Cal. Code Regs. tit. 10 § 2250

Current through Register 2024 Notice Reg. No. 45, November 8, 2024

Section 2250 - Definitions

The following definitions shall apply to this Article.

(a) "Policy form" means a form that an insurer uses to provide workers' compensation insurance coverage to an employer after the form is approved by the Insurance Commissioner.

(b) "Endorsement" or "endorsement form" means a form, agreement or document that amends, adds to, subtracts from, supplements, or revises a policy form and is attached to a policy form to be effective.

(c) "Attached" means that a writing is part of the policy of insurance by (1) being physically connected to the policy or (2) including a statement in the writing that it is incorporated by reference into the policy.

(d) "Attachment clause" means a provision in an endorsement or ancillary agreement identifying the policy of insurance and incorporating the endorsement or ancillary agreement by providing blank spaces for the insertion of a policy number, endorsement or ancillary agreement number, endorsement or ancillary agreement effective date, name of policyholder, and if applicable, a countersignature.

(e) "Limiting and restricting endorsement" means an endorsement that excludes from coverage some portion of workers' compensation liability for which the employer is required to secure payment pursuant to the Labor Code that, after approval of the endorsement by the Insurance Commissioner, may be endorsed to a workers' compensation policy.

(f) "Ancillary agreement" means an agreement that is a supplementary writing or contract relating to a policy or endorsement form that adds to, subtracts from, or revises the obligations of either the insured or the insurer regarding any terms of an insurance policy including, but not limited to, dispute resolution agreements, policy premium amounts or rates, expense or tax reimbursement or allocation, deductible amounts, policy duration, cancellation, or claims administration. "Ancillary agreements" do not include:

(1) Limiting and restricting endorsements as defined in Subdivision (e) of this regulation;

(2) Customized limiting and restricting endorsements as defined in Subdivision (g) of this regulation; or

(3) Agreements specifying only terms described in subdivisions (f)(3)(A) through (f)(3)(F) below, but only if, such terms are disclosed and negotiated contemporaneously with the inception or renewal of the underlying policy, and any revisions or additions to such terms subsequent to the inception or renewal of the policy are mutually agreed upon by the parties:

(A) the method for making payments,

(B) the method for funding deductible amounts or other policy-related charges due under a policy,

(C) the amounts of collateral or security the insured is required to maintain for claims that do not exceed the deductible,

(D) payment due dates,

(E) payment transmittal information, or

(F) the method of selecting a claims administrator, provided that such claims administrator may only administer claims that do not exceed the deductible.

(g) "Customized limiting and restricting endorsement" means an endorsement unique to a specific policy used (1) When the employer's business is conducted in such a manner that it is impossible or impracticable to determine the nature, scope, and extent of employment covered by the insurer, or (2) To prevent the performance of work in such an extremely hazardous manner or under such hazardous conditions as would reflect a reckless disregard by the employer for the welfare of its employees, or (3) To prevent the issuance of an unrestricted policy if it would encourage an operation that is contrary to law or to the rules of a regulatory agency.

(h) "Rating organization" means a workers' compensation rating organization as defined by Insurance Code Section 11750.1(b), and licensed pursuant to Insurance Code Section 11751.1.

(i) "Advisory organization" means a workers' compensation advisory organization as defined by Insurance Code Section 11750.1(e).

(j) "Standard policy form" or "standard endorsement form" means a policy or endorsement form that is submitted to the Insurance Commissioner by a rating organization on behalf of its insurer members for use by any of its insurer members as an insurance policy or endorsement form.

(k) "Non-standard policy form" or "non-standard endorsement form" means a policy form, endorsement form, or ancillary agreement that a rating organization submits to the Insurance Commissioner on behalf of a single insurer member for use as an insurance policy, endorsement, or ancillary agreement.

(l) "Withdrawal of approval" means the Commissioner's notification to an insurer that a policy form, endorsement form, or ancillary agreement that was previously approved will be disapproved and shall not be used.

(m) "Filed" means the date the California Department of Insurance receives a document or electronic transmittal of information, through a Department-approved electronic filing system.

Cal. Code Regs. Tit. 10, § 2250

1. New section filed 2-2-2016; operative 4-1-2016 (Register 2016, No. 6). For prior history, see Register 58, No. 4.

Note: Authority cited: Section 12921(a), Insurance Code. Reference: Sections 11650, 11651, 11652, 11653, 11654, 11655, 11656, 11656.7, 11657, 11658, 11659, 11660, 11735(e), 11750.1(b), 11750.1(e), 11750.3(e), 11751.1, 11751.4, 11752.6(h), 11752.8 and 12957, Insurance Code.

1. New section filed 2-2-2016; operative 4/1/2016 (Register 2016, No. 6). For prior history, see Register 58, No. 4.