By:  Cook of Colorado                                             H.B. No. 2095


A BILL TO BE ENTITLED
AN ACT
relating to provision of workers' compensation insurance coverage through a certified self-insurance group; providing penalties. BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: SECTION 1. Subtitle A, Title 5, Labor Code, is amended by adding Chapter 407A to read as follows:
CHAPTER 407A. GROUP SELF-INSURANCE COVERAGE
SUBCHAPTER A. GENERAL PROVISIONS
Sec. 407A.001. DEFINITIONS. (a) In this chapter: (1) "Administrator" means an individual, partnership, or corporation engaged by the board of trustees of a group to implement the policies established by the board of trustees and to provide day-to-day management of the group. (2) "Commissioner" means the commissioner of insurance. (3) "Department" means the Texas Department of Insurance. (4) "Group" means a workers' compensation self-insurance group that holds a certificate of approval under this chapter. (5) "Modified annual premium" means premium derived from standard premium adjusted by any advance schedule rating plan factors. (6) "Service company" means a person that provides services to the group other than services provided by the administrator, including: (A) claims adjustment; (B) safety engineering; (C) compilation of statistics and the preparation of premium, loss, and tax reports; (D) preparation of other required self-insurance reports; (E) development of members' assessments and fees; and (F) administration of a claim fund. (7) "Standard premium" means premium derived from the filed rates as adjusted by experience modification factors but before the application of any advance premium discounts. (b) For purposes of this chapter, when used as a modifier of "benefits," "liabilities," or "obligations," the term "workers' compensation" includes both workers' compensation and employers' liability. Sec. 407A.002. APPLICATION OF CHAPTER; ESTABLISHMENT OF PRIVATE GROUP. (a) An unincorporated association or business trust composed of five or more private employers may establish a workers' compensation self-insurance group under this chapter if the employers: (1) are engaged in the same or a similar type of business; (2) are members of a bona fide trade or professional association that has been in existence in this state for purposes other than insurance for at least five years before the establishment of the group; and (3) enter into agreements to pool their liabilities for workers' compensation benefits and employers' liability in this state. (b) This chapter does not apply to public employees or governmental entities. Sec. 407A.003. MERGER OF GROUPS. (a) Subject to the approval of the commissioner, a group may merge with another group engaged in the same or a similar type of business if the resulting group assumes in full all obligations of the merging groups. (b) The commissioner may conduct a hearing on a proposed merger and shall conduct a hearing if any party, including a member of either group, requests a hearing. Sec. 407A.004. GROUP NOT INSURER. A group issued a certificate of approval by the commissioner under this chapter is not: (1) an insurer based on that certificate; and (2) subject to the insurance laws and rules of this state except as otherwise provided by this chapter. Sec. 407A.005. CERTIFICATE OF APPROVAL REQUIRED. An association of employers may not act as a workers' compensation self-insurance group unless it has been issued a certificate of approval by the commissioner under this chapter. Sec. 407A.006. SERVICE OF PROCESS. (a) Each group shall be deemed to have appointed the commissioner as its attorney to receive service of legal process issued against the group in this state. (b) The appointment of the commissioner is irrevocable, binds any successor in interest, and remains in effect as long as any obligation or liability of the group for workers' compensation benefits exists in this state. Sec. 407A.007. HEARINGS. A hearing required under this chapter shall be conducted by the State Office of Administrative Hearings in the manner provided for a contested case under Chapter 2001, Government Code. Sec. 407A.008. RULES. The commissioner shall adopt rules as necessary to implement this chapter.
