Bulletin No October 18, Broadway, Suite 900 Oakland, CA Fax

Transcription

1 WCIRB Bulletin Bulletin No October 18, Broadway, Suite 900 Oakland, CA Fax Revised Standard Endorsement Forms Rating Effective Date Endorsement (WC A) Estimated Annual Premium Endorsement California (WC A) The Insurance Commissioner has approved the attached endorsement forms WC A, Rating Effective Date Endorsement, and WC A, Estimated Annual Premium Endorsement California, as Standard Forms for use in California. These forms were revised to reflect changes to the California Workers Compensation Uniform Statistical Reporting Plan 1995 (USRP) and California Workers Compensation Experience Rating Plan 1995 (ERP) that were recently approved by the Insurance Commissioner. The approved changes remove from the USRP and ERP references to the Anniversary Rating Date (ARD). Effective January 1, 2018, changes to the USRP s provisions, including changes to classification phraseologies and footnotes, will apply to a policy as of its effective date, rather than on the ARD. Additionally, for consistency with other jurisdictions, the ERP will use the term rating effective date instead of ARD to describe the date an experience modification will apply to a risk. Based on these changes, forms WC , Anniversary Rating Date Endorsement, and WC , Estimated Annual Premium Endorsement California, were revised as follows: Rating Effective Date Endorsement (WC A) This form was revised to remove references to the ARD and replace them with rating effective date and to remove the language stating that rates may change on a policy s rating effective date. This form can now be used to show the insured s rating effective date if different from the policy inception date and advise that the experience modification and premium may change on the rating effective date. Estimated Annual Premium Endorsement California (WC A) This endorsement may be used to estimate the annual premium if the applicable experience modification has not been promulgated. WC was revised to remove a reference to the normal anniversary rating date and replace it with rating effective date, and state that the estimated annual premium is based on an estimated experience modification rather than limiting the experience modification used to estimate premium to only that which was previously applicable to the insured s operations. Policy Period Endorsement (WC ) The WCIRB has also updated the Notes to WC , Policy Period Endorsement, to conform to language in the USRP and for clarity. Insurers do not need to file the revised WC form with the WCIRB because the Notes are instructional and are not part of the endorsement form. For your ease of reference, two copies of each of the above referenced endorsement forms are attached. One copy identifies the deletions (stricken) and additions (underscored), and the other is in final format Workers Compensation Insurance Rating Bureau of California. All Rights Reserved. See for more information.

2 Bulletin No October 18, 2017 As with any Standard Form, an insurer may file WC A, Rating Effective Date Endorsement, and WC A, Estimated Annual Premium Endorsement California, with the WCIRB electronically through SERFF and may use them after receiving the WCIRB s notification indicating that each form has been reviewed as to form and substance and is ready for use. When filing a Standard Form with the WCIRB through SERFF, each insurer must submit a copy of the Standard Form and a cover letter requesting authorization to use the form. Affiliated insurers must each make a separate filing. THE ATTACHED FORMS ARE ADVISORY ONLY AND INSURERS ARE THEREFORE NOT OBLIGATED OR REQUIRED TO USE THEM. Insurers that choose not to use these Standard Forms may, but are not obligated to, prepare their own forms. Insurers choosing to prepare their own forms must submit them to the WCIRB through SERFF, along with a detailed cover letter and Document Submission Form, for review and transmission to the Insurance Commissioner. Insurers may use these forms if the Commissioner approves the forms in writing or does not take any action on the forms within 30 days after the date that the WCIRB submits them to the Commissioner. All three of the revised Standard Forms are available for download in the Knowledge Center in WCIRB Connect Workers Compensation Insurance Rating Bureau of California. All Rights Reserved. See for more information.

3 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC A (Ed ) ANNIVERSARY RATING EFFECTIVE DATE ENDORSEMENT The premium and rates for this policy, and the experience rating modification factor, if any, for this policy may change on your anniversary rating effective date shown in the Schedule. Schedule Anniversary Rating Effective Date (Month) (Day) (Year) Notes: 1. The anniversary rating effective date is explained in the California Workers Compensation Experience Rating Plan 1995, Section V, paragraph This endorsement may be used to show the insured s anniversary rating effective date if different from the policy inception date. 3. The insurer may show the anniversary rating date in Item 4 of the Information Page.

4 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC A (Ed ) RATING EFFECTIVE DATE ENDORSEMENT The premium and experience rating modification factor for this policy may change on your rating effective date shown in the Schedule. Schedule Rating Effective Date (Month) (Day) (Year) Notes: 1. The rating effective date is explained in the California Workers Compensation Experience Rating Plan 1995, Section V, paragraph This endorsement may be used to show the insured s rating effective date if different from the policy inception date.

