Chapter 12. Responsibilities of Insurers
Regulation .01 Definitions.LinkCopy Citation
A.
In this chapter, the following term has the meaning indicated.
B.
Terms Defined.
(1)
“Competent Individual” means an individual who has sufficient skill, knowledge, and experience to handle and adjust disputed claims and who has authority to resolve claims without having to routinely contact an out-of-State representative of the insurer.
(2)
“Commission designee” means the National Council on Compensation Insurance or any other entity that the Commission, from time to time, may designate as its representative to receive notices required by this regulation.
(3)
“Insurance policy” means a policy or binder for workers' compensation insurance under Labor and Employment Article, Title 9, Annotated Code of Maryland.
Regulation .02 Notices of Insurance, Cancellation, Reinstatement, and Election of Coverage.LinkCopy Citation
A.
Notice of Insurance. When an insurance policy is issued or renewed, the insurer issuing or renewing it shall file a notice of insurance with the Commission designee within 45 days after the effective date of the policy.
B.
Notice of Cancellation.
(1)
Required Filing. When an insurance policy is cancelled by the insurer or by the insured, the insurer shall file a notice of cancellation with the Commission designee.
(2)
Time for Filing.
(a)
Cancellation by Insurer.
(i)
If the insurer cancels the insurance policy for nonpayment of premium, the notice of cancellation shall be filed at least 10 days before the effective date of the cancellation, in compliance with Insurance Article, §19-406(f), Annotated Code of Maryland.
(ii)
If the insurer cancels the insurance policy for any other reason, the notice of cancellation shall be filed at least 45 days before the effective date of the cancellation, in compliance with Insurance Article, §19-406(a), Annotated Code of Maryland.
(b)
Cancellation by Insured. When the cancellation is initiated by the insured, the notice of cancellation shall be filed by the insurer within 15 days after the effective date of the cancellation.
C.
Notice of Reinstatement — Time of Filing. When an insurance policy is reinstated, the insurer shall file a notice of reinstatement with the Commission designee within 15 days after the effective date of the reinstatement.
D.
Notice of Insurance, Cancellation, and Reinstatement — Form and Content. A notice of insurance, cancellation, or reinstatement shall contain all the following information:
(1)
The employer's name;
(2)
All names under which the employer trades;
(3)
All nontemporary business addresses of the employer in Maryland;
(4)