Rates of Workers' Compensation Policies Issued to Business Entities With Majority Interest Held by the Same Person; Limitation on Maintenance of Reserves; Investigations of Complaints

  1. Law
  2. Georgia Code
  3. Insurance
  4. Regulation of Rates, Underwriting Rules, and Related Organizations
  5. Rates of Workers' Compensation Policies Issued to Business Entities With Majority Interest Held by the Same Person; Limitation on Maintenance of Reserves; Investigations of Complaints

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  1. An insurer shall not assign an adverse experience modification factor which is applicable to the rate of a workers' compensation insurance policy issued to a particular business entity to the rate of a workers' compensation policy issued to another business entity maintaining a separate payroll for federal and state tax purposes and engaging in a distinctly different business enterprise for the sole reason that the majority interest in both business entities is held by the same person.
  2. For experience rating purposes, no workers' compensation insurer shall maintain any case reserve for any claim in excess of the amount established by final judgment, by settlement, or otherwise. All reductions in case reserves shall be made and reported to the appropriate rating organization within 90 days. Any further adjustments upward in the case reserve shall only be made due to additional paid claims or a case reserve established on a claim which was previously closed but reopened due to a claimant's request for additional benefits. This limitation on the maintenance of reserves shall be enforced through this Code section, as well as through Code Section 33-9-21, relating to rate filings, Code Section 33-9-23, relating to examination of insurers, and any other appropriate enforcement procedures.
    1. The Commissioner shall cause an investigation to be made of each complaint filed by a licensee under this title or under Article 5 of Chapter 9 of Title 34 or a person acting for or on behalf of such licensee against an insurer or workers' compensation group self-insurance fund alleging that such insurer or fund is:
      1. Using an improper rate;
      2. Using an improper classification; or
      3. Using an improper experience modification in issuing a contract of workers' compensation insurance.
    2. If the Commissioner finds the complaint to be justified, in addition to all other appropriate action under this title, the Commissioner may assess the cost of such investigation against the insurer or workers' compensation group self-insurance fund and retain the proceeds therefrom for reimbursement of the cost of conducting such investigation.
    3. If the person making the complaint is a licensee under this title or under Article 5 of Chapter 9 of Title 34 or a person acting for or on behalf of such licensee and the Commissioner finds the complaint not to be justified, the Commissioner may, in addition to all other appropriate action under this title:
      1. Assess the reasonable verified cost of such investigation against such person and retain the proceeds therefrom for reimbursement of the cost of conducting such investigation; and
      2. If such person files six or more complaints the Commissioner finds not to be justified in any 12 month period, assess an administrative penalty not to exceed $2,000.00 for the sixth and each subsequent complaint found to be not justified.

(Code 1981, §33-9-40.1, enacted by Ga. L. 1992, p. 1286, § 1; Ga. L. 1996, p. 705, § 5; Ga. L. 1997, p. 927, § 1; Ga. L. 2009, p. 42, § 3/SB 76.)


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