5 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC A (Ed ) ESTIMATED ANNUAL PREMIUM ENDORSEMENT CALIFORNIA The premium with respect to the insurance provided by this policy by reason of the designation of California in item 3 of the Information Page is subject to experience modification. TheYour experience modification, when issued, will be effective on, your normal anniversary rating effective date determined by the Workers Compensation Insurance Rating Bureau of California (WCIRB) in accordance with California law. Pending the issuance of theyour experience modification by the Workers Compensation Insurance Rating Bureau of CaliforniaWCIRB, the estimated annual premium shown below is based on thean estimated experience modification previously applicable to your operations. The estimated annual premium will be revised when the BureauWCIRB issues theyour applicable experience modification. ESTIMATED ANNUAL PREMIUM $ The estimated annual premium shown above is based on a prior experience modification of which was effective on. NOTE: THE ESTIMATED ANNUAL PREMIUM MAY BE INCREASED WHEN THE BUREAUWCIRB ISSUES THE EXPERIENCE MODIFICATION APPLICABLE TO THIS POLICY. Note: This endorsement may be used to estimate the annual premium based upon the most recently expiredan estimated experience modification if the applicable experience modification has not been promulgated.

6 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC A (Ed ) ESTIMATED ANNUAL PREMIUM ENDORSEMENT CALIFORNIA The premium with respect to the insurance provided by this policy by reason of the designation of California in item 3 of the Information Page is subject to experience modification. Your experience modification, when issued, will be effective on, your rating effective date determined by the Workers Compensation Insurance Rating Bureau of California (WCIRB) in accordance with California law. Pending the issuance of your experience modification by the WCIRB, the estimated annual premium shown below is based on an estimated experience modification. The estimated annual premium will be revised when the WCIRB issues your applicable experience modification. ESTIMATED ANNUAL PREMIUM $ NOTE: THE ESTIMATED ANNUAL PREMIUM MAY BE INCREASED WHEN THE WCIRB ISSUES THE EXPERIENCE MODIFICATION APPLICABLE TO THIS POLICY. Note: This endorsement may be used to estimate the annual premium based upon an estimated experience modification if the applicable experience modification has not been promulgated.

7 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC POLICY PERIOD ENDORSEMENT (Ed ) The policy period shown in Item 2 of the Information Page consists of the consecutive periods shown in the Schedule. Our Manuals and all provisions of the policy apply separately to each period. Schedule Notes: 1. Use this endorsement if the policy period is longer than one year and sixteen days and does not consist of complete twelve-month periods. 2. The Basic Manual Anniversary Rating Date (ARD) requires that this endorsement must show which period, the first or the last, is to be less than twelve months. California Notes: 1. This endorsement may be used if the policy period is longer than one year and sixteen days and does not consist of consecutive twelve-month periods. 2. The California Workers Compensation Uniform Statistical Reporting Plan 1995 (USRP), Part 2, Section II, Rule 2(c)(1), requires that for a continuing form policy, the first period of coverage to be treated as a short-term policy and the effective dates of the short-term policy to be endorsed onto the policy at its inception. Rule 2c(2) requires that for a fixed-term policy, either the first period or last period of coverage be treated as a short-term policy and an endorsement showing the effective dates of the policy periods into which the policy is divided be endorsed on the policy at policy inception. 3. Part 2, Section II, Rules 2(d) and 2e, of the USRP states that an Annual Rating Endorsement (A.R.E.) shall be submitted to the Workers Compensation Insurance Rating Bureau of California (WCIRB) annually for each continuing form policy or fixed-term policy written for a period in excess of one year and sixteen days to be effective on the anniversary date set by such policyeffective date of the second period of coverage. The A.R.E. shall be submitted to the WCIRB no later than sixty (60) days after inception. (USRP, Part 2, Section I, Rule 1.b. (2).). A policy written for a period of no longer than one year and sixteen (16) days shall be treated as if the policy were written for a period of one year. (USRP, Part 2, Section II, Rule 1.c. (1).) National Council on Compensation Insurance.

8 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC POLICY PERIOD ENDORSEMENT (Ed ) The policy period shown in Item 2 of the Information Page consists of the consecutive periods shown in the Schedule. Our Manuals and all provisions of the policy apply separately to each period. Schedule California Notes: 1. This endorsement may be used if the policy period is longer than one year and sixteen days and does not consist of consecutive twelve-month periods. 2. The California Workers Compensation Uniform Statistical Reporting Plan 1995 (USRP), Part 2, Section II, Rule 2c(1), requires that for a continuing form policy, the first period of coverage be treated as a short-term policy and the effective dates of the short-term policy be endorsed on the policy at its inception. Rule 2c(2) requires that for a fixed-term policy, either the first period or last period of coverage be treated as a short-term policy and an endorsement showing the effective dates of the policy periods into which the policy is divided be endorsed on the policy at policy inception. 3. Part 2, Section II, Rules 2d and 2e, of the USRP state that an Annual Rating Endorsement (ARE) shall be submitted to the Workers Compensation Insurance Rating Bureau of California (WCIRB) annually for each continuing form policy or fixed-term policy written for a period in excess of one year and sixteen days to be effective on the effective date of the second period of coverage. The ARE shall be submitted to the WCIRB no later than sixty (60) days after inception (USRP, Part 2, Section I, Rule 1b(2)). A policy written for a period of no longer than one year and sixteen (16) days shall be treated as if the policy were written for a period of one year (USRP, Part 2, Section II, Rule 1c(1)) National Council on Compensation Insurance.