GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2005
SENATE BILL 319
RATIFIED BILL
AN ACT establishing the north carolina self‑insurance security system and clarifying the procedures by which subsidiary and AFFILIATE companies may be licensed as self‑insurers for workers compensation and to make other conforming and technical changes to the workers compensation laws respecting individual self‑insurers in article 5 of chapter 97 of the general statutes.
The General Assembly of North Carolina enacts:
SECTION 1.1. The title of Article 4 of Chapter 97 reads as rewritten:
"Article 4.
North Carolina Self‑Insurance
Guaranty Security Association."
SECTION 1.2. G.S. 97‑130 reads as rewritten:
"§ 97‑130. Definitions.
As used in this Article:
(1) "Association"
means the North Carolina Self‑Insurance Guaranty Security Association
established by G.S. 97‑131.
(1a) "Association Aggregate Security System" means the security system established by the Association under G.S. 97‑133 whereby individual self‑insurers collectively secure their aggregate self‑insured workers' compensation liabilities through the North Carolina Self‑Insurance Security Association.
(2) "Board" means the Board of Directors of the Association established by G.S. 97‑132.
(3) "Commissioner" means the North Carolina Commissioner of Insurance.
(4) "Covered claim" means an unpaid claim against an insolvent individual self‑insurer or group self‑insurer that relates to an injury that occurs while the individual self‑insurer or group self‑insurer is a member of the Association and that is compensable under this Chapter.
(5) "Fund" means the
North Carolina Self‑Insurance Guaranty Security Fund
established by G.S. 97‑133.
(5a) "Group" or "Group self‑insurer" means a group self‑insurer licensed by the Commissioner under Part 1, Article 47 of Chapter 58 of the General Statutes.
(5b) "Individual self‑insurer" means an individual employer licensed by the Commissioner under Article 5 of this Chapter.
(6) "Member self‑insurer"
or "member" means a self‑insurer which is authorized by the
Commissioner to self‑insure pursuant to G.S. 97‑93 and G.S. 97‑94.an
individual self‑insurer or group self‑insurer that is required to
be a member of the Association under this Article or Part 1, Article 47 of
Chapter 58 of the General Statutes.
(7) "Plan" means the Plan of Operation authorized by G.S. 97‑134.
(8) "Self‑insurer"
means either: (i) an individual employer who has demonstrated under G.S. 97‑93
the financial ability to directly pay compensation in the amounts and manner
and when due as provided in this Chapter or (ii) a group of two or more
employers who have agreed to pool their liabilities under this Chapter pursuant
to G.S. 97‑93.
(9) "Servicing facility" means those persons delegated by the Board and approved by the Commissioner to settle or compromise claims and to expend Fund assets to pay claims."
SECTION 2. G.S. 97‑131 reads as rewritten:
"§ 97‑131. Creation.
(a) There is created a
nonprofit unincorporated legal entity to be known as the North Carolina Self‑Insurance
Guaranty Security Association. The Association is to provide
mechanisms for the payment of covered claims under self‑insurance
coverage, against member self‑insurers, to avoid excessive
delay in payment, payment of covered claims, to avoid financial
loss to claimants because of the insolvency of a member self‑insurer,
and to assist, when called upon to do so by the Commissioner, to
assist the Commissioner in the detection of self‑insurer insolvencies.insolvencies,
to fund the Association Aggregate Security System, and to capitalize the Fund
to ensure the availability of financial resources to pay covered claims and to
fund the activities of the Association.
(b) All individual self‑insurers
and group self‑insurers shall be and remain members of the
Association as a condition of authority being licensed to self‑insure
in this State under G.S. 97‑93. State. The Association
shall perform its functions under a Plan of Operation established or amended,
or both, by the Board and approved by the Commissioner, and shall exercise its
powers through the Board.
(1) A An individual
self‑insurer or a group self‑insurer shall be deemed to be a
member of the Association for purposes of another self‑insurer'smember's
insolvency, as defined in G.S. 97‑135, when:
a. The individual self‑insurer or group self‑insurer is a member of the Association when an insolvency occurs, or
b. The individual self‑insurer or group self‑insurer has been a member of the Association at some point in time during the 12‑month period immediately preceding the insolvency in question.
(2) A An individual
self‑insurer or a group self‑insurer shall be deemed to be a
member of the Association for purposes of its own insolvency if it is a member
when the compensable injury occurs.
(3) In determining the
membership of the Association pursuant to for the purposes of subdivisions
(1) and (2) of this subsection for any date after the effective date of this
Article, no employer individual self-insurer or group of
employers claiming self‑insurer statusself‑insurer may
be deemed to be a member of the Association on any date after the effective
date of this Article, unless that employer or is on that date
licensed as an individual self‑insurer by the Commissioner under Article
5 of this Chapter or a group of employers is at that time authorized licensed
as a group self‑insurer by the Commissioner pursuant to G.S. 97‑93
and G.S. 97‑94.under Article 47 of Chapter 58 of the General
Statutes."
SECTION 3. G.S. 97‑132 reads as rewritten:
"§ 97‑132. Board of directors.
The Board shall consist of not
less than nine persons directors serving terms as established in
the Plan. The members of the Board directors shall be selected by
the member self‑insurers, members of the Association, subject
to the approval of the Commissioner, and shall serve for terms which shall
not exceed three years. If no members of the Board are selected within 60 days
after the effective date of this Article, the Commissioner may appoint the
initial members of the Board. three‑year terms and until a
successor is elected and qualified. There is no limitation on the number of
terms a director may serve. In approving selections to the Board, the
Commissioner shall consider, among other things, whether all member individual
self‑insurers and group self‑insurers are fairly represented. Members
of the Board Directors may be reimbursed from the assets of the
Association for expenses incurred by them as members of the Board.directors."
SECTION 4. G.S. 97‑133 reads as rewritten:
"§ 97‑133. Powers and duties of the Association.
(a) The Association shall:
(1) Repealed by Session Laws 1999‑219, s. 7.2, effective June 25, 1999.
(1a) Administer a fund, to be known as the North Carolina Self‑Insurance Security Fund, which shall receive the assets of the North Carolina Self‑Insurance Guaranty Fund previously established under subdivision (2) of this subsection, the assessments required by subdivisions (2a) and (3a) of this subsection and any other sums received by the Association. In its discretion, the Board may determine that the assets of the Fund should be segregated or that a separate accounting shall be made in order to identify that portion of the Fund which represents assessments paid by individual self‑insurers and that portion of the Fund which represents assessments paid by group self‑insurers. If the Board segregates the Fund in this manner, the Association shall thereafter pay covered claims against individual member self‑insurers from that portion of the Fund that represents assessments against individual self‑insurers and shall thereafter pay covered claims against group member self‑insurers from that portion of the Fund that represents assessments against group self‑insurers. The costs of administering the Association shall be borne by the Fund. The Association is authorized to secure insurance, primary excess insurance, reinsurance, bonds, other insurance, financial guarantees and related financial instruments to effectuate the purposes of the Association. The Board will invest the Fund assets pursuant to an investment policy adopted by the Board and reviewed and approved annually by the Department of the State Treasurer. The earnings from investment of Fund assets shall be placed in or credited to the Fund.