[Sections 407A.009-407A.050 reserved for expansion]
SUBCHAPTER B. APPLICATION REQUIREMENTS FOR
CERTIFICATE OF APPROVAL FOR SELF-INSURANCE GROUP
Sec. 407A.051. APPLICATION FOR INITIAL CERTIFICATE OF APPROVAL; APPROVAL REQUIREMENTS. (a) An association of employers that proposes to organize as a workers' compensation self-insurance group shall file with the department an application for a certificate of approval. (b) The application must be in the form prescribed by the commissioner and must include: (1) the name of the group; (2) the location of the group's principal office; (3) the date of organization of the group; (4) the name and address of each employer that is a member of the group; and (5) any other information reasonably required by the commissioner. (c) The application must be accompanied by: (1) a nonrefundable $1,000 filing fee; (2) proof of compliance with the financial requirements under Section 407A.053; (3) proof of compliance with the excess insurance requirements under Section 407A.054; (4) a copy of the articles of association or declaration of trust of the group, if any; (5) a copy of any agreements entered into with an administrator or a service company; (6) a copy of the bylaws of the proposed group; (7) a copy of the agreement between the group and each employer who is a member of the group that: (A) secures the payment of workers' compensation benefits; and (B) includes provisions for payment of assessments as provided by Section 407A.355; (8) designation of the initial board of trustees and administrator of the group; (9) the address in this state where the books and records of the group will be maintained at all times; (10) a pro forma financial statement, in a form acceptable to the commissioner, that shows the financial ability of the group to pay the workers' compensation obligations of the employers who are members of the group; (11) proof of one of the following: (A) payment to the group, or a bona fide promise to pay on approval of the group, by each employer who is a member of the group of not less than 25 percent of that member's first year estimated annual net premium on a date prescribed by the commissioner, which shall be considered part of the first year premium payment of each member; or (B) if the group is formed from a trust existing on September 1, 2003, that the assets of the trust are sufficient to cover the workers' compensation obligations of the trust; (12) a $250,000 performance bond for the administrator in the form prescribed by the commissioner; (13) a $250,000 performance bond for the service company in the form prescribed by the commissioner; and (14) an indemnity agreement that meets the requirements of Section 407A.056. (d) Not later than the 30th day after the effective date of the change, a group shall notify the commissioner of any change in: (1) the information required to be filed under Subsection (c); or (2) the manner of the group's compliance with Subsection (c). (e) The commissioner shall evaluate the financial information provided with the application as necessary to ensure that: (1) the funding is sufficient to cover expected losses and expenses; and (2) the funds necessary to pay workers' compensation benefits will be available on a timely basis. (f) Except as otherwise provided by this subsection, the commissioner shall act on a complete application for a certificate of approval not later than the 90th day after the date on which the application is filed with the department. If, because of the number of applications, the commissioner is unable to act on an application in a timely manner, the commissioner may extend the period for an additional 30 days. Sec. 407A.052. ISSUANCE OF CERTIFICATE OF APPROVAL; REFUSAL. (a) The commissioner shall issue a certificate of approval to a proposed group on finding that the group has met the requirements of this subchapter. (b) If the commissioner determines that a proposed group has not satisfied the requirements under this subchapter for a certificate of approval, the commissioner shall issue an order refusing the certificate. The order must set forth the reasons for the refusal. (c) On issuance of the certificate of approval, the group is authorized to provide workers' compensation benefits. Sec. 407A.053. FINANCIAL REQUIREMENTS. (a) To obtain an initial certificate of approval and to be eligible to renew its certificate of approval, each group shall comply with the financial requirements adopted under this section. (b) The combined net worth of all employers who are members of the group must be at least $1 million. A member of the group may not be required to submit an audited financial statement to establish the $1 million combined net worth, but the group must file a compiled report certified by a certified public accountant and based on financial statements or tax returns to support the existence of a combined net worth of at least $1 million for the initial group. In the case of a group composed of a trust existing on September 1, 2003, the trust may satisfy the financial requirements of this section by showing that the trust has participant surplus, including accrued participant dividends of at least $2 million, in lieu of the requirement of the $1 million combined net worth of its members. (c) The group must post security in the form and amount prescribed by the commissioner, not to exceed $200,000. The security may be provided by a surety bond, security deposit, financial security endorsement, or any combination of those securities. If a surety bond is used to meet the security requirement, the surety bond must be issued by a corporate surety company authorized to transact business in this state. If a security deposit is used to meet the security requirement, the following are acceptable securities: (1) a bond or other evidences of indebtedness