Tenn. Comp. R. & Regs. 0780-01-81-.02 - DEFINITIONS

(1) "Affiliate" or "affiliated" means an entity or person who directly or indirectly through one or more intermediaries, controls or is controlled by, or is under common control with, a specified entity or person.

(2) "Commissioner" means the Commissioner of the Department of Commerce and Insurance.

(3) "Control" (including the terms "controlling," "controlled by" and "under common control with") means the possession, direct or indirect, of the power to direct and/or cause the direction of the management and/or policies of a person, whether through the ownership of voting securities, by contract other than a commercial contract for goods or non-management services, or otherwise, unless the power is the result of an official position with or corporate office held by the person. Control shall be presumed to exist if any person, directly or indirectly, owns, controls, holds with the power to vote, or holds proxies representing, ten percent (10%) or more of the voting securities of any other person. This presumption may be rebutted by a showing made in the manner provided by the Insurance Holding Company System Act, T.C.A. §§ 56-11-201, et seq., that control does not exist in fact. The Commissioner may determine, after furnishing all persons in interest notice and an opportunity to be heard and making specific findings of fact to support the determination, that control exists in fact, notwithstanding the absence of a presumption to that effect or the filing of a disclaimer in like manner to T.C.A. § 56-11-205(k).

(4) "Employer" means a single employer that is self-insuring their workers' compensation liabilities under T.C.A. § 50-6-405(a) pursuant to T.C.A. §§ 50-6-405(a) and (b).

(5) "GAAP" means United States generally accepted accounting principles consistently applied.

(6) "Insurance producer" means a person who sells, solicits or negotiates a contract of insurance as those terms are defined in this Rule.

(7) "Insurer" means a person undertaking to provide workers' compensation insurance coverage through a company requiring a certificate of authority issued pursuant to T.C.A. § 56-2-205.

(8) "NAIC" means the National Association of Insurance Commissioners.

(9) "Negotiate" means the act of conferring directly with or offering advice directly to a purchaser or prospective purchaser of a particular contract of insurance or plan of self-insurance concerning any of the substantive benefits, terms or conditions of the contract, provided that the person engaged in that act either sells insurance or obtains insurance coverage from insurers for the purchaser.

(10) "Person" means an individual or business entity.

(11) "Sell" means to exchange a contract of insurance or plan of self-insurance by any means, for money or its equivalent, on behalf of an insurer, employer, or pool.

(12) "Solicit" means attempting to sell insurance or a plan of self-insurance or asking or urging a person to apply for a particular kind of insurance or plan of self-insurance from a particular insurer, employer, or pool.

(13) "Third party administrator" means a person who directly or indirectly collects charges or premiums from, adjusts or settles claims, or provides loss control or account managing services in connection with workers' compensation insurance coverage offered or provided by a self-insured employer under T.C.A. §§ 50-6-405(a) and (b), or a self-insured pool under T.C.A. § 50-6-405(c), except any of the following:

(a) An insurance producer licensed to sell insurance coverage in this state, whose activities are limited exclusively to the sale of insurance;

(b) A person who adjusts or settles claims in the normal course of that person's practice or employment as an attorney at law and who does not collect charges or premiums in connection with workers' compensation insurance coverage;

(c) A person licensed as a managing general agent in this state, whose activities are limited exclusively to the scope of activities conveyed under such license;

(d) A self-insured employer under T.C.A. §§ 50-6-405(a) and (b), or a self-insured pool under T.C.A. § 50-6-405(c) which have been granted a certificate of authority by the Commissioner, as long as their activities are limited to their own self-insurance programs and do not perform such services for others;

(e) A third party administrator who is affiliated with an insurer, as defined in this Rule, and who only performs the contractual duties (between the third party administrator and the insurer) of a third party administrator for the direct and assumed insurance business of the affiliated insurer. The insurer is responsible for the acts of the third party administrator and is responsible for providing all of the third party administrator's books and records to the Commissioner, upon a request from the Commissioner;

(f) An employee of a licensed third party administrator who performs functions as part of their employment with the licensed third party administrator; and

(g) An administrator, as that term is used in Chapter 0780-01-54, appropriately licensed by the Commissioner that does not perform any of the acts set forth herein except the collection of premium or charges in connection with the workers' compensation coverage by the pool in which the person acts an administrator.

(h) A Tennessee licensed insurance company that performs services on behalf of a self-insured employer under T.C.A. §§ 50-6-405(a) and (b) or a self-insured pool under T.C.A. § 50-6-405(c).

(14) "Pool" means a self-insurance pool operating pursuant to T.C.A. § 50-6-405(c).

(15) "Workers' compensation benefits and/or insurance coverage" means the benefits intended to pay the liabilities that arise out of the requirements of T.C.A. § 50-6-405(a) for an employer's liability.

Notes

Tenn. Comp. R. & Regs. 0780-01-81-.02

Original rule filed September 12, 2005; effective November 26, 2005. Amendment filed October 13, 2008; effective December 27, 2008.

Authority: T.C.A. §§ 50-6-405(b), 50-6-405(c), 50-6-405(h), 56-6-101, et seq. and 56-6-501, et seq.