West Virginia Offices of the Insurance Commissioner 2009 Annual ...

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