issued, assumed, or guaranteed by the United States of America or by an agency or instrumentality of the United States of America; (2) certificates of deposit in a federally insured bank; (3) shares or savings deposits in a federally insured savings and loan association or credit union; (4) a bond or security issued by a state and backed by the full faith and credit of that state; (5) a financial security endorsement described by Subsection (e); (6) public securities described by Subsection (f); and (7) commercial paper payable in United States currency that is rated in one of the two highest credit rating categories by each rating agency. (d) Any securities posted must be deposited in the state treasury and must be assigned to and made negotiable by the executive director of the commission under a trust document acceptable to the commissioner. Interest accruing on a negotiable security deposited under this subsection shall be collected and transmitted to the depositor if the depositor is not in default. (e) A financial security endorsement that is issued as part of an acceptable contract for excess insurance coverage may be used to meet all or part of the security requirement in lieu of a security described under Subsection (c). A bond, security deposit, or financial security endorsement must be: (1) made for the benefit of the state, to be used solely to pay claims and associated expenses; and (2) payable on the failure of the group to pay workers' compensation benefits that it is legally obligated to pay. (f) Public securities may be used as security under this section if the public securities bear interest or are sold at a discount and are issued by any corporation, denominated in United States dollars. Sec. 407A.054. EXCESS INSURANCE REQUIREMENTS. (a) To obtain an initial certificate of approval and to be eligible to renew its certificate of approval, each group must comply with the excess insurance requirements adopted under this section. (b) Each group shall obtain specific excess insurance for losses that exceed the group's retention in a form prescribed by the commissioner. The commissioner may establish minimum requirements for the amount of specific excess insurance based on differences among groups in size, types of employment, years in existence, and other relevant factors. Sec. 407A.055. STANDARD PREMIUM REQUIREMENTS. Each group must have an estimated annual standard premium of at least $250,000 during the group's first year of operation. Thereafter, the annual standard premium must be at least $500,000. Sec. 407A.056. INDEMNITY AGREEMENT REQUIREMENTS. (a) An indemnity agreement filed under Section 407A.051 must jointly and severally bind the group and each employer who is a member of the group to meet the workers' compensation obligations of each member. (b) The indemnity agreement must be in the form prescribed by the commissioner and must include minimum uniform substantive provisions as prescribed by the commissioner. Subject to the commissioner's approval, a group may add other provisions necessary because of that group's particular circumstances. Sec. 407A.057. ADDITIONAL PERFORMANCE BOND REQUIREMENTS. In addition to the requirements under Section 407A.051, the commissioner may require a service company providing claim services to furnish a performance bond of $250,000 in the form prescribed by the commissioner.
[Sections 407A.058-407A.100 reserved for expansion]
SUBCHAPTER C. TERMINATION OF CERTIFICATE OF APPROVAL
Sec. 407A.101. CERTIFICATE OF APPROVAL; TERMINATION. (a) A certificate of approval remains in effect until terminated at the request of the group or revoked by the commissioner. (b) The commissioner may not grant the request of any group to terminate its certificate of approval unless the group has insured or reinsured all incurred workers' compensation obligations with an authorized insurer under an agreement filed with and approved in writing by the commissioner. For purposes of this subsection, those obligations include: (1) known claims and expenses associated with those claims; and (2) incurred but not reported claims and expenses associated with those claims.
[Sections 407A.102-407A.150 reserved for expansion]
SUBCHAPTER D. BOARD OF TRUSTEES
Sec. 407A.151. BOARD MEMBERSHIP. (a) Each group shall be operated by a board of trustees composed of at least five persons whom the members of the group elect for stated terms of office. The trustees must be employees, officers, or directors of employers who are members of the group. Each board member shall be a resident of this state or an officer of a corporation authorized to do business in this state. (b) An administrator or service company of the group, or owner, officer, employee of, or any other person affiliated with the administrator or service company, may not serve on the board of trustees. Sec. 407A.152. BOARD GENERAL POWERS AND DUTIES. The board of trustees shall: (1) maintain minutes of its meetings and make the minutes available to the commissioner; (2) designate an administrator and delineate in the written minutes of its meetings the areas of authority it delegates to the administrator; and (3) retain an independent certified public accountant to audit the financial statements required by Section 407A.251. Sec. 407A.153. PROHIBITED ACTIVITIES. The board of trustees may not: (1) extend credit to individual members for payment of a premium, except under payment plans approved by the commissioner; or (2) without first advising the commissioner of the nature and purpose of the loan and obtaining prior approval from the commissioner, borrow any money from the group or in the name of the group except in the ordinary course of business. Sec. 407A.154. GROUP FUNDS. The board of trustees shall maintain responsibility for all money collected or disbursed from the group.
