Md. Code Regs. 14.09.14.01-1 - Application
A. Application for
governmental group coverage for the express purpose of establishing a group
self-insurers' fund, to be administered under the direction of an elected board
of trustees, and to provide workers' compensation coverage for a group of
public employers of the same type of unit, shall be made to the Workers'
Compensation Commission.
B. The
application shall be made on a prescribed form and shall contain answers to all
questions and shall be accompanied by the application fee in the amount as may
be approved by the Commission from time to time.
C. Additional Requirements. The application,
as submitted by the initial board of trustees of self-insurers' fund, shall be
accompanied by all of the following:
(1) A
copy of the bylaws of the proposed group self-insurers' fund.
(2) An individual application of each member
of the group applying for coverage in the fund.
(3) A current financial statement and a
budget report that shows planned expenditures are funded.
(4) Evidence of the financial ability of the
group to meet its obligations under the Workers' Compensation Law.
(5) A composite listing of the estimated
standard premium to be developed by each member of the group individually and
in total as a group.
(6) Proof of
payment by each member of not less than 25 percent of the estimated annual
standard premium into a designated depository. For governmental entities, a
letter of intent signed by the responsible financial officer pledging payment
within 10 days of the approval of the fund by the Commission may constitute
proof of payment.
(7) A
confirmation of excess insurance by an authorized carrier in an acceptable
amount and which complies with the requirements in Regulation .07 of this
chapter.
(8) Designation of a
qualified employee or administrator of the association or group, or a qualified
service company with a copy of the signed service agreement.
(9) Designation of the initial board of
trustees.
(10) Proof of a fidelity
bond and errors and omissions policy in a form and amount acceptable to the
Commission.
(11) If required, a
surety bond written by an authorized carrier in an amount acceptable or other
acceptable security.
(12) A copy of
a trust and indemnity agreement which shall be subject to approval by the
Commission. The agreement shall contain a provision jointly and severally
binding the group and each member of it to comply with the provision of the
Workers' Compensation Law.
(13) A
breakdown of all projected administrative expenses for the fund year in an
amount and as a percentage of the annual standard premium collected.
(14) Proof, satisfactory to the Commission,
that the annual gross premiums of the fund will not be less than $500,000. The
premium collected from each member shall be computed by applying the
appropriate manual rates per payroll code classification and multiplying the
manual rate by an experience modification factor, if the modification factor is
applicable.
(15) Proof that the
fund has within its own organization ample facilities and competent personnel
to service its own program with respect to underwriting matters and industrial
safety engineering or shall contract with a qualified service company or
employer adjusters to provide these services. A qualified service company shall
be used to handle claims adjusting and reporting of loss
data.
Notes
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