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

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Employer Coverage Unit The Employer Coverage Unit consists of a team of six. This unit works with WV employers to insure that they are compliant with current workers’ compensation laws as they relate to requirements for coverage. The unit has three primary functions. The first function focuses on compliance. The unit verifies coverage for other agencies and governmental bodies. They also try to insure that all employers required to carry workers’ compensation comply with the law. This is done by extracting expired policy data provided by the National Council on Compensation Insurance (NCCI) and comparing to other agency information to determine if coverage is needed. If an employer is found to be noncompliant, the unit sets up a rogue account to assess the employer a fine. In 2009, the unit was responsible for setting up 1,738 of these accounts. These fines are related to WV Code 23-2C-8(d)(3) Workers’ Compensation Uninsured Employers Fund. Since the opening of the private market in July 2008, the unit also has taken on the task of carrier compliance with the Proof of Coverage (POC) system. Carriers that fail to report timely as required by the POC guidelines are maintained and reported to Regulatory Compliance for further review. The second primary function relates directly to the Uninsured Employers’ Fund. The unit serves as the entry point of contact for the processing of workers’ compensation claims filed by employees of WV employers who are uninsured. These claims are governed by Title 85 Series 8, The Workers’ Compensation Uninsured Employers’ Fund. This fund was established in order to provide a safety net for workers who are injured while working for an illegally operating employer. Once a claim is accepted into the Fund, the employer is responsible for reimbursement to the fund for all monies paid on their behalf. The third function is to review requests for exemptions from coverage from employers and make appropriate determination of exemption. State law does not require that exempt employers file an exemption but many do because of local governments, individuals or contractors requiring proof that an employer has coverage or meets the criteria for being exempt before they begin a job. In these cases, the Employer Coverage unit issues letters of exemption to employers to present verifying they are not required to carry workers’ compensation insurance under current law. This function relates directly to Title 85, Series 9 Workers’ Compensation Policies, Coverage Issues and Related Topics. In 2009, the Unit processed 2,938 exemption applications of which there were 2,269 exemptions granted. These exemptions were entered into the West Virginia Offices of the Insurance Commissioner’s Proof of Coverage (POC) system in order to include these employers for automated compliance purposes. In addition to being the public’s contact for coverage verification, the Unit is responsible for maintaining the POC system which is widely used for statutory coverage verification. The unit works hand in hand with the Revenue Recovery Unit and Regulatory Compliance to recognize and fine employers that are not carrying the mandatory coverage. Other major accomplishments of the unit in 2009 included working with the IT department to program and update some processes for a more timely assessment of fines. 50
OIC Employer Coverage Unit Employer Exemption Statistics Exemptions Current 12 - Month Period New Exemptions Issued Total Exemptions Issued Renewals Granted Jan-09 98 49 147 CY09 - YTD Feb-09 73 67 140 Total Exemptions Issued 2,269 Mar-09 105 123 228 Total Denials 669 Apr-09 112 123 235 Number of Applications Received 2,938 May-09 62 162 224 Jun-09 115 185 300 Jul-09 73 121 194 Aug-09 76 131 207 Sep-09 76 132 208 Oct-09 84 90 174 Nov-09 45 58 103 Dec-09 45 64 109 964 1,305 2,269 Employer Coverage YTD as of 12/31/09 Activity Total Compliance requests completed 2,564 Phone Calls 4,965 Walk-Ins 337 Uninsured Claims Received 41 DOL Reports Investigated 2,941 Rogue Account Set-ups 1,738 51
Page 1 and 2: West Virginia Offices of the Insura
Page 3 and 4: Executive Summary This report to th
Page 5 and 6: TABLE OF CONTENTS SECTION 1 GENERAL
Page 7 and 8: Admitted Assets, Liabilities, Commo
Page 9 and 10: Organizational Chart Virgil Helton,
Page 11 and 12: FEES AND TAXES COLLECTED DURING THE
Page 13 and 14: WEST VIRGINIA OFFICES OF THE INSURA
Page 15 and 16: APPROPRIATED APPROPRIATED EXPENDITU
Page 17 and 18: SECTION 2 DIVISIONAL REPORTS 17
Page 19 and 20: An applicant must be a resident of
Page 21 and 22: Major Activities in 2009 The Plan
Page 23 and 24: Agents Licensing and Education Divi
Page 25: Workers’ Compensation Board of Re
Page 28 and 29: The focused settlement initiative h
Page 30 and 31: October 2008 November 2008 December
Page 32 and 33: Offices of the Insurance Commission
Page 34 and 35: January 2009 February 2009 March 20
Page 36 and 37: Representing Consumers in First and
Page 38 and 39: FIRST PARTY COMPLAINTS HANDLED BY T
Page 40 and 41: CERTIFICATE OF NEED - March 2009 FA
Page 42 and 43: Hospital Rate Review The Office of
Page 44 and 45: Consumer Service Division The Consu
Page 46 and 47: CONSUMER SERVICE COMPLAINTS CALENDA
Page 48 and 49: CONSUMER SERVICE COMPLAINTS CALENDA
Page 52 and 53: Financial Accounting Unit The Finan
Page 54 and 55: Financial Conditions Division The p
Page 56 and 57: FINANCIAL CONDITIONS DIVISION West
Page 58 and 59: FINANCIAL CONDITIONS DIVISION West
Page 60 and 61: WEST VIRGINIA ESSENTIAL PROPERTY IN
Page 62 and 63: 2009 Summary of West Virginia Opera
Page 64 and 65: American Retirement Life Insurance
Page 66 and 67: ADP Totalsource, Inc. d/b/a ADP Tot
Page 68 and 69: FINANCIAL CONDITIONS DIVISION Merit
Page 70 and 71: FINANCIAL CONDITIONS DIVISION Compa
Page 78 and 79: FINANCIAL CONDITIONS DIVISION Risk
Page 92 and 93: National Health Club Purchasing Gro
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FINANCIAL CONDITIONS DIVISION Name
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ADA Risk Purchasing Group, Inc. (Am
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FINANCIAL CONDITIONS DIVISION Liqui
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Office of Inspector General—Fraud
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The following chart depicts statist
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James R. Hiroskey Jr., age 25 of Lo
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Ramona Mack, age 40 of Winfield, pl
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Jennifer Jo & Matthew Nichols, ages
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Senate Bill 284 - Relating to Viati
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Senate Bill 537 - Relating to Worke
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Senate Bill 537 -continued §33-2-2
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House Bill 3047 - Clarifying that t
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114 CSR 42 - Continuing Education f
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09-EO-03 - Emergency Order entered
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DISCIPLINARY ACTIONS Individual Ins
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Market Conduct Unit Four (4) “Agr
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Employer Violator System (EVS) The
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MANAGED HEALTH CARE PLANS: The West
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A Client Reporting process was deve
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Non-Workers’ Compensation Matters
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Rates and Forms Division The Rates
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2009 Filings by Product Commercial
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Approved Rate Change History of Top
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Private Passenger Auto Market Share
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2009 West Virginia Market Share Rep
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Total for Top 10 Insurers 76.87% $4
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Admitted Assets, Liabilities, Net W
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Admitted Assets, Liabilities, Commo
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Domestic Property Insurers Common P
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Admitted Assets, Liabilities, Capit
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Admitted Assets, Liabilities, Capit
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West Virginia Offices of the Insurance Commissioner 2009 Annual ...

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