[Sections 407A.155-407A.200 reserved for expansion]
SUBCHAPTER E. GROUP MEMBERSHIP; TERMINATION; LIABILITY
Sec. 407A.201. ADMISSION OF EMPLOYER AS MEMBER. (a) An employer who joins an approved workers' compensation self-insurance group shall: (1) submit an application for membership to the board of trustees or its administrator; and (2) enter into the indemnity agreement as required by Section 407A.056. (b) The board of trustees shall maintain as a permanent record the employer's application for membership and the approval of the application. (c) The membership of an individual member of a group is subject to cancellation by the group as provided by the bylaws of the group. An individual member may also elect to terminate participation in the group. The group shall notify the commissioner and the commission of the cancellation or termination of a membership not later than the 10th day after the date on which the cancellation or termination takes effect and shall maintain coverage of each canceled or terminated member until the 30th day after the date of the notice, at the terminating member's expense, unless before that date the commission notifies the group that the canceled or terminated member has: (1) obtained workers' compensation insurance coverage; (2) become a certified self-insurer; or (3) become a member of another group. (d) The group shall pay each workers' compensation claim for which a member of the group incurs liability during the period of membership. A member who elects to terminate membership or whose membership is canceled by the group remains jointly and severally liable for the workers' compensation obligations of the group and its members incurred during the canceled or terminated member's period of membership. (e) A member of a group is not relieved of workers' compensation liabilities incurred during its period of membership except through payment by the group or the member of required workers' compensation benefits. (f) The insolvency or bankruptcy of a member does not relieve a group or any other member of the group of liability for the payment of any workers' compensation benefits incurred during the insolvent or bankrupt member's period of membership.
[Sections 407A.202-407A.250 reserved for expansion]
SUBCHAPTER F. EXAMINATIONS, FINANCIAL STATEMENTS, AND OTHER REPORTS
Sec. 407A.251. FINANCIAL STATEMENT. (a) Each group shall submit to the commissioner financial statements audited by an independent certified public accountant on or before the last day of the sixth month following the end of the group's fiscal year. (b) The financial statement must include a balance sheet, income statement, and statement of cash flow and must be prepared on the basis of accounting principles generally accepted in the United States. (c) The actuarial opinion required by this section must be given by a member of the American Academy of Actuaries or another qualified loss reserve specialist, as defined in the annual statement adopted by the National Association of Insurance Commissioners. Sec. 407A.252. EXAMINATION. (a) The commissioner may examine the financial condition of each group to determine the group's ability to meet the group's obligations under this subtitle. The commissioner may not examine a group more frequently than once every three years unless the commissioner determines that the group: (1) is in an impaired financial condition; or (2) otherwise may not be able to continue to meet the group's obligations under this subtitle. (b) The commissioner has full access to the records, officers, agents, and employees of a group as necessary to complete an examination under this section.
