DEPARTMENT OF REGULATORY AGENCIES
Division of Insurance
3 CCR 702-5
PROPERTY AND CASUALTY
Proposed New Regulation 5-3-6
CONCERNING WORKERS’ COMPENSATION FORM FILINGS FOR NEW AND REVISED POLICY FORMS AND ANNUAL REPORT FILINGS
Section 1 Authority
Section 2 Scope and Purpose
Section 3 Applicability
Section 4 Definitions
Section 5 Rules
Section 6 Severability
Section 7 Enforcement
Section 8 Effective Date
Section 9 History
Appendix A Colorado Workers’ Compensation Insurance Certification Form for New and Revised Policy Forms and Annual Reports – Form WC
Section 1 Authority
This regulation is promulgated and adopted by the Commissioner of Insurance under the authority of §§ 8-44-102, 10-1-109, and 10-4-419.5, C.R.S.
Section 2 Scope and Purpose
The purpose of this regulation is to establish the requirements for the filing and certification of new and revised workers’ compensation forms and annual reports as they relate to policy forms, endorsements, riders, letters, notices, or other documents affecting workers’ compensation insurance policies or contracts.
Section 3 Applicability
This regulation shall apply to all property and casualty insurers or carriers writing workers’ compensation insurance in Colorado, including Pinnacol Assurance, that are required to file workers’ compensation forms and annual reports with the Division, and to appointed rating and/or advisory organizations issuing workers’ compensation insurance policy forms in Colorado.
Section 4 Definitions
A. “Annual report for workers’ compensation insurance” means, for the purposes of this regulation, the completion of the Form Schedule Tab in SERFF, and includes the documents and information listed in section 5.G. of this regulation.
B. “Certification of compliance” means, for the purposes of this regulation, the form that contains the necessary elements of certification, as determined by the commissioner, which has been signed by the designated officer of the insurer.
C. “Insurer” or “entity” means, for the purposes of this regulation, every licensed insurer or carrier, including Pinnacol Assurance, providing workers’ compensation insurance that is authorized to conduct business in Colorado.
D. “Listing of new policy forms for workers’ compensation insurance” shall mean, for the purposes of this regulation, completing the Form Schedule Tab in SERFF, including the documents and information listed in Section 5.H. of this regulation.
E. “Officer of an insurer” means, for the purposes of this regulation, the president, vice president, assistant vice president, corporate secretary, assistant corporate secretary, chief executive officer (CEO), chief financial officer (CFO), chief underwriting officer (CUO), general counsel, or actuary who is also a corporate officer, or any officer appointed by the board of directors.
F. “Policy form” means, for the purposes of this regulation, any policy forms, endorsements, riders, letters, notices, or other documents that affect an insurance policy or contract.
G. “Signature” includes an electronic signature as defined in § 24-71.3-102, C.R.S.
Section 5 Rules for Insurers
A. At least thirty-one (31) days prior to using any new or revised form, each insurer subject to the provisions of this regulation must file a certification of compliance form found in Appendix A of this regulation.
B. The Form Schedule Tab in SERFF must be completed with the form name, form number, edition date, form type, and action for each new, revised, or withdrawn policy form. Listing the readability score and attaching the actual forms is not required.
C. An annual report of workers’ compensation insurance containing policy forms must be filed no later than July 1 of each year. These annual reports will consist of completing the Form Schedule Tab in SERFF, and must include a certification of compliance.
D. Certification requirements.
1. The elements of certification are as follows:
a. The name of the entity;
b. A statement that the officer signing the certification form is knowledgeable of workers’ compensation insurance;
c. A statement that the officer signing the certification form has carefully reviewed the policy forms on the SERFF Form Schedule tab or Annual Report;
d. A statement that the officer signing the certification form has read and understands each applicable law, regulation, and bulletin;
e. A statement that the officer signing the certification form is aware of applicable penalties for certification of a noncomplying form or contract;
f. A statement that the officer signing the certification form certifies that the policy forms identified in the SERFF Form Schedule tab or Annual Report provide all applicable mandated coverages and are in full compliance with all Colorado insurance laws and regulations;
g. The name and title of the officer signing the certification form and the date the certification form is signed; and
h. The original signature of the officer. Signature stamps, photocopies or a signature on behalf of the officer are not acceptable. Electronic signatures must be in compliance with § 24-71.3-102, C.R.S., and applicable regulations.
2. The elements of certification must be included in Form WC (Colorado Workers’ Compensation Insurance Certification Form for New and Revised Policy Forms and Annual Reports) found in Appendix A of this regulation.
E. If the individual signing the certification is not an officer of an insurer, as defined in Section 4.E. of this regulation, documentation must be included that shows that this individual has been appointed as an officer of the organization by the board of directors. This documentation is required to be submitted with every filing.
