West Virginia Offices of the Insurance Commissioner 2009 Annual ...
West Virginia Offices of the Insurance Commissioner 2009 Annual ...
West Virginia Offices of the Insurance Commissioner 2009 Annual ...
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85 CSR 9 - Workers’ Compensation Uninsured Employers’ Fund (“UEF”) (amended rule effective<br />
November 8, <strong>2009</strong>)<br />
The rule was amended for <strong>the</strong> purpose <strong>of</strong> addressing changes made to W. Va. Code §§23-2A-1<br />
and 23-2C-17 by Senate Bill 537 (passed April 11, <strong>2009</strong>; effective July 10, <strong>2009</strong>), pertaining to<br />
subrogation and <strong>the</strong> decision appeals process.<br />
Regarding subrogation, changes were made to section 5 <strong>of</strong> <strong>the</strong> rule to reflect changes in <strong>the</strong> law<br />
by <strong>the</strong> Legislature to clarify that <strong>the</strong> Commission may pursue subrogation against third-party lawsuits<br />
brought by <strong>the</strong> claimant for all amounts paid to date or paid in <strong>the</strong> future. Also, <strong>the</strong> Code was unclear<br />
as to whe<strong>the</strong>r <strong>the</strong> claimant had to first bring a suit against <strong>the</strong> third-party or if <strong>the</strong> UEF could bring suit<br />
separately. The amendments to W. Va. Code §23-2A-1 clarified that <strong>the</strong> claimant must first bring suit.<br />
Regarding <strong>the</strong> appeals process, previously, <strong>the</strong> Legislature amended W. Va. Code §23-2C-8 to<br />
give <strong>the</strong> Workers’ Compensation Office <strong>of</strong> Judges (“OOJ”) jurisdiction to hear all decisions regarding<br />
<strong>the</strong> UEF. (Previously, <strong>the</strong> OOJ had no jurisdiction to hear protests regarding <strong>the</strong> WV <strong>Offices</strong> <strong>of</strong> <strong>the</strong><br />
<strong>Insurance</strong> <strong>Commissioner</strong>’s initial decision to accept or not accept a claim into <strong>the</strong> UEF). Changes were<br />
made to section 4 <strong>of</strong> <strong>the</strong> rule to reflect <strong>the</strong>se changes in <strong>the</strong> law.<br />
85 CSR 32 - State Agency Revocation Or Refusal To Grant, Issue Or Renew Contracts, Licenses,<br />
Permits, Certificates Or O<strong>the</strong>r Authority To Conduct A Trade, Pr<strong>of</strong>ession Or Business To Or With<br />
An Employing Unit In Default Of Its Workers’ Compensation Obligations (amended rule effective<br />
November 8, <strong>2009</strong>)<br />
The rule was amended for <strong>the</strong> purpose <strong>of</strong> updating <strong>the</strong> rule with certain procedural, stylistic and<br />
technical changes to reflect <strong>the</strong> workers’ compensation regulatory transition from <strong>the</strong> former Workers’<br />
Compensation Commission to <strong>the</strong> <strong>West</strong> <strong>Virginia</strong> <strong>Offices</strong> <strong>of</strong> <strong>the</strong> <strong>Insurance</strong> <strong>Commissioner</strong>. This<br />
amended rule sets forth certain processes and procedures applicable to <strong>the</strong> obligation <strong>of</strong> o<strong>the</strong>r <strong>West</strong><br />
<strong>Virginia</strong> state agencies to revoke licenses, permits, certificates, etc., <strong>of</strong> businesses who are in default<br />
status regarding workers’ compensation.<br />
The following Title 114 insurance related legislative rules (authorized for promulgation by Senate Bill<br />
227) became effective in <strong>2009</strong>:<br />
114 CSR 32 - Long-Term Care (“LTC”) (amended rule effective July 1, <strong>2009</strong>)<br />
This major revision was made to conform <strong>the</strong> rule to <strong>the</strong> NAIC’s 2006 amendments to its<br />
Model Regulation 641. As amended, <strong>the</strong> rule provides a comprehensive scheme for regulating LTC<br />
insurance by adding provisions to address <strong>the</strong> following: Unintentional lapses; required disclosure <strong>of</strong><br />
rating practices; initial filing requirements; premium rate schedule increases; notice to <strong>the</strong> policyholder<br />
<strong>of</strong> <strong>the</strong> availability <strong>of</strong> new services or providers; right to reduce coverage and lower premium; and<br />
standards for benefit triggers. The amendments also change <strong>the</strong> reporting requirements imposed on<br />
insurers, adopts new loss ratio standards, and changes <strong>the</strong> standards for marketing. The existing<br />
section governing insurers’ efforts to determine <strong>the</strong> appropriateness <strong>of</strong> <strong>the</strong> recommended purchase or<br />
replacement is greatly expanded.<br />
114 CSR 41 - Actuarial Opinion and Memorandum Rule (amended rule effective May 14, <strong>2009</strong>)<br />
The amendments to this rule, which mirror <strong>the</strong> changes in 2001 by <strong>the</strong> NAIC to its actuarial<br />
opinions model, were needed to maintain <strong>the</strong> NAIC accreditation that permits <strong>West</strong> <strong>Virginia</strong>’s<br />
financial examinations to be accepted in o<strong>the</strong>r accredited states.<br />
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