[Sections 407A.253-407A.300 reserved for expansion]
SUBCHAPTER G. TAXES, FEES, AND ASSESSMENTS
Sec. 407A.301. MAINTENANCE TAX FOR COMMISSION. (a) Each group shall pay a self-insurance group maintenance tax under this section for: (1) the administration of the commission; and (2) the prosecution of workers' compensation insurance fraud in this state. (b) The tax liability of a group under this section is based on gross premium for the group's retention multiplied by the rate assessed insurance carriers under Sections 403.002 and 403.003. The tax under this section does not apply to premium collected by the group for excess insurance. Sec. 407A.302. MAINTENANCE TAX FOR DEPARTMENT. (a) Each group shall pay a self-insurance group maintenance tax under this section for the administrative costs incurred by the department in implementing this chapter. (b) The tax liability of a group under this section is based on gross premium for the group's retention and does not include premium collected by the group for excess insurance. (c) The maintenance tax assessed under this section is subject to Article 5.68, Insurance Code, and shall be collected by the comptroller in the manner provided by that article. Sec. 407A.303. COLLECTION AND PAYMENT OF TAXES. (a) The taxes imposed under Section 407A.301 are due on the 60th day after the date of the issuance of a certificate of approval and on the 60th day after each anniversary of the date of certificate of approval. (b) The commission shall compute the taxes due under Section 407A.301 and notify the group of the amounts due. The group shall remit the taxes to the commission for deposit in the state treasury to the credit of the commission. (c) A group commits a violation if the group does not pay the taxes imposed under Sections 407A.301 and 407A.302 in a timely manner. A violation under this subsection is a Class B administrative violation. Each day of noncompliance constitutes a separate violation. (d) If the certificate of approval of a group is terminated, the commissioner or the executive director of the commission shall immediately notify the comptroller to collect taxes as directed under Sections 407A.301 and 407A.302. Sec. 407A.304. PREMIUM TAX. (a) Each group shall pay to the comptroller a premium tax on gross premiums for the group's retention. The premium tax assessed under this subsection does not apply to premium collected for excess insurance. (b) The rate for the premium tax under this section is the rate assessed under Article 4.10, Insurance Code.
[Sections 407A.305-407A.350 reserved for expansion]
SUBCHAPTER H. RATES; REFUNDS; PREMIUM PAYMENTS; RESERVES; DEFICITS
Sec. 407A.351. RATES. (a) Except as provided by Subsection (b), each group shall use the uniform classification system, experience rating plan, and rate relativities of the department. (b) A group may: (1) use the relativities promulgated by the department modified to produce rates in accordance with the group's historical experience; or (2) file its own rates with the department, including any reasonable and supporting information required by the commissioner. (c) As approved by the commissioner, a group may use rating debits or credits and optional rating plans. (d) Rates of the group may not be excessive, inadequate, or unfairly discriminatory. Sec. 407A.352. AUDITS. Each member of a group shall be audited annually by the administrator or by an auditor acceptable to the commissioner to verify proper classifications, experience rating, payroll, and rates. The group shall maintain a record of the audit as part of the group's records that are available to the commissioner during an examination conducted under Section 407A.252. The audit shall be performed at the expense of the group. Sec. 407A.353. REFUNDS. (a) The board of trustees may declare refundable any money for a fund year in excess of the amount necessary to fund all obligations. (b) The board of trustees shall give each member a written description of the group's refund plan at the time of application for membership. Sec. 407A.354. PREMIUM PAYMENT PLAN; RESERVES. (a) Until the assets of a group reach a level sufficient to cover the group's liabilities, each group shall establish to the satisfaction of the commissioner a premium payment plan. (b) As long as the assets of the group remain sufficient to cover the group's liabilities, the group may determine its own premium plan if the premium plan is disclosed to each member at the time of application and is filed with the commissioner. (c) Each group shall establish and maintain actuarially appropriate loss reserves, which must include reserves for: (1) known claims and expenses associated with those claims; and (2) claims incurred but not reported and expenses associated with those claims. (d) Each group shall establish and maintain bad debt reserves based on the historical experience of the group or of other groups composed of similar employer members. Sec. 407A.355. DEFICITS; INSOLVENCIES. (a) For purposes of this section, "insolvent" means the inability of a group to pay the group's outstanding lawful obligations as they mature in the regular course of business. (b) If the assets of a group are at any time insufficient to enable the group to discharge its legal liabilities and other obligations and to maintain the reserves required under this chapter, the group shall make up the deficiency or levy an assessment on its members for the amount needed to make up the deficiency. (c) In the event of a deficiency in any fund year, the deficiency shall be made up immediately from: (1) surplus from a fund year other than the current fund year; (2) administrative funds; (3) assessments of the membership, if ordered by the group; or (4) any alternate method that the commissioner approves or directs. (d) The commissioner shall be notified before any transfer of surplus funds from one fund year to another under Subsection (c). (e) If the group fails to assess its members or to otherwise make up a deficit, the commissioner shall order the group to do so. If the commissioner determines that the group is in a hazardous financial condition, the commissioner may order the group to rectify the condition through an alternate method under Subsection (c)(4). (f) If the group fails to make the required assessment of its members after the commissioner's order under Subsection (e), or if the deficiency is not fully made up, the group shall be deemed to be insolvent. (g) If a group is liquidated, the commissioner shall secure release of the security deposit and levy an assessment on the members of the group in an amount determined necessary by the commissioner to discharge all liabilities of the group, including the reasonable cost of liquidation.
[Sections 407A.356-407A.400 reserved for expansion]
SUBCHAPTER I. DISCIPLINARY ACTIONS; PENALTIES
Sec. 407A.401. PROHIBITED SOLICITATION. In connection with the solicitation of membership in a group, a person may not make an untrue statement of a material fact, or omit to state a material fact necessary to make the statement made, in light of the circumstances under which it is made, not misleading. Sec. 407A.402. FINES. After notice and an opportunity for a hearing, the commissioner may impose a fine on any person or group found to be in violation of this chapter or a rule adopted under this chapter. A fine assessed under this section may not exceed $1,000 for each act or violation and may not exceed $10,000 in the aggregate. The amount of any fine assessed under this section shall be paid to the commissioner and deposited in the state treasury. Sec. 407A.403. CEASE AND DESIST ORDERS. (a) After notice and an opportunity for a hearing, the commissioner may issue an order requiring a person or group to cease and desist from engaging in an act or practice found to be in violation of this chapter or a rule adopted under this chapter. (b) On a finding, after notice and opportunity for a hearing, that a person or group has violated a cease and desist order issued under this section, the commissioner may: (1) impose a fine not to exceed $1,000 for each violation of the order, not to exceed an aggregate fine of $100,000; (2) revoke the group's certificate of approval or any license held by the person issued under the Insurance Code; or (3) impose the fine and revoke the certificate or license. Sec. 407A.404. REVOCATION OF CERTIFICATE OF APPROVAL. (a) After notice and an opportunity for a hearing, the commissioner may revoke a group's certificate of approval if the group: (1) is found to be insolvent; (2) fails to pay a tax, assessment, or special fund contribution imposed on the group; or (3) fails to comply in a timely manner with this chapter, a rule adopted under this chapter, or an order of the commissioner. (b) In addition, the commissioner may revoke a group's certificate of approval if, after notice and an opportunity for hearing, the commissioner determines that: (1) a certificate of approval issued to the group was obtained by fraud; (2) there was a material misrepresentation in the application for the certificate of approval; or (3) the group or its administrator has misappropriated, converted, illegally withheld, or refused to pay on proper demand any money that belongs to a member, an employee of a member, or a person otherwise entitled to the money and that has been entrusted to the group or its administrator in their fiduciary capacities. SECTION 2. Section 401.011(27), Labor Code, is amended to read as follows: (27) "Insurance carrier" means: (A) an insurance company; (B) a certified self-insurer for workers' compensation insurance; [or] (C) a certified self-insurance group under Chapter 407A; or (D) a governmental entity that self-insures, either individually or collectively. SECTION 3. (a) Except as provided by Subsection (b) of this section, this Act takes effect September 1, 2003. (b) A workers' compensation self-insurance group created under Chapter 407A, Labor Code, as added by this Act, that is issued a certificate of approval by the commissioner of insurance under that chapter, may offer workers' compensation insurance coverage beginning January 1, 2004. Chapter 407A, Labor Code, as added by this Act, applies only to a claim for workers' compensation benefits based on a compensable injury that occurs on or after January 1, 2004. A claim based on a compensable injury that occurs before that date is governed by the law in effect on the date that the compensable injury occurred, and the former law is continued in effect for that purpose.