34 Pa. Code § 125.134 - Decision on application
(a) The
application of an applicant which meets the requirements of the act relating to
matters such as the number of homogeneous employers, aggregate net worth and
aggregate premium will be approved if the Bureau determines that the applicant
has demonstrated, with reasonable certainty, that it will meet the liabilities
incurred by its members under the act and the Occupational Disease Act. The
Bureau will include the following factors in assessing the applicant's ability
to meet those liabilities:
(1) The adequacy of
member contributions.
(2) The
applicant's plans for the establishment of surpluses to absorb matters such as
unexpected losses and uncollected contributions.
(3) The applicant's plans for member
assessments needed to maintain actuarially appropriate loss reserves.
(4) Restrictions on the payment of dividends
on surplus.
(5) The overall
financial ability of the members to satisfy their obligations to the
applicant.
(6) The applicant's
ability to control losses through the safety and loss control program
proposed.
(7) The excess insurance
coverage obtained by the fund, if any.
(8) The validity of the actuarial assumptions
used to predict the likely loss levels, if any.
(9) The liquidity and safety of the fund's
assets.
(10) The likely stability
of membership in the fund.
(11) The
adequacy of the trust agreement, bylaws and written policies.
(12) The degree to which the total risk of
the fund is spread among the members.
(b) If the Bureau's assessment under
subsection (a) is that the applicant can meet its obligations, it will send to
the applicant a preliminary approval notice of the application and a list of
conditions under subsection (d) that shall be met before the applicant may
operate as a fund.
(c) An applicant
has 60 days from the receipt of the preliminary approval notice to comply with
the conditions set forth by the Bureau. The applicant may toll the 60-day
compliance period by filing a request for a conference under subsection (f). An
applicant may be granted a 30-day extension to meet the conditions if the
applicant requests an extension in writing to the Bureau within the initial
60-day compliance period. The application of an applicant which does not meet
the conditions within the compliance period will be deemed withdrawn.
(d) The applicant will be issued a permit
which is effective no sooner than 15 days after the following has been filed
with the Bureau:
(1) The trust agreement and
bylaws as approved by the Bureau and executed by the members.
(2) Security in an amount as determined by
the Bureau, if any. This requirement does not apply to funds comprised
exclusively of political subdivisions.
(3) A certificate providing evidence of
excess insurance as required by the Bureau.
(4) Confirmation of the name and address of
the administrator, fiscal agent and of service companies the applicant will
use.
(5) Certification by the
administrator that each member has paid 25% of its annual contribution to the
fund.
(6) One or more fidelity
bonds to protect the fund against misappropriation or misuse of assets on a
form and in an amount approved by the Bureau. The fidelity bonds shall cover
the individuals and contractors who will handle fund assets or who will have
authority to gain access to fund assets, including trustees, the administrator,
the fiscal agent and the claims service company. The fiscal agent need not be
covered by a bond if it is a duly chartered commercial bank or trust
company.
(7) Documents relating to
other requirements set by the Bureau to protect the compensation rights of
employes of members.
(e)
If upon review of the pertinent data the Bureau finds that the applicant does
not meet the requirements of subsection (a), it will send to the applicant a
written preliminary denial notice of the application. The notice will state the
documents, evidence and other data received from the applicant or otherwise
reviewed or considered by the Bureau in reaching its preliminary
determination.
(f) The applicant
may request a conference with the Bureau upon receipt of the Bureau's
preliminary approval notice or denial notice. A conference request shall be
made in writing within 20 days after the receipt of the preliminary notice. At
the conference, the applicant may present additional evidence or data to
support its application or the alteration of the conditions required in the
preliminary approval notice. The applicant may present that information to the
Bureau in writing, or in person, or both.
(g) After a conference and the receipt of
written submissions, the Chief of the Self-Insurance Division of the Bureau
will promptly review the entire record of the applicant and will issue a
reconsideration decision on the application.
(h) An applicant shall have a right to appeal
a reconsideration decision issued under subsection (g) with the Bureau within
30 days of the receipt of the reconsideration decision. Untimely appeals will
be dismissed without further action by the Bureau. A hearing will be conducted
on the appeal as specified in §
125.154 (relating to
hearings).
Notes
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