Agent. The statistical data shall be presented in a legible and understandable format. Technical terms shall be avoided wherever possible. It shall be permissible for the insurer to provide the unit statistical report, by whatever name called, in lieu of an independently created form, provided the unit statistical report is accompanied by a legible and understandable explanation of its format.

(b) The disclosure statement contained in Form GID-63 attached hereto and incorporated herein, or one substantially the same, shall be attached to the statistical data provided to the Insured.

1. The disclosure shall provide a statement in bold face type, to be signed by an authorized representative of the Insured, that the statistical data has been reviewed and is accurate, and a representative of the Insurer has explained to the Insured's representative that the statistical data may affect the Insured's premium for Georgia Workers' Compensation insurance.

2. The disclosure shall indicate that the statistical data will be deemed accurate if the disclosure is not returned to the address provided by the Insurer within 30 days from the date mailed.

(i) The Insurer shall deliver the statistical data and disclosure in person or by depositing the information in the United States mail to be dispatched by at least first-class mail to the last address of record of the Insured, and receiving the receipt provided by the United States Postal Service or such other evidence of mailing as prescribed or accepted by the United States Postal Service.

(ii) Statistical data that is deemed to be accurate will not in any way affect the right of the Insured to appeal to the Georgia Worker's Compensation Appeals Board.

3. The disclosure shall also provide a statement for an authorized representative of the Insured to dispute the accuracy of the data. The statement shall direct the Insured to clearly identify any discrepancies. The disputed data shall be furnished to the Insurer by the return date indicated on the disclosure statement.

(i) If the Insurer confirms the accuracy of the information provided by the Insured, the Insurer shall correct their records and proceed to furnish the amended data to the Statistical Agent.

(ii) If the Insurer does not agree with the data provided by the Insured, the Insurer shall submit the Insurer's data to the Statistical Agent.

(I) The Insurer shall notify the risk within 60 days of the original mail date that the experience modification factor will be promulgated from the information provided by the Insurer.

(II) The Insured shall be instructed, in detail, of their right to appeal to the Georgia Workers' Compensation Appeals Board.

(III) The Insurer's failure to respond to the Insured in the time prescribed shall be deemed an acknowledgement that the insured's records are accurate, and amendments are to be made before reporting the statistical data to the Statistical Agent.

(c) Verification of data shall not be mandatory for insured who are not eligible for experience rating, however, the data and explanation shall be furnished to insureds upon request.

Notes

Ga. Comp. R. & Regs. R. 120-2-36-.06

O.C.G.A. Secs. 33-2-9, 33-9-20, 33-9-21, 34-9-133, 33-24-47, 34-9-136.

Original Rule entitled "Insurers Required to Provide Statistics, Data and Information to Statistical Agent" was filed on December 1, 1983; effective January 1, 1984, as specified by the Agency. Repealed: New Rule entitled "Insurers Required to Provide Statistics, Data and Information to Statistical Agent and Insured" adopted. F. Aug. 10, 1993; eff. Aug. 30, 1993. Editor's Note: In accordance with O.C.G.A., Sec. 50-13-21, the content of this Rule is not filed with or published by the Secretary of State; only the name and designation is filed, printed, and distributed. This Regulation is on file in the Office of the Comptroller General and is open for public examination and copying. (See Editor's Note, p. 88.03.)