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Review Requirements Checklist - Workers' Compensation

Updated 10/06/2015 - Return to Index

Indicates new addition since last update.Indicates new addition since last update.

Workers' Compensation Checklist
REVIEW REQUIREMENTS REFERENCE COMMENTS
Filing Standards
Prior Approval for Non-Standard Endorsements §2052.002, Texas Insurance Code Policy form and standard endorsements are adopted by the Commissioner. Insurance companies must get prior approval in order to use a non-standard endorsement or a non-standard form.
FORMS
Cancellation & Nonrenewal
30-day Notice of Cancellation & Nonrenewal §406.008, Texas Labor Code Policyholder must receive at least 30 days notice of cancellation or nonrenewal sent by certified mail if policy is cancelled for any reason other than the reasons set forth under the 10-day notice requirement.
10-day Notice of Cancellation & Nonrenewal §406.008, Texas Labor Code Policyholder must receive at least 10 days notice of cancellation or non-renewal, sent by certified mail, if policy is cancelled for one of these reasons: (1) fraud in obtaining coverage; (2) misrepresentation of payroll used in calculating premium; (3) failure to pay premium when due; (4) an increase in the hazard of the policyholder that would cause the rates to increase; (5) a determination made by the Commissioner that continuation of the policy would place the insurer in violation of the law or would be hazardous to the interest of subscribers, creditors or the general public.
Policy
Policy Language Promulgated by Commissioner §2052.002, Texas Insurance Code Form WC 00 00 00 A and WC 00 00 01 (Information Page) adopted by the Commissioner and is required to be used for all Texas workers' compensation policies. Specimen copies of the standard policy are not required to be filed for approval. Insurance companies are required to use the policy language as adopted by the Commissioner.
Endorsements/Forms (Standard) §2052.002, Texas Insurance Code Indicates new addition since last update.The standard WC policy, endorsements and forms are published in NCCI's Forms Manual. Insurance companies are required to use these forms as adopted by the Commissioner.
Endorsements/Forms (Non-Standard) §2052.002, Texas Insurance Code Insurance companies must file for prior approval any WC endorsement to be used on a Texas workers' compensation policy that is not one of the standard endorsements adopted by the Commissioner.
Endorsements/Negotiated Deductible Chapter 2053, Subchapter E and §2052.002, Texas Insurance Code Indicates new addition since last update.Insurance companies desiring to write workers' compensation policies with negotiated deductibles must file an endorsement for approval as no standard endorsement is adopted. The terms of the company specific endorsement cannot be in conflict with the Texas Miscellaneous rules set forth in NCCI's Basic Manual with Texas Exceptions. Negotiated deductibles cannot be written until notice of TDI approval is received by the insurance company.
Toll Free Information
Notice of Toll-Free Telephone Numbers and Information about Complaint Procedures 28 TAC 1.601, Texas Administrative Code To satisfy requirements for §521.005 and §§521.101 - 521.103 noted above.
Toll-Free Information & Complaint Number §521.005, Texas Insurance Code Insurance companies are required to provide with every policy an information bulletin that includes the toll-free telephone number of the Texas Department of Insurance and a description of the services offered through the number. Specimen bulletin does not have to be submitted.
Insurer's Toll-Free Number and Complaint Filing Information §§521.101 - 521.103, Texas Insurance Code Insurance companies are required to maintain a toll-free number to provide information concerning policies issued by the insurer and to accept complaints from policyholders.
MANUAL RULES
Promulgated Article 5.96, Texas Insurance Code Indicates new addition since last update.Insurance company specific rules are not accepted for workers' compensation in Texas. NCCI's Basic Manual with Texas Exceptions, as adopted by the Commissioner, contains rules that pertain to policy issuance, premium determination, and the uniform classification system. NCCI's Experience Rating Plan with Texas Exceptions contains the uniform experience rating plan. The Texas section of NCCI's Forms Manual contains the standard policy, endorsements and forms.
RATES
Pricing
Rates - File and Use Chapter 2053, Subchapter A & §2053.051, Texas Insurance Code Rates may not be excessive, inadequate or unfairly discriminatory. Insurance companies must either adopt the workers' compensation classification relativities as adopted by the Commissioner or must file their own rates. In addition, insurance companies must file any deviation to be applied to the relativities and/or rates along with justification for the deviation. The relativity and/or rate after deviation is applied becomes the filed rate to be charged in writing Texas workers' compensation insurance.
Schedule Rating Plan - File and Use Chapter 2053, Subchapter A & §2053.051, Texas Insurance Code Insurance companies must file the range of percentages that will be given in schedule rating debts or credits. In addition, the insurance companies must file criteria and applicable percentage to be considered for each category used to determine the amount of schedule rating for policyholders.
Rating Plan Requirements
Experience Rating Plan §2053.052, Texas Insurance Code Insurance companies are required to use the experience rating plan adopted by the Commissioner. The law requires that TDI adopt a uniform experience rating plan.
Retrospective Rating Plan Article 5.77, Texas Insurance Code Insurance companies are required to use the retrospective rating plan adopted by the Commissioner, unless approval has been given by the Commissioner for another plan to be used.


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Last updated: 10/08/2015

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