Section 0780-01-83-.02 - DEFINITIONS(1). "Aggregate Excess Insurance" means the amount of insurance required to cover the total accumulated workers' compensation benefits for all claims payable for a given period of time with the Employer retaining an obligation for a designated amount as a deductible and the insurer paying all amounts due thereafter up to a maximum total obligation.(2) "Certificate of Authority" means a license issued by the Commissioner to an Employer granting it the authority to self-insure the workers' compensation liabilities of its Employees in this State.(3) "Commissioner" means the Commissioner of Commerce and Insurance.(4) "Department" means the Tennessee Department of Commerce and Insurance.(5) "Employee" means an employee of an Employer that self-insures its workers' compensation benefits and liabilities pursuant to T.C.A. § 50-6-405(a)(2).(6) "Employer" means an employer that self-insures its workers' compensation liabilities pursuant to T.C.A. § 50-6-405(a)(2).(7) "IBNR" means incurred but not reported claims.(8) "Impaired Employer" means an Employer:(a) Whose liabilities exceed the value of its assets and/or that has stopped paying debts in the ordinary course of business or is unable to pay them as its debts fall due, as may be shown by an excess of the Employer's required reserves and other liabilities over its assets;(b) Who has suspended payment of workers' compensation benefits as determined by the Commissioner;(c) Who has filed for relief under bankruptcy laws;(d) Against whom bankruptcy proceedings have been filed; or(e) For whom a receiver has been appointed by a court of this state.(9) "Known Claims" means claims that have been incurred by an Employee of the Employer and submitted to an Employer for payment of workers' compensation benefits.(10) "Loss Prevention Effort" means an ongoing effort by the Employer to integrate health and safety into the workplace in such a manner that occupational injuries and illnesses are reduced.(11) "Loss Prevention Plan" means a plan developed by the Employer with the primary emphasis on reduction of workplace injuries and illnesses.(12) "Loss Prevention Services" means services designed to advise and assist Employers in the identification, evaluation, and control of existing and potential causes of accidents and occupational health and safety problems.(13) "Loss Prevention Services Program" means a program intended to promote occupational health and safety, and to help eliminate and control work hazards to Employees.(14) "Loss Reserves" means funds of the Employer immediately available to pay:(a) Known or open claims and expenses therewith;(b) IBNR and expenses associated therewith;(c) Unearned premiums; and(d) Bad or uncollectible debts.(15) "NAIC" means the National Association of Insurance Commissioners.(16) "Person" means an individual or a business entity.(17) "Qualified Actuary" means an individual who:(a) Is a member in good standing of the American Academy of Actuaries and an associate or fellow of the Casualty Actuarial Society;(b) Is qualified to sign statements of actuarial opinion for workers' compensation insurance company annual statements in accordance with the American Academy of Actuaries and Casualty Actuarial Society's qualification standards for actuaries signing such statements;(c) Is familiar with the reserve requirements applicable to workers' compensation insurance companies and self-insuring Employers; and(d) Has not been found by the Commissioner (or if so found has subsequently been reinstated as a qualified actuary), following appropriate notice and hearing to have: 1. Violated any provision of, or any obligation imposed by, the Tennessee Insurance Law or other law in the course of his or her dealings as a qualified actuary;2. Been found guilty of fraudulent or dishonest practices;3. Demonstrated his or her incompetence, lack of cooperation, or untrustworthiness to act as a qualified actuary;4. Submitted to the Commissioner during the past five (5) years an actuarial opinion or memorandum that the Commissioner rejected because it did not meet the provision of this Chapter including standards set by the Actuarial Standards Board; or5. Resigned or been removed as an actuary within the past five (5) years as a result of failure to adhere to generally acceptable actuarial standards.(18) "Qualified United States Financial Institution" shall have the meaning assigned by T.C.A. § 56-2-209(c).(19) "Reserve" means the amount necessary to satisfy all debts, past, present, and future, incurred by reason of industrial accidents or occupational diseases, the origins of which commenced prior to the date of reserve determination.(20) "Specific Excess Insurance" means the amount of insurance required to cover the workers' compensation benefits arising out of a specific occurrence (accident) or occupational disease under the Workers' Compensation Law with the Employer retaining an obligation for a designated amount as a deductible and the insurer assuming the obligation for all amounts due thereafter up to a maximum total obligation.(21) "Tennessee Insurance Law" means any law administered by the Commissioner affecting the business of insurance in this state, including, but not limited to T.C.A. § 50-6-405 and T.C.A. §§ 56-1-101, et. seq. as well as any rules promulgated thereunder.(22) "Third party administrator" means any person engaged by an Employer, excluding an employee of the Employer, to carry out the policies established by the Employer and to provide day to day management of the Employer's workers' compensation benefits.(23) "Workers' compensation" means both workers' compensation and employer's liability as prescribed under Title 50, Chapter 6 of the Tennessee Code Annotated.Tenn. Comp. R. & Regs. 0780-01-83-.02
Original rule filed August 11, 2005; effective October 25, 2005.Authority: T.C.A. §§ 50-6-405(b)(8) and 50-6-405(h).