(2) Assess each
member of the Association as follows:
a. Each
individual member self‑insurer shall be annually assessed an amount equal
to two percent (2%) of the annual gross premiums, as determined under G.S. 105‑228.5(b),
(b1), and (c), that would have been paid by that member self‑insurer for
workers' compensation insurance during the prior calendar year; and payment to
the Association shall be made no later than May 15 following the close of that
calendar year. Where any such assessment is paid based in whole or in part upon
estimates of annual gross premiums for the prior calendar year, there shall be
made in the next year's assessment an adjustment of the assessment of such
prior year based on actual audited annual gross premiums. Each group member
self‑insurer shall be annually assessed an amount equal to two percent
(2%) of the annual gross premiums, as determined under G.S. 105‑228.5(b),
(b1), and (c), of the group member self‑insurer during the prior calendar
year; and payment to the Association shall be made no later than May 15
following the close of that calendar year. Regardless of the size of the Fund,
during its first 12 months of membership, no member self‑insurer may
discount or reduce this two percent (2%) assessment. For the purpose of making
the assessments authorized by this subsection and subsections (c) and (d) of
this section, the Secretary of Revenue shall provide to the Association the
self‑insurer premium and payroll information as determined under G.S. 105‑228.5(b),
(b1) and (c), and the Commissioner shall provide to the Association the group
self‑insurer premium information reported to the Commissioner under G.S. 58‑47‑75
and G.S. 58‑2‑165.
b. Each member
self‑insurer shall be notified of the assessment no later than 30 days
before it is due.
c. If a self‑insurer
is a member of the Association for less than a full calendar year, the annual
gross premiums shall be adjusted by that portion of the year the self‑insurer
is not a member of the Association.
d. If application
of the contribution rates referenced in sub‑subdivision a. of this
subdivision would produce an amount in excess of the five million dollar
($5,000,000) limits of the fund, an equitable proration may be made; provided
that every self‑insurer that becomes a member of the Association shall
pay an initial assessment, in an amount established by the Board, regardless of
the size of the fund at the time the member joins the Association.
(2a) Establish, operate, and maintain the Association Aggregate Security System as defined in G.S. 97‑130 and G.S. 97‑165 as follows:
a. The Association shall annually prepare and submit to the Commissioner a written plan to provide an Association Aggregate Security System through a combination of cash on deposit in the Fund, securities, surety bonds, irrevocable letters of credit, insurance or other financial instruments or guarantees owned or entered into by the Association and acceptable to the Commissioner. The written plan shall include, but not be limited to, (i) a description of the institutions that will issue or guarantee the securities, surety bonds, irrevocable letters of credit, insurance or other financial instruments or guarantees, including, but not limited to, the credit rating, financial strength, and AM best rating, if applicable to the institutions (ii) applicable cash flow information and financial assumptions (iii) a description of the methodology to be used by the Association to assess and collect the Association Aggregate Security System assessments to be made pursuant to subdivision (3a) of this subsection and (iv) a proposed timetable for the release of existing individual company deposits posted pursuant to G.S. 97‑185(c), provided, however, that no individual company deposits posted pursuant to G.S. 97‑185(c) shall be released without the written consent of the Commissioner. The noncash elements of the composite security may be one‑year or multiple‑year instruments.
b. Within 90 days following the submission of the initial plan under sub‑subdivision a. of this subdivision, the Commissioner shall either approve or disapprove the initial plan and shall notify the Association in writing. If the Commissioner does not approve or disapprove the initial plan within 90 days following submission, then the initial plan shall be deemed to be approved by the Commissioner. All subsequent plans shall be either approved or disapproved within 60 days following submission.
c. The Commissioner shall also determine the total undiscounted claims liability of each individual self‑insurer that will participate in the Association Aggregate Security System as well as the aggregate total undiscounted outstanding claims liabilities of all the individual self‑insurers that are to participate in the Association Aggregate Security System and shall notify the Association of this determination.
d. Upon approval by the Commissioner of the Association's plan for the Association Aggregate Security System, the Association shall assess the individual self‑insurers that participate in the Association Aggregate Security System pursuant to subdivision (3a) of this subsection.
e. If the Commissioner disapproves the plan for any year, every self‑insurer shall deposit with the Commissioner, or continue to deposit, the amount required by G.S. 97‑185(b3) in the manner prescribed by G.S. 97‑185(c).
f. Group self‑insurers shall not participate in the Association Aggregate Security System.
(3) Administer a
fund, to be known as the North Carolina Self‑Insurance Guaranty Fund,
which shall receive the assessments required in subdivision (2) of this
subsection. Once the Fund reaches five million dollars ($5,000,000), no further
assessments shall be made except initial assessments of new member self‑insurers
that are required to be made in subdivision (2)d. of this subsection.
Assessments may be subsequently made only to maintain the Fund at a level of
five million dollars ($5,000,000). In its discretion, the Board may determine
that the assets of the Fund should be segregated, or, that a separate
accounting shall be made, in order to identify that portion of the Fund which
represents assessments paid by individual self‑insurers and that portion
of the Fund which represents assessments paid by group self‑insurers. If
the Board determines to segregate the Fund in this manner, the Association
shall thereafter pay covered claims against individual member self‑insurers
from that portion of the Fund which represents assessments against individual
self‑insurers and shall thereafter pay covered claims against group
member self‑insurers from that portion of the Fund which represents
assessments against group self‑insurers. The cost of administration
incurred by the Association shall be borne by the Fund and the Association is
authorized to secure reinsurance and bonds and to otherwise invest the assets
of the Fund to effectuate the purpose of the Association, subject to the
approval of the Commissioner. All earnings from investment of Fund assets shall
be placed in or credited to the Fund.
The
Association may purchase primary excess insurance from an insurer licensed by
the Commissioner for the appropriate lines of authority to defray its exposure
to loss occasioned by the default of one of its members. The terms of any
excess insurance so purchased shall be limited to providing coverage of
liabilities which exceed the Fund's assets after the payment by member self‑insurers
of the maximum post‑insolvency assessment provided in subdivision (c)(1)
of this section herein and the Association shall fund any such purchase by
levying a special assessment on its members for this purpose or by application
of any unencumbered earnings of the Fund or any other available funds. The
Association may obtain from each member any information the Association may
reasonably require in order to facilitate the securing of this primary excess
insurance. The Association shall establish reasonable safeguards designed to
insure that information so received is used only for this purpose and is not
otherwise disclosed;
(3a) Assess members of the Association as follows:
a. Association Aggregate Security System assessments. – The Association shall assess each individual self‑insurer participating in the Association Aggregate Security System a security system assessment. The amount of the security system assessment charged to each individual self‑insurer participating in the Association Aggregate Security System shall be based on the Association's reasonable consideration of all of the following factors:
1. The total amount of assessments necessary to provide aggregate security for all participating individual self‑insurers.
