Texas Workers' Compensation

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§ 166.3. Annual Information Submitted by Insurance Companies

(a) Initial annual report by insurance company.

(1) Not later than April 1, 2014, each insurance company writing workers’ compensation insurance in Texas as of the effective date of this section shall file with the division an initial annual report on its accident prevention services. An insurance company that writes its first workers’ compensation insurance policy after the effective date of this section shall file with the division an initial annual report on its accident prevention services not later than the effective date of its first workers’ compensation insurance policy.

(2) An initial annual report required by this subsection shall be filed in the format and manner prescribed by the division and shall include:

(A) insurance company’s name;

(B) group name;

(C) name, email, phone number, and mailing address of the primary loss control contact for Texas;

(D) National Association of Insurance Commissioners (NAIC) number;

(E) company’s A.M. Best rating;

(F) changes in ownership, organizational structure, or management of the insurance company since the last annual report that affect the provision of accident prevention services;

(G) for each of the accident prevention services listed in § 166.2(a)(1)-(7) of this title (relating to Adequacy of Accident Prevention Services):

(i) criteria, including the specific time frame and manner, that the insurance company will use to evaluate and determine a policyholder’s need for accident prevention services required by the nature of its policyholder’s operations based on frequency and severity of claims and risk exposures, including how the insurance company will ascertain the date of the final determination;

(ii) the specific time frame and manner in which an insurance company will make an offer of accident prevention services to policyholders once a determination has been made;

(iii) the specific time frame and manner in which services will be provided to policyholders;

(iv) specify each entity that will provide the services, such as the insurance company, contracted provider, or contracted policyholder; and

(v) how the provision of services to policyholders will be documented;

(H) the manner in which an insurance company determines a loss ratio;

(I) insurance company qualification requirements for employing or contracting with accident prevention personnel;

(J) method for assuring that the accident prevention personnel provide the requisite level of service to the insurance company’s policyholders;

(K) total number of workers’ compensation policies in effect as of December 31 of the report year;

(L) number of policies in the following premium groups that received any type of workers’ compensation accident prevention services:

(i) less than $25,000;

(ii) $25,000-$100,000; and

(iii) more than $100,000;

(M) total dollar amount spent for accident prevention services for Texas workers’ compensation policyholders;

(N) number of policyholder requests for service;

(O) number of policyholder requests for service fulfilled;

(P) number of surveys performed;

(Q) number of work-related fatalities incurred by policyholders;

(R) evidence of the effectiveness of and accomplishments in accident prevention; and

(S) contact information of and certification by an insurance company representative that the information submitted under this subsection is correct and complete.

(b) Subsequent annual reports by insurance company.

(1) Subsequent to an insurance company’s initial annual report under subsection (a) of this section, an insurance company shall file with the division an annual report on its accident prevention services not later than April 1 of each calendar year.

(2) An annual report required by this subsection shall be filed with the division in the format and manner prescribed by the division and shall include the:

(A) insurance company’s name;

(B) group name;

(C) name, email, phone number, and mailing address of the primary loss control contact for Texas;

(D) NAIC number;

(E) information in subsection (a)(2)(E)-(R) of this section that has changed since the last annual report; and

(F) contact information of and certification by an insurance company representative that the information submitted under this subsection is correct and complete.

(c) The initial and subsequent annual reports shall not include the expenses or the costs of underwriting visits to a policyholder’s premises unless accident prevention services are provided during the visit. In that case, the proportionate costs of the accident prevention services may be included in the report.

(d) When resuming writing workers’ compensation insurance in Texas, any insurance company that has not written workers’ compensation insurance with exposures in Texas for 12 months or more shall submit, not later than the effective date of its first workers’ compensation policy, the initial annual report required under this section.

(e) Insurance companies are responsible for timely and accurate reporting under this section. A report required by this section is considered filed with the division only when it accurately contains all of the required data elements and is received by the division.

(f) This section is effective October 1, 2013.

The provisions of this §166.3 adopted to be effective September 1, 1995, 20 TexReg 5248; amended to be effective October 1, 2013, 38 TexReg 2000.

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At a Glance:

Title:

§ 166.3. Annual Information Submitted by Insurance Companies

Title:

Title 28. Insurance

Status:

Current

Usage:

New Law Rule

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