053-2 Wyo. Code R. § 2-3

Current through April 27, 2019

Section 2-3 - Experience Rating

(a) One (1) experience modification rating shall be assigned to each employer number for those eligible employers under the Act. An employer who elects to establish a separate employer number for each separate legal entity of the employer's businesses shall be assigned an experience rating for each employer number.

(b) An employer's experience modification rating (whereby, hereafter shall be known as EMR) is computed by using three (3) years claims experience [or maximum available portions of three (3) years] for each eligible employer.

• (i) Private sector employers will receive an EMR based on three (3) years claims experience effective January 1 of their fifth (5th) calendar year.

• (ii) Public sector employers will receive an EMR based on three (3) years claims experience effective July 1 of their sixth (6th) fiscal year.

(c) Pursuant to W. S. § 27-14-207(j), the out-of-state employer must direct their insurance company to submit their EMR history directly to the Division.

• (i) If an out-of-state employer expanding or moving their operations to Wyoming has previously been self-insured, and does not have any experience history available from a third party workers' insurance company, they will be assigned an EMR of one (1) and will be charged at the industry base rate for their classification.

• (ii) The Division will use the employers experience history to calculate the EMR according to the current EMR split-plan calculation.

(d) For an employer having less than one (1) full year (private employers follow a fiscal year; public employers follow a calendar year) of premium obligation during the EMR period, the employer's EMR will be equal to a modification of one (1).

(e) For an employer having greater than one (1) full year of premium obligation during the EMR period, but less than three (3) full years of premium obligation, the actual premium obligation will be based on the employer's actual experience as recorded by the Division in the quarterly or monthly reports in the premium year.

(f) The Division, through the qualified actuary, as defined by W. S. § 27-14-201(b), shall annually determine key parameters of the EMR plan to meet the requirements of W. S. § 27 - 14201(d). The Division will notify each employer who qualifies for an EMR of the key parameters (i, ii, iii) of this sub-section on the yearly EMR notice. The key parameters will also be published on the Division website for any employer to inspect.

• (i) Split Point - The claim cost amount at which an employer's EMR moves from the measure of frequency to the measure of severity. The Division will apply a plus or minus cap of 15% (percent) to the employer's EMR beginning with rate year 2017 and to apply to rate year 2018, excluding Group I.

• (ii) Group Premium Rate - There will be five (5) groups for premium bands. Each Group Premium Rate will have a credit/debit maximum percent amount to affect the employer's Experience Modification Rate (EMR). At no time shall this exceed +/- eighty-five percent (85%). Individual employer groups are based on the amount of premium over a three (3) year period and the actuarial process.

  Group 1 not to exceed +/- 20%

  Group 2 not to exceed +/- 25%

  Group 3 not to exceed +/- 45%

  Group 4 not to exceed +/- 65%

  Group 5 not to exceed +/- 85%

• (iii) Chargeable minimum and maximum - There will be a claim cost minimum on medical only cases, which are not ratable to the employer and will not affect the EMR. There will also be a claim cost maximum at which point claim cost above the maximum single loss are not ratable and will not affect the EMR.

(g) For employers in Group I, the experience adjustment for claims occurring within the three (3) year EMR period shall be as follows:

• (i) Zero percent (0%) if the employer's account has been charged with one (1) claim which exceeds the annual minimum claim cost amount.

• (ii) Twenty percent (20%) penalty if the employer's account has been charged with two (2) or more claims which exceed the annual minimum claims cost amount.

• (iii) Twenty percent (20%) credit if the employer's account has not been charged with a claim exceeding the annual claims cost amount.

(h) The formula for computing the split plan experience modification rating (EMR) is defined below, with each term defined in Section 15, is as follows:

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Where: Zp = Credibility Primary Value

Ap = Actual Primary Losses

Ep = Expected Primary Losses

Ze = Credibility Excess Value

Ae = Actual Excess Losses

Ee = Expected Excess Losses

E = Expected Losses

(See Glossary of Terminology in Section 15.)

(i) Contesting Experience Modification Rating. Any employer may contest the annual EMR or case reserve amounts assigned by the Division. Contest shall be made by filing a written objection with the Division within thirty (30) days after notification by the Division as provided in W. S. § 27-14-201(h). The Division shall resolve the matter administratively within forty-five (45) days after the filing of the objection. If the matter is not resolved within forty-five (45) days then the Division shall refer the objection to an independent hearing officer appointed for such purpose, pursuant to these rules and the Wyoming Administrative Procedure Act.

(j) Contesting Chargeability of Claims Costs. An employer may apply for non-chargeability of claims costs pursuant to W. S. § 27-14-201(d).

• (i) An employer who is current on premium payments required by the act may contest the chargeability of claims costs by filing a written application with the Division on a form supplied by the Division.

• (ii) The application to determine chargeability must be filed no later than one (1) year after the determination of compensability for an injury occurring on or after July 1, 2015.

• (iii) Upon receipt of said application, the Division shall schedule a time and date for a hearing. The employer shall be notified of the time and date of the hearing.

• (iv) The hearing shall be conducted pursuant to the Division's Rules, Chapter 1, Section 4 or https://rules.wyo.gov/Search.aspx?mode=1

• (v) The hearing shall be conducted by a panel from the Division, including the Administrator of the Workers' Compensation Division, the Deputy Administrator of Employer Services, the Deputy Administrator of Claims, the District Manager from the appropriate district, the claims analyst assigned to the underlying claim, a representative from OSHA, and a representative from the Attorney General's Office.

• (vi) The employer will present its case to the panel after which the panel shall take the issue under advisement and issue a written, final determination.

• (vii) If an employer fails to appear for the hearing, the initial determination on chargeability will become the final agency action.

053-2 Wyo. Code R. § 2-3

Amended, Eff. 10/13/2016.

Amended, Eff. 8/24/2017.

Amended, Eff. 12/11/2018.