2. The individual self‑insurer's total workers' compensation liabilities under the Act.
3. The financial strength and creditworthiness of the participating individual self‑insurer.
4. Any other relevant factors.
b. Special assessment. – In the event that there are covered claims against an insolvent member or members and the assets of the Fund are not sufficient to pay the obligations of the Association, then the Association may collect a special assessment from the members in an amount sufficient to pay the aggregate value of such covered claims. Each member's special assessment shall be determined by the Board and shall be based on the proportion of the member's total obligations under the Act to the aggregate total of all members' obligations under the Act.
c. Initial assessments. – An individual self‑insurer that becomes a member and does not initially participate in the Association Aggregate Security System shall pay an initial assessment to the Association in an amount determined by the Board. A group self‑insurer, upon receiving its initial license from the Commissioner, shall pay an initial assessment to the Association in an amount determined by the Board.
d. Each member shall be notified of assessments no later than 30 days before the assessment is due.
e. Delinquent assessments, except as otherwise provided, shall bear interest at a rate to be established by the Board.
(4) Be obligated to the
extent of covered claims occurring prior to the determination of the member
self‑insurer's insolvency, or occurring after such determination but
prior to the obtaining by the self‑insurer of workers' compensation
insurance as otherwise required under this Chapter.pay covered claims.
(5) After paying any claim
resulting from a self‑insurer's insolvency, covered claim, be
subrogated to the rights of the injured employee and dependents and be entitled
to enforce liability against the self‑insurer or any third party by
any appropriate action brought in its own name or in the name of the injured
employee and dependents;dependents.
(6) Assess the Fund in an
amount necessary to pay only:Expend Fund assets in amounts necessary to
pay all of the following:
a. The obligations for of
the Association under this Article subsequent to an insolvency;insolvency.
b. The expenses of handling
covered claims subsequent to an insolvency;insolvency.
c. The cost of examinations
under G.S. 97‑137; andG.S. 97‑137.
d. The costs of implementing and operating the Association Aggregate Security System.
e. Other All
other expenses authorized by this Article;Article.
(7) Investigate claims
brought against the Association and adjust, compromise, settle, and pay covered
claims to the extent of the Association's obligation; and deny all other
claims. The Association may review settlements to which the insolvent self‑insurermember
was a party to determine the extent to which such settlements may be properly contested;contested.
(8) Notify such persons as
the Commissioner directs under G.S. 97‑136;G.S. 97‑136.
(9) Handle claims through its
employees directors, its employees, or through one or more self‑insurersmembers
or other persons designated as servicing facilities. Designation of a servicing
facility is subject to the approval of the Commissioner, but designation of a
member self‑insurer as a servicing facility may be declined by
such self‑insurer;member.
(10) Reimburse each servicing
facility for obligations of the Association paid by the facility and for
expenses incurred by the facility while handling claims on behalf of the Association;Association.
(11) Pay the any other
expenses of the Association authorized by this section; andsection.
(12) Establish in the
Plan a mechanism to calculate the assessments required by subdivisions (2) and
(3) of this subsection by a simple and equitable means to convert from policy
or fund years that are different from a calendar year.
(b) The Association may:
(1) Employ or retain such persons
persons, including, but not limited to, adjustors, brokers, accountants,
attorneys, financial advisors, investment bankers, placement agents, and
consultants, as the Board may determine are necessary to handle claims
claims, and perform other duties of of, provide
services to, and consult with the Association;Association.
(2) Borrow funds necessary to
effect the purposes of this Article in accord with the Plan;Plan,
including entering into standby lines of credit.
(3) Sue or be sued;sued.
(4) Negotiate and become a
party to such contracts as are necessary to carry out the purpose of this section;
andsection.
(5) Perform such other acts as are necessary or proper to effectuate the purpose of this section.
(6) Reimburse the Department of Insurance up to twenty thousand dollars ($20,000) for consultants retained by the Department to review the initial plan submitted pursuant to G.S. 97‑133(a)(2a).
(c) In the event
that the assets of the Fund are not sufficient to pay the obligations of the
Association, then the Association shall impose an additional assessment upon
its members, which shall be known as a post‑insolvency assessment which
shall be imposed as follows:
(1) Each individual
member self‑insurer shall be assessed in an amount not to exceed two
percent (2%) each year of the annual gross premiums, as determined under G.S. 105‑228.5(b),
(b1), and (c), that would have been paid by that member self‑insurer
during the prior calendar year. The assessments of each individual member self‑insurer
shall be in the proportion that the annual gross premiums, as determined under G.S. 105‑228.5(b),
(b1), and (c), of the individual member self‑insurer for the premium
calendar year bears to the annual gross premiums of all individual member self‑insurers
for the preceding calendar year. For group member self‑insurers, the
assessment shall not exceed two percent (2%) each year the annual premium
collected by that group member self‑insurer during the prior calendar
year. The assessments of each group member self‑insurer shall be in the
proportion that the annual gross premiums of the group member self‑insurer
for the premium calendar year bears to the annual gross premiums of all group
member self‑insurers for the preceding calendar year.
(2) Each member
self‑insurer shall be notified of the assessment no later than 30 days
before it is due.
(3) The Association
may exempt or defer, in whole or in part, the assessment of any member self‑insurer,
if the assessment would cause that member's financial statement to reflect
liabilities in excess of assets.
(4) Delinquent
assessments, except as provided in subdivision (3) of this subsection, shall
bear interest at the rate to be established by the Board, but not to exceed the
discount rate of the Federal Reserve Bank, Richmond, Virginia, on the due date
of the assessment, plus four percent (4%) annually, computed from the due date
of the assessment.
(5) The Association
shall establish in the Plan a mechanism to calculate the assessments required
by subdivision (1) of this subsection by a simple and equitable means to
convert from policy or fund years that are different from a calendar year.
(c1) The Association shall provide in its Plan that the functions of administration and adjusting claims shall not be performed by the same entity that provides legal representation to the Association for claims.
(d) No individual
member self‑insurer may be assessed in any calendar year an amount
greater than two and one‑half percent (2.5%) of the annual gross
premiums, as determined under G.S. 105‑228.5(b), (b1), and (c), that
would have been paid by that individual member self‑insurer during the
prior calendar year. No group member self‑insurer may be assessed in any
calendar year an amount greater than two and one‑half percent (2.5%) of
the annual gross premiums of that group member self‑insurer during the
prior calendar year. If the maximum assessment does not provide in any one year
an amount sufficient to make all necessary payments, the funds available shall
be prorated and the unpaid portion shall be paid as soon thereafter as funds
become available. There shall be established in the Plan a mechanism to
calculate the assessments required by this section by a simple and equitable
means to convert from policy or fund years that are different from a calendar
year."
SECTION 5. G.S. 97‑134 reads as rewritten:
"§ 97‑134. Plan of Operation.
The Plan is as follows:
(1) The Association shall
submit to the Commissioner a Plan and any amendments necessary or suitable to
assure the fair, reasonable, and equitable administration of the Association.
The Plan and any amendments become effective upon approval in writing by the
Commissioner. If the Association at any time fails to submit a suitable Plan
or suitable amendment to the Plan the Commissioner shall, after notice and
hearing, adopt such reasonable rules as are necessary or advisable to
effectuate this Article. Such The rules shall continue in force
until modified by the Commissioner or superseded by a Plan submitted by the
Association and approved by the Commissioner.
(2) All member self‑insurers shall comply with the Plan.
(3) The Plan shall:
a. Establish the procedures
whereby all the powers and duties of the Association under G.S. 97‑133
will be performed;performed.
b. Establish procedures for
handling assets of the Association;investing and managing Fund
assets.
c. Adopt a reasonable
mechanism and procedure to achieve equity in assessing the funds required in
G.S. 97‑133. Consideration shall be given to adjustments for audited
payroll, differential effects caused by rate changes, and other relevant
factors;members under G.S. 97‑133.
d. Establish the amount and
method of reimbursing members of the Board under G.S. 97‑132;G.S.
97‑132.
e. Establish procedures by which
claims may be filed with the Association and establish acceptable forms of
proof of covered claims. A list of such claims shall be periodically
submitted to the Association;
f. Establish regular
places and times for meetings of the Board;Board.
g. Establish procedures for
records to be kept of all financial transactions of the Association, its
agents, and the Board;Board.
h. Provide that any member
self‑insurer aggrieved by any final action or decision of the Association
may appeal to the Commissioner within 30 days after the action or decision;decision.
i. Establish the
procedures whereby selections for the Board shall be submitted to the Commissioner;
andCommissioner.
j. Contain additional provisions necessary or proper for the execution of the powers and duties of the Association."
SECTION 6.1. G.S. 97‑135 reads as rewritten:
"§ 97‑135. Insolvency.
A member self‑insurer shall be insolvent for the purposes of this Article under any of the following circumstances:
(1) Determination of
insolvency by a court of competent jurisdiction; orjurisdiction.
(2) Institution of bankruptcy
proceedings by or regarding the member self‑insurer; orself‑insurer.
(3) The Board determines that the member self‑insurer's total liabilities exceed its total assets or the member self‑insurer is unable or ceases to pay its debts as they fall due or in the ordinary course of business.
(4) A member self‑insurer is deemed to be insolvent, bankrupt, or in default as defined by the terms of any security instrument created pursuant to the Association Aggregate Security System."
SECTION 6.2. G.S. 97‑136 reads as rewritten:
"§ 97‑136. Powers and duties of the Commissioner.
(a) The Commissioner shall
notify shall:
(1) Notify the Association of the existence of an insolvent member self‑insurer not later than 30 days after he receives notice of an insolvency pursuant to the standards set forth in G.S. 97‑135.
(2) Approve or disapprove the plan for an Association Aggregate Security System as required under G.S. 97‑133(a)(2a)b. and notify the Association of the information required under G.S. 97‑133(a)(2a)c.
(b) The Commissioner may:
(1) Require that the
Association notify the insureds of the insolvent member self‑insurer and
any other interested parties of the insolvency and of their rights under this
Article. Such The notifications shall be by mail at their last
known addresses, where available; but if required information for notification
is not available, notice by publication in a newspaper of general circulation
in this State shall be sufficient; and
(2) Revoke the designation of
any servicing facility if he the Commissioner finds claims are
being handled unsatisfactorily."
SECTION 7. G.S. 97‑140 reads as rewritten:
"§ 97‑140. Nonduplication of recovery.
Any person having a covered claim that may be recovered under more than one insurance or self‑insurance guaranty or security association or its equivalent shall seek recovery first from the association of the place or residence of the claimant. Any recovery under this Article shall be reduced by the amount of recovery from any other insurance guaranty or security association or its equivalent."
SECTION 8. G.S. 97‑143 reads as rewritten:
"§ 97‑143. Use of deposits made by insolvent member self‑insurers.
After the Commissioner has notified
the Association, under G.S. 97‑136(a), that a member is insolvent,
the Commissioner shall assign and deliver to the Association, and the
Association is authorized to expend the any deposit made by the
insolvent member under G.S. 58‑47‑90 or G.S. 97‑185,
to the extent the deposit is needed by the Association to pay covered claims
against the insolvent member as required by this Article, and to the extent the
deposit is needed to pay expenses of the Association relating to covered claims
against the insolvent member. For insolvent individual member self‑insurers
that participate in the Association Aggregate Security System, the Association
is authorized to pursue recovery under every instrument, contract, and form of
security comprising the composite security. The Association shall account
to the Commissioner and the insolvent member or its successor for all deposits
received from the Commissioner under this section."
SECTION 9. G.S. 97‑165 reads as rewritten:
"§ 97‑165. Definitions.
As used in this Article:
(1) 'Act' means the Workers' Compensation Act established in Article 1 of this Chapter.
(1a) 'Affiliate of' or 'person affiliated with' a specific person means a person that indirectly through one or more intermediaries or directly controls, is controlled by, or is under common control with the person specified.
(1b) 'Association Aggregate Security System' means the security system established pursuant to G.S. 97‑133 whereby individual self‑insurers collectively secure their aggregate self‑insured workers' compensation liabilities under the Act through the North Carolina Self‑Insurance Security Association.
(2) 'Certified audit' means
an audit on which a certified public accountant expresses his or her
professional opinion that the accompanying statements fairly present the
financial position of the self‑insurer, self‑insurer or
the guarantor, in conformity with generally accepted accounting
principles.accounting principles generally accepted in the United
States.
(3) 'Certified public
accountant' or 'CPA' means a CPA who is in good standing with the American
Institute of Certified Public Accountants and in all states in which the CPA is
licensed to practice. A CPA shall be recognized as independent as long as the
CPA conforms to the standards of the profession, as contained in the Code of
Professional Ethics of the American Institute of Certified Public Accountants
and Rules and Regulations and Code of Ethics and Rules of Professional Conduct
of the North Carolina State Board of Certified Public Accountant Examiners, or
similar code. The Commissioner may hold a hearing to determine whether a CPA is
independent and, considering the evidence presented, may rule that the CPA is
not independent for purposes of expressing an opinion on the GAAP financial
statement and require the individual self‑insurer or the
guarantor to replace the CPA with another whose relationship with the individual
self‑insurer or the guarantor is independent within the
meaning of this definition.
(4) 'Commissioner' means the Commissioner of Insurance.
(4a) 'Control', 'controlling', 'controlled by', and 'under common control with' mean the direct or indirect possession of the power to direct or cause the direction of the management and policies of a person through ownership of or through proxies for voting of greater than fifty percent (50%) of the voting securities, or in the case of a not‑for‑profit entity, the power to direct or cause the direction of the management and policies of the entity.
(5) 'Corporate surety' means an insurance company authorized by the Commissioner to write surety business in this State.
(6) 'GAAP financial
statement' means a financial statement as defined by generally accepted accounting
principles.principles generally accepted in the United States.
(6a) 'Guarantor' means a person within the same holding company system who controls the applicant, whose financial statement is used by the applicant to become a self‑insurer under the Act, and who has guaranteed the payment of the self‑insurer's liability under the Act.
(7) 'Hazardous financial condition' means that, based on its present or reasonably anticipated financial condition, a self‑insurer or guarantor is insolvent or, although not yet financially impaired or insolvent, is unlikely to be able to meet its obligations with respect to known claims and reasonably anticipated claims or to pay other obligations in the normal course of business.
(7a) 'Holding company system' means an entity comprising two or more affiliated persons.
(8) 'Management' means those persons who are authorized to direct or control the operations of a self‑insurer.
(8a) 'Person' means an individual, corporation, partnership, limited liability company, association, joint stock company, trust, unincorporated organization, or any similar entity or any combination of the foregoing acting in concert.
(9) 'Qualified actuary' means a member in good standing of the Casualty Actuarial Society or 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, and is in compliance with G.S. 58‑2‑171.
(10) 'Self‑insurer' means
an employer who retains liability under the Act and is licensed under this
Article. individual self‑insurer as defined by G.S. 97‑130(5b).
(11) 'Subsidiary of' a specific person means an affiliate controlled by such person indirectly through one or more intermediaries or an affiliate directly controlled by such person."
SECTION 10. G.S. 97‑170 reads as rewritten:
"§ 97‑170. License applications; required information.
(a) No employer shall self‑insure its workers' compensation liabilities under the Act unless it is licensed by the Commissioner under this Article. This subsection does not apply to an employer authorized to self‑insure its workers' compensation liabilities under the Act prior to December 1, 1997, whose authority to self‑insure its workers' compensation liabilities under the Act has not terminated after that date.
(b) An applicant for a license as a self‑insurer shall file with the Commissioner the information required by subsection (d) of this section on a form prescribed by the Commissioner at least 90 days before the proposed licensing date. No application is complete until the Commissioner has received all required information. A copy of the application must also be filed with the North Carolina Self‑Insurance Security Association at least 90 days before the proposed licensing date.
(c) Only an applicant whose
total fixed assets amount to five hundred thousand dollars ($500,000) or more
may apply for a license. In judging the applicant's financial strength and
liquidity relative to its ability to comply with the Act, the Commissioner
shall consider all of the following relative to the applicant's:applicant:
(1) Organizational structure
and management;management.
(2) Financial strength;strength.
(3) Source and reliability of
financial information;information.
(4) Risks to be retained;retained.
(5) Workers' compensation
loss history;history.
(6) Number of employees;employees.
(7) Claims administration;administration.
(8) Excess insurance; andinsurance.
(9) Access to excess insurance.
(d) The license application
shall comprise be comprised of the following information:
(1) Company name, Applicant
name; organizational structure, structure of the applicant,
including any controlling entity, subsidiaries, or affiliates; location of
principal office, office; contact person, person; organization
date, date; type of operations within this State, State;
management background, background; and addresses of all
plants or offices in this State.
(2) Certified audited GAAP
financial statements prepared by a CPA for the two most recent years. The
financial statement formulation presentation shall facilitate
application of ratio and trend analysis.
…
(6) Summary of workers'
compensation benefits paid for the last three calendar years, as well as years
and the total liability for all open claims within 30 days or some other
period acceptable to the Commissioner not to exceed 90 days, before the filing
of the application.
…
(8) Book value of
fixed assets located within the State.
(9) Proof of compliance with the claims administration provisions of Article 47 of Chapter 58 of the General Statutes.
(10) A letter of assent,
stipulating the applicant's acceptance of membership status in approval for
membership by the North Carolina Self‑Insurance Guaranty Association
under Article 4 of this Chapter.Security Association.
(e) Every applicant shall
execute and file with the Commissioner an agreement, as part of the
application, in which the applicant agrees to participate in the Association
Aggregate Security System, or if excluded from the Association Aggregate Security
System, to deposit with the Commissioner pursuant to G.S. 97‑185
cash, acceptable securities, an irrevocable letter of credit in a form
acceptable to the Commissioner issued by a bank acceptable to the Commissioner,
or a surety bond issued by a corporate surety surety, or a
combination thereof, that will guarantee the applicant's compliance with
this Article and the Act pursuant to G.S. 97‑185.Act."
SECTION 11. Article 5 of Chapter 97 of the General Statutes is amended by adding the following new section:
"§ 97‑177. License covering applicant and any subsidiary or applicant relying on a guarantor; procedure; requirements.
(a) The Commissioner may, in the Commissioner's discretion, upon request by an applicant, issue a license to an applicant or to an applicant and one or more of its subsidiaries if all of the following requirements are satisfied:
(1) The applicant or a guarantor of the applicant executes a guaranty agreement, in a form prescribed by the Commissioner, for the payment of all workers' compensation liabilities covered under the Act. For any applicant or guarantor that is a corporation, there shall be submitted, along with the guaranty agreement, a board of directors' resolution from the respective corporation authorizing the guaranty of the liabilities of the subsidiary company or companies and granting signature authority to each person or officer executing the agreement.
(2) The applicant or guarantor files a statement with the Commissioner that lists the percentage of ownership of voting securities or proxies representing voting securities owned or held by the applicant or guarantor for each subsidiary, or in the case of a not‑for‑profit entity, documentation acceptable to the Commissioner evidencing control.
(3) The applicant and its guarantor or the applicant and its subsidiaries, whichever applies, satisfy the requirements of G.S. 97‑170(c).
(4) All other applicable requirements for licensure under the Act are satisfied.
(b) A license issued by the Commissioner pursuant to this section shall include the name of the applicant, the name of each licensed subsidiary, and the date of issuance for each licensed subsidiary.
(c) If a self‑insurer requests to add a subsidiary to its license, the Commissioner shall review the request in accordance with this section. Upon approval, the Commissioner shall issue to the self‑insurer a new license that includes the newly licensed subsidiary and the date of license issuance for the newly licensed subsidiary, and the self‑insurer shall return the original license to the Commissioner.
(d) A self‑insurer shall neither include nor delete a subsidiary from its license without the Commissioner's prior written approval.
(e) If a controlling relationship or guaranty agreement terminates, the self‑insurer shall retain all liabilities under the Act that were incurred by the self‑insurer during the period of self‑insurance and shall account for all such liabilities until discharged, as evidenced by reports filed with the Commissioner. Termination of a guaranty agreement does not affect the guarantor's liability for payment of liabilities arising prior to termination of the agreement."
SECTION 12. G.S. 97‑180 reads as rewritten:
"§ 97‑180. Reporting and records.
(a) Every self‑insurer
shall submit, within 120 days after the end of its fiscal year, a certified
audited GAAP financial statement, prepared by a CPA, for that fiscal year. The
financial statement formulation presentation shall facilitate the
application of ratio and trend analysis. If the self‑insurer was
issued a license pursuant to G.S. 97‑177, the financial statement
required under this subsection shall be that of the guarantor.
(b) Every self‑insurer
shall submit within 120 days after the end of its fiscal year a certification
report from a qualified actuary setting forth the actuary's an opinion
relating to certifying the loss and loss adjustment expense
reserves for workers' compensation obligations for in North
Carolina. The certification report shall show liabilities, excess
insurance carrier and other qualifying credits, if any, and net retained
workers' compensation liabilities. The qualified actuary shall present an
annual report to the self‑insurer on the items within the scope of and
supporting the certification, within 90 days after the close of the self‑insurer's
fiscal year. Upon request, the report shall be submitted to the Commissioner.
(c) Every self‑insurer
shall submit within 120 days after the end of its fiscal year a report in the
form of a sworn statement prescribed by the Commissioner, setting forth the
total workers' compensation benefits paid in the previous fiscal year, as
well as and the total outstanding workers' compensation liabilities
for each loss year, recorded at the close of its fiscal year for the net
retained liability.
(d) Upon the request of the Commissioner, every self‑insurer shall submit a report of its annual payroll information. The report shall summarize payroll, by annual amount paid, and the number of employees, by classification, using the rules, classifications, and rates in the most recently approved Workers' Compensation and Employers' Liability Insurance Manual governing the audits of payrolls and the adjustments of premiums. Every self‑insurer shall maintain true and accurate payroll records. These payroll records shall be maintained to allow for verification of the completeness and accuracy of the annual payroll report.
(e) Every self‑insurer
shall report promptly to the Commissioner changes in the names and addresses
name or address of the businesses it self‑insures or
intends to self‑insure, as well as self‑insurer or guarantor;
significant changes in the financial condition, condition of the
self‑insurer, guarantor, or any affiliate, including bankruptcy filings,
filings; and changes in its business organizational structure,
including its divisions, subsidiaries, affiliates, and internal
organization. subsidiaries and affiliates. Any change shall be
reported in writing to the Commissioner within 10 days after the effective date
of the change. Upon request by the Commissioner, a self‑insurer shall
provide the Commissioner copies of documents or information deemed necessary to
determine whether any change has affected the privilege of the employer to self‑insure."
SECTION 13. G.S. 97‑185 reads as rewritten:
"§ 97‑185. Deposits; surety bonds; letters of credit.
(a) (Effective
January 1, 2005, until January 1, 2006) Every self‑insurer
shall deposit with the Commissioner an amount not less than seventy‑five
percent (75%) of the self‑insurer's total undiscounted outstanding claim
liability per the most recent certification from a qualified actuary as
required by G.S. 97‑180(b), but not less than five hundred thousand
dollars ($500,000), or such other greater amount as the Commissioner prescribes
based on, but not limited to, the financial condition of the self‑insurer
and the risk retained by the self‑insurer.
(a) (Effective
January 1, 2006) Every self‑insurer shall deposit with the
Commissioner an amount not less than one hundred percent (100%) of the self‑insurer's
total undiscounted outstanding claim liability per the most recent
certification from a qualified actuary as required by G.S. 97‑180(b),
but not less than five hundred thousand dollars ($500,000), or such other
greater amount as the Commissioner prescribes based on, but not limited to, the
financial condition of the self‑insurer and the risk retained by the self‑insurer.
(a1) All individual self‑insurers as defined in G.S. 97‑130(5b) shall participate in the Association Aggregate Security System established under G.S. 97‑131 unless excluded by the Board of Directors of the North Carolina Self‑Insurance Security Association. The Board of Directors of the North Carolina Self‑Insurance Security Association shall exclude all of the following from the Association Aggregate Security System:
(1) Individual self‑insurers whose licenses have previously been revoked by the Commissioner.
(2) Individual self‑insurers with a debt rating as established by Standard & Poor's Rating Service or by Moody's Investor Service, below the minimum Standard & Poor's and Moody's ratings established in the written plan for the Association Aggregate Security System submitted by the Association and approved by the Commissioner under G.S. 97‑133(a)(2a).
(3) Individual self‑insurers that have defaulted on the payment of its self‑insured workers' compensation liabilities from participation in the Association Aggregate Security System.
The Board of Directors of the North Carolina Self‑Insurance Security Association shall notify the Commissioner of the individual self‑insurers that are excluded from participating in the Association Aggregate Security System.
(b) Repealed by Session Laws 2003‑115, s. 3, effective January 1, 2004.
(b1) Notwithstanding
subsection (a) of this section, member self insurers with a debt rating of BBB
or better from Standard and Poor's Rating Service, a division of McGraw Hill,
Inc., or an equivalent rating from another national rating agency shall deposit
with the Commissioner an amount not less than twenty five percent (25%) of the
self insurer's total undiscounted outstanding claim liability per the most
recent certification from a qualified actuary as required by G.S. 97
180(b), but not less than five hundred thousand dollars ($500,000). The
Commissioner shall consider and may, in the Commissioner's discretion, increase
or reduce the deposit to a greater or lesser percentage of the member self
insurer's claims liability based on the financial strength of the self insurer
and other financial information submitted by the self insurer.
(b2) An individual self‑insurer that is excluded from participation in the Association Aggregate Security System, including individual self‑insurers that are granted a license to self‑insure after the North Carolina Self‑Insurance Security Association annually implements the Association Aggregate Security System, shall deposit with the Commissioner an amount not less than one hundred percent (100%) of the individual self‑insurer's total undiscounted outstanding claims liability per the most recent report from a qualified actuary as required by G.S. 97‑180(b), but not less than five hundred thousand dollars ($500,000), or such greater amount as the Commissioner prescribes based on, but not limited to, the financial condition of the individual self‑insurer and the risk retained by the individual self‑insurer.
(b3) During any period of time that no Association Aggregate Security System is in effect, individual self‑insurers with a debt rating of BBB or better from Standard & Poor's Rating Service, a division of McGraw Hill, Inc., or an equivalent rating from another national rating agency shall deposit with the Commissioner an amount not less than twenty-five percent (25%) of the individual self‑insurer's total undiscounted outstanding claims liability per the most recent report from a qualified actuary as required by G.S. 97-180(b), but not less than five hundred thousand dollars ($500,000). An individual self‑insurer licensed pursuant to G.S. 97‑177 may utilize the debt rating of its guarantor for the purpose of establishing the application of this subsection. The Commissioner shall consider and may, in the Commissioner's discretion, increase or reduce the deposit to a greater or lesser percentage of the individual self‑insurer's claims liability based on the financial strength of the individual self‑insurer and other financial information submitted by the individual self‑insurer. All other individual self‑insurers shall deposit with the Commissioner an amount not less than one hundred percent (100%) of the individual self‑insurer's total undiscounted outstanding claims liability per the most recent report from a qualified actuary as required by G.S. 97‑180(b), but not less than five hundred thousand dollars ($500,000), or such greater amount as the Commissioner prescribes based on, but not limited to, the financial condition of the individual self‑insurer and the risk retained by the individual self‑insurer.
(c) Deposits received,
changes to existing deposits, or deposits exchanged after the effective date of
this section, shall comprise be comprised of one or more of the
following:
(1) Interest‑bearing bonds of the United States of America.
(2) Interest‑bearing bonds of the State of North Carolina, or of its cities or counties.
(3) Certificates of deposit issued by any solvent bank domesticated in the State of North Carolina that have a maturity of one year or greater.
(4) Surety bonds in a form acceptable to the Commissioner and issued by a corporate surety. A surety bond deposited pursuant to this subsection shall require that the surety reimburse the Commissioner, or his successors, assigns, or transferees, for any costs incurred in the collection of the proceeds of the surety bond, including reasonable attorneys' fees, and any costs incurred in administering the insolvent self‑ insurer's workers' compensation claims.
(4a) Irrevocable letters of
credit in a form acceptable to the Commissioner issued by a bank acceptable to
the Commissioner. An irrevocable letter of credit deposited pursuant to this
subsection shall require that the bank reimburse the Commissioner, or his successor,
successors, assigns, or transferees for any costs incurred in the
collection of the proceeds of the letter of credit, including reasonable
attorneys' fees.
(4b) The reimbursement of attorneys' fees and collections cost provided for in subdivisions (4) and (4a) of this subsection shall be no greater than fifteen percent (15%) of the penal amount of the bond and shall not come from the proceeds of the bond or the letter of credit but shall be in addition to the proceeds of the bond or the letter of credit.
(5) Any other investments that are approved by the Commissioner.
(d) All bonds or securities that are posted as a security deposit shall be valued annually at market value. If the market value is less than the face value, the Commissioner may require the self‑insurer to post additional securities. In making this determination, the Commissioner shall consider the self‑insurer's or guarantor's financial condition, the amount by which market value is less than face value, and the likelihood that the securities will be needed to provide benefits.
(e) Securities deposited under this section shall be assigned to the Commissioner, the Commissioner's successors, assigns, or trustees, on a form prescribed by the Commissioner in a manner that renders the securities negotiable by the Commissioner. If a self‑insurer or guarantor is deemed by the Commissioner to be in a hazardous financial condition, the Commissioner may sell or collect, or both, such amounts that will yield sufficient funds to meet the self‑insurer's obligations under the Act. In the case of a letter of credit, the Commissioner may draw the full amount of a letter of credit if the letter of credit is not renewed within 90 days prior to its expiration or at any time that the bank issuing the letter of credit is no longer acceptable to the Commissioner. Interest accruing on any negotiable security deposited under this Article shall be collected and transmitted to the self‑insurer if the self‑insurer or guarantor is not in a hazardous financial condition.
(f) No judgment creditor, other than a claimant entitled to benefits under the Act, may levy upon any deposits made under this section.
(g) Securities Pursuant
to the provisions of this section and with the approval of the Commissioner,
deposits held by the Commissioner under this section may be exchanged
or replaced by the self‑insurer with other securities of
like nature and amount as long as the self‑insurer is not in a hazardous
financial condition. No release shall be effectuated until replacement
securities or bonds of an equal value have been substituted. acceptable
forms of deposit in amount determined by the Commissioner. Any surety
bond may deposit to be exchanged or replaced with another
surety bond that meets the requirements of this section if 90 days' advance
written notice is given to the Commissioner. If a self‑insurer ceases to
self‑insure or desires to replace securities with an acceptable surety
bond or bonds, the self‑insurer shall notify the Commissioner, and may
recover all or a portion of the securities deposited with the Commissioner upon
posting instead an acceptable special release bond issued by a corporate surety
in an amount equal to the total value of the securities. The special release
bond shall cover all existing liabilities under the Act plus an amount to cover
future loss development and shall remain in force until all obligations under
the Act have been discharged fully.another form of deposit shall not be
released until the approved replacement deposit is received by the
Commissioner.
(h) If a self‑insurer
ceases to self‑insure, no deposits shall be released by the Commissioner
until the self‑insurer has discharged fully all of the self‑insurer's
obligations under the Act.Any self‑insurer that ceases to self‑insure,
whether by voluntary termination or by revocation of license, shall continue to
secure and be liable for its obligations under the Act and shall continue to
report to the Commissioner pursuant to G.S. 97‑180. Upon the request
of the Commissioner, a self‑insurer that ceases to self‑insure
shall submit filings, as prescribed in G.S. 97‑180, to determine
whether the deposit is sufficient to satisfy those workers' compensation
obligations incurred during the period that the self‑insurer was licensed
as a self‑insurer. The Commissioner may require an increase in the
deposit amount or may grant a reduction in the deposit amount to ensure that
the deposit is sufficient to cover all existing and future obligations incurred
by the self‑insurer while subject to the provisions of the Act.
(i) An endorsement to a surety bond shall be filed with the Commissioner within 90 days after the effective date of the endorsement."
SECTION 14. G.S. 97‑190 reads as rewritten:
"§ 97‑190. Excess insurance.
(a) Every self‑insurer, as a prerequisite for licensure under this Article, shall maintain specific and aggregate excess loss coverage through an insurance policy. A self‑insurer shall maintain limits and retentions commensurate with its risk. A self‑insurer's retention shall be the lowest retention suitable for the self‑insurer's exposures and level of annual premium. The Commissioner may require different levels, or waive the requirement, of specific and aggregate excess loss coverage consistent with the market availability of excess loss coverage, the self‑insurer's claims experience, and the self‑insurer's or guarantor's financial condition.
(b) An excess insurance
policy required by this section shall be issued by either a licensed an
insurance company licensed in this State or an approved eligible
surplus lines insurance companyinsurer as defined in G.S. 58‑21‑10
and shall:
(1) Provide for at least 30 days' written notice of cancellation by registered or certified mail, return receipt requested, to the self‑insurer and to the Commissioner.
(2) Be renewable automatically at its expiration, except upon 30 days' written notice of nonrenewal by certified mail, return receipt requested, to the self‑insurer and to the Commissioner.
(c) Every self‑insurer shall provide to the Commissioner evidence of coverage and any amendments within 30 days after their effective dates. Every self‑insurer shall, at the request of the Commissioner, furnish copies of its excess insurance policies and amendments."
SECTION 15. G.S. 97‑195 reads as rewritten:
"§
97‑195. Revocation of license. Revocation, suspension or
restriction of license.
(a) The
Commissioner summarily may revoke a license if there is satisfactory evidence
for the revocation. In determining whether to revoke a license summarily, the
Commissioner may consider any or all of the following:
(1) Determination
of insolvency by a court of competent jurisdiction.
(2) Institution of
bankruptcy proceedings.
(3) If the self
insurer is in a hazardous financial condition.
(a1) The Commissioner may, upon at least 45 days notice and opportunity for a hearing, revoke, suspend, or restrict the license of a self‑insurer if any of the following apply:
(1) The self‑insurer fails or refuses to comply with any law, order, or rule applicable to the self‑insurer.
(2) There is a determination of insolvency by a court of competent jurisdiction.
(3) The self‑insurer is in a hazardous financial condition.
(4) The self‑insurer has experienced a material loss or deteriorating operating trends, or has reported a deficit financial position.
(5) Any affiliate or subsidiary is insolvent, threatened with insolvency, or delinquent in payment of its monetary or any other obligation.
(6) The self‑insurer has failed to pay premium taxes pursuant to Article 8B of Chapter 105 of the General Statutes.
(7) Contingent liabilities, pledges, or guaranties that either individually or collectively involve a total amount that in the Commissioner's opinion may affect a self‑insurer's solvency.
(8) The management of a self‑insurer has failed to respond to the Commissioner's inquiries about the condition of the self‑insurer or has furnished false and misleading information in response to an inquiry by the Commissioner.
(9) The management of a self‑insurer has filed any false or misleading sworn financial statement, has released a false or misleading financial statement to a lending institution or to the general public, or has made a false or misleading entry or omitted an entry of material amount in the filed financial information.
(10) The self‑insurer has experienced, or will experience in the foreseeable future, cash flow or liquidity problems.
(11) The self‑insurer has failed to make proper and timely payment of claims, as required by this Article.
(12) Failure to pay any North Carolina Self‑Insurance Security Association assessments made pursuant to G.S. 97‑133.
(13) Failure to participate in the Association Aggregate Security System or, if excluded from participation in the Association Aggregate Security System, failure to provide and maintain the deposit required by G.S. 97‑185.
(b) The
Commissioner, upon at least 45 days' notice, may revoke a license if there is
satisfactory evidence for the revocation. In determining whether to revoke a
license under this subsection, the Commissioner may consider any or all of the
following:
(1) Whether the
self‑insurer has experienced a material loss or deteriorating operating
trends, or reported a deficit financial position.
(2) Whether any
affiliate or subsidiary is insolvent, threatened with insolvency, or delinquent
in payment of its monetary or any other obligation.
(3) Whether the
self‑insurer has failed to pay premium taxes pursuant to Article 8B of
Chapter 105 of the General Statutes.
(4) Repealed by
Session Laws 2003‑221, s. 15, effective June 19, 2003.
(5) Contingent
liabilities, pledges, or guaranties that either individually or collectively
involve a total amount that in the Commissioner's opinion may affect a self‑insurer's
solvency.
(6) Whether the
management of a self‑insurer has failed to respond to the Commissioner's
inquiries about the condition of the self‑insurer or has furnished false
and misleading information in response to an inquiry by the Commissioner.
(7) Whether the
management of a self‑insurer has filed any false or misleading sworn
financial statement, has released a false or misleading financial statement to
a lending institution or to the general public, or has made a false or
misleading entry or omitted an entry of material amount in the filed financial
information.
(8) Whether the
self‑insurer has experienced or will experience in the foreseeable
future, cash flow or liquidity problems.
(9) Whether the
self‑insurer has not complied with the other provisions of this Article
or the Act.
(10) Whether the self‑insurer
has failed to make proper and timely payment of claims as required by this
Article.
(c) Any self‑insurer
subject to license revocation revocation, suspension, or restriction under
subsection (a) or (b) (a1) of this section may request an
administrative hearing before the Commissioner to review that order. If a
hearing is requested, a notice of hearing shall be served, and the notice shall
state the time and place of hearing and the conduct, condition, or ground on
which the Commissioner based the order. Unless mutually agreed upon between the
Commissioner and the self‑insurer, the hearing shall occur not less than
10 days nor more than 30 days after notice is served and shall be either in
Wake County or in some other place designated by the Commissioner. The
Commissioner shall hold all hearings under this section privately unless the
self‑insurer requests a public hearing, in which case the hearing shall
be public. The request for a hearing shall not stay the effect of the
order."
SECTION 16. Article 5 of Chapter 97 of the General Statutes is amended by adding the following new section:
"§ 97‑196. Civil penalties or restitution for violations; administrative procedure.
(a) Whenever the Commissioner has reason to believe that a self‑insurer has violated any of the provisions of this Article, and the violation subjects the license of the self‑insurer to suspension or revocation, the Commissioner may, after notice and opportunity for a hearing, proceed under the appropriate subsections of this section.
(b) If the Commissioner finds a violation of this Article, the Commissioner may, in addition to or instead of suspending or revoking the license, order the payment or a monetary penalty as provided in subsection (c) of this section or petition the Superior Court of Wake County for an order directing payment of restitution as provided in subsection (d) of this section, or both. Each day during which a violation occurs constitutes a separate violation.
(c) If the Commissioner orders the payment of a monetary penalty pursuant to subsection (b) of this section, the penalty shall not be less than one hundred dollars ($100.00) nor more than one thousand dollars ($1,000). In determining the amount of the penalty, the Commissioner shall consider the degree and extent of harm caused by the violation, the amount of money that inured to the benefit of the violator as a result of the violation, whether the violation was committed willfully, and the prior record of the violator in complying or failing to comply with laws, rules, or orders applicable to the violator. The clear proceeds of the penalty shall be remitted to the Civil Penalty and Forfeiture Fund in accordance with G.S. 115C‑457.2. Payment of the civil penalty under this section shall be in addition to payment of any other penalty for a violation of the criminal laws of this State.
(d) Upon petition of the Commissioner, the court may order the self‑insurer who committed a violation specified in subsection (b) of this section to make restitution in an amount that would make whole any person harmed by the violation. The petition may be made at any time, and the petition may be made in any appeal of the Commissioner's order.
(e) Restitution to any State agency for extraordinary administrative expenses incurred in the investigation and hearing of the violation may also be ordered by the court in such amount that would reimburse the agency for the expenses.
(f) Nothing in this section prevents the Commissioner from negotiating a mutually acceptable agreement with any self‑insurer as to the status of the self‑insurer's license or as to any civil penalty or restitution.
(g) Unless otherwise specifically provided for, all administrative proceedings under this Article are governed by Chapter 150B of the General Statutes. Appeals of the Commissioner's orders under this section shall be governed by G.S. 58‑2‑75."
SECTION 17. G.S. 58‑2‑161(a)(1)p. reads as rewritten:
"§ 58‑2‑161. False statement to procure or deny benefit of insurance policy or certificate.
(a) For the purposes of this section:
(1) "Insurer" has the same meaning as in G.S. 58‑1‑5(3) and also includes:
. . .
p. The North Carolina Self‑Insurance
Guaranty Security Association under Article 4 of Chapter 97 of
the General Statutes.
…"
SECTION 18. G.S. 58‑30‑10(7) reads as rewritten:
"§ 58‑30‑10. Definitions.
As used in this Article, unless the context clearly indicates otherwise:
. . .
(7) "Domestic guaranty
association" means the Postassessment Insurance Guaranty Association in
Article 48 of this Chapter, as amended; the North Carolina Self‑Insurance
Guaranty Security Association in Article 4 of Chapter 97 of the
General Statutes; the Life and Accident and Health Insurance Guaranty
Association in Article 62 of this Chapter, as amended; or any other similar
entity hereafter created by the General Assembly for the payment of claims of
insolvent insurers.
. . . "
SECTION 19. G.S. 58‑47‑65(f)(14) reads as rewritten:
"(f) The license application shall comprise the following information:
. . .
(14) A letter stipulating the
applicant's acceptance of membership in the North Carolina Self‑Insurance
Guaranty Security Association under Article 4 of Chapter 97 of
the General Statutes.
. . . "
SECTION 20. G.S. 105‑259(b)(16a) reads as rewritten:
"(b) Disclosure Prohibited. – An officer, an employee, or an agent of the State who has access to tax information in the course of service to or employment by the State may not disclose the information to any other person unless the disclosure is made for one of the following purposes:
. . .
(16a) To provide the North
Carolina Self‑Insurance Guaranty Security Association
information on self‑insurers' premiums as determined under G.S. 105‑228.5(b),
(b1), and (c) for the purpose of collecting the assessments authorized in G.S. 97‑133(a).
. . . "
SECTION 21. This act becomes effective January 1, 2006.
In the General Assembly read three times and ratified this the 24th day of August, 2005.
_____________________________________
Beverly E. Perdue
President of the Senate
_____________________________________
James B. Black
Speaker of the House of Representatives
_____________________________________
Michael F. Easley
Governor
Approved __________.m. this ______________ day of ___________________, 2005