F. If an insurer uses the optional method of electronic dissemination of newly issued or renewed policy forms or endorsements, the insurer must comply with Colorado’s Uniform Electronic Transaction Act (UETA) § 24-71.3-101 et seq., C.R.S. UETA guidance is provided by the Colorado Office of Information Technology and the Colorado Division of Insurance.
G. All filings submitted in SERFF, which is the format prescribed by the commissioner, must have the Form Schedule Tab completed with the form name, unique form number for new policies, edition date, form type, action, and action specific data.
H. In order to file an annual report for workers’ compensation insurance the insurer must complete the Form Schedule Tab in SERFF. The report must also include all workers’ compensation insurance policy forms currently in use and issued or delivered to any policyholder in Colorado. Attaching the actual forms is not required.
I. In order to file a listing of new policy forms for workers’ compensation insurance the insurer must complete the Form Schedule Tab in SERFF. This tab must include any new or revised workers’ compensation insurance policy forms. Attaching the actual policy form(s) is not required, but the information required in Paragraph F. of this section must be included.
Section 6 Rules for Appointed Rating and/or advisory organization or third party administrators
A. If an insurer chooses to use a rating and/or advisory organization, or a third party administrator to submit a filing on its behalf, that rating and/or advisory organization, or a third party administrator must be appointed by an insurer prior to making any new or revised policy form certification filing or annual report form filing.
B. All of the requirements found in Section 5 of this regulation apply when an insurer chooses to appoint a rating and/or advisory organization, or a third party administrator to submit a filing on its behalf.
C. All rating and/or advisory organizations that issue policy forms in Colorado will place the actual new or revised policy form on file and attach the policy form to the Forms Schedule Tab in SERFF.
D. Filings made by a rating and/or advisory organization, or a third party administrator, shall include the following:
1. A letter signed by the company officer appointing the rating and/or advisory organization, or the third party administrator to file on the company’s behalf;
2. A certification of compliance which has been signed by the designated officer of the appointing insurer; and
3. A listing of new policy forms for workers’ compensation insurance.
Section 7 Severability
If any provision of this regulation or the application of it to any person or circumstance is for any reason held to be invalid, the remainder of this regulation shall not be affected.
Section 8 Enforcement
Noncompliance with this regulation may result in the imposition of any of the sanctions made available in the Colorado statutes pertaining to the business of insurance, or other laws, which include the imposition of civil penalties, issuance of cease and desist orders, and/or suspensions or revocation of license, subject to the requirements of due process.
Section 9 Effective Date
This regulation shall become effective on July 1, 2015.
Section 10 History
New regulation effective July 1, 2015.
Appendix A
FORM WC
COLORADO WORKERS’ COMPENSATION INSURANCE CERTIFICATION FORM FOR NEW AND REVISED POLICY FORMS AND ANNUAL REPORTS
I, THE UNDERSIGNED OFFICER OF ______
(Name of Entity)
AM KNOWLEDGEABLE OF WORKERS’ COMPENSATION INSURANCE;
HAVE CAREFULLY REVIEWED THE CONTENTS OF THE POLICY FORMS, ENDORSEMENTS, RIDERS, LETTERS, NOTICES, AND OR OTHER DOCUMENTS AFFECTING AN INSURANCE POLICY OR CONTRACT IDENTIFIED ON THE ATTACHED LISTING OF NEW POLICY FORMS OR ANNUAL REPORT WHICH IS HEREBY FILED WITH THE COLORADO COMMISSIONER OF INSURANCE;
HAVE READ AND UNDERSTAND EACH OF THE APPLICABLE COLORADO LAWS, RULES, AND REGULATIONS;
AM AWARE OF THE PENALTIES WHICH MAY BE ENFORCED FOR CERTIFICATION OF A NONCOMPLYING FORM; AND
CERTIFY, TO THE BEST OF MY KNOWLEDGE THAT THE POLICY FORMS IDENTIFIED ON THE LISTING OF NEW POLICY FORMS OR ANNUAL REPORT, FILED WITH THIS CERTIFICATION, ARE IN FULL COMPLIANCE WITH ALL COLORADO INSURANCE LAWS AND REGULATIONS.
(Original Signature of Officer*) (Title of Officer*)
(Printed Name of Officer*) (Date)
* If the individual signing the certification is other than the president, vice president assistant vice president, corporate secretary, assistant corporate secretary, CEO, CFO, COO, CUO, general counsel, or an actuary that is also a corporate officer, documentation must be included that shows that this individual has been appointed as an officer of the organization by the Board of Directors.
Version 1.0 – July 1, 2015