N.Y. Comp. Codes R. & Regs. tit. 12 § 317.2

Current through Register Vol. 46, No. 43, October 23, 2024

Section 317.2 - Definitions

For purposes of these rules:

(a) American institution, shall mean an institution created or existing under the laws of the United States of America or of any State, district or territory thereof.

(b) Board of trustees, shall mean that body, identified in the trust agreement, which is responsible for all operations of the group self-insurer and which shall take all necessary action to protect the assets of the group self-insurer.

(c) Claims shall mean, for purposes of financial reporting and determining trust liabilities, the present value of all workers' compensation claims, including those incurred but not reported, and the expenses associated therewith which the group is obliged to settle and adjust. Such claims must be determined on an actuarial basis and may be discounted at a reasonable rate. The board may reject discount rates considered to be unreasonable. Claims may be variously referred to as claim reserves, loss reserves or reserves for loss and loss adjustment expenses in group self-insurers' financial statements and actuarial reports.

(d) Claims administrator or third party administrator shall mean an individual or entity licensed by the Workers' Compensation Board pursuant to subdivision (3-b) or (3-d) of section 50 of the Workers' Compensation Law which is responsible for the administration and defense of workers' compensation claims of members of an authorized group self-insurer.

(e) Contribution shall mean the annual charge to individual members of a group self-insurer to cover its workers' compensation liabilities and assessments.

(f) Excess insurance shall mean insurance, purchased from an insurance company authorized by the superintendent of insurance, which reduces the exposure of the group self-insurer:

(1) for workers' compensation claims; and

(2) for employers' liability.

Such excess insurance may be specific, aggregate or other insurance, singly or in combination, in amounts and form acceptable to the chair.

(g) Group administrator shall mean an individual or entity that is responsible for ensuring compliance with the provisions of these rules and the coordination of outside services including but not limited to claims processing, loss control and legal, accounting, and actuarial services.

(h) Group member or employer shall mean an individual employer that is participating in a group self insurance arrangement in accordance with subdivision (3-a) of section 50 of the Workers' Compensation Law.

(i) Group self-insurer, employer group, group, or self-insurance trust, shall mean an association of employers performing related activities in a given industry that contractually agree, in accordance with section 50 (3-a) of the Workers' Compensation Law, to assume the workers' compensation liabilities of each associated member.

(j) Marketing materials shall mean any financial statement, pamphlet, circular, graphic, form letter, sales literature, advertising or other communication, whether written, recorded, electronic or verbal, intended for or directed to current or prospective members of the group self insurer.

(k) Municipal corporation, shall mean a county, town, city, village, school district (except a school district in a city with a population of 125,000 or more), board of cooperative educational services, fire district, a district corporation or a special improvement district governed by a separate board of commissioners.

(l) Related activities in a given industry, as described in section 317.3(a) of this Part, shall mean that there exists a homogeneity in the nature of the group members' business activities.

(m) Trust account or trust fund shall mean a trust account or fund, financed by the contributions of and assessments on members of a group self-insurer, for the exclusive purpose of paying for and otherwise administering workers' compensation liabilities incurred by members of the group self-insurer.

(n) Trust assets shall mean cash and deposits in a bank or trust company insured under the provisions of the Federal Deposit Insurance Act or investments permitted pursuant to section 317.8(c) of this Part. For purposes of these rules, assets shall not include fixed assets nor shall they include the security posted by the group self-insurer under section 317.5 of this Part.

(o) Trust liabilities shall mean all claims, accrued Workers' Compensation Board assessments, accrued expenses including administrative costs, costs of excess insurance policies, and other fixed costs, accounts payable, loans, bonds and notes payable, unearned contributions and all other trust obligations.

(p) Qualified actuary shall mean an individual who:

(1) is a member in good standing of the Casualty Actuarial Society;

(2) is a member in good standing of the American Academy of Actuaries who has been approved as qualified for signing casualty loss reserve opinions by the Casualty Practice Council of the American Academy of Actuaries; or

(3) satisfies the requirements of 11 NYCRR 95.5(d).

(q) Termination shall mean:

(1) such action taken by a group self-insurer to remove a group member from participation in the group; or

(2) the cessation of a group's status as a self-insurance trust.

(r) Withdrawal shall mean such action taken by a group member to remove itself from a group self-insurer.

N.Y. Comp. Codes R. & Regs. Tit. 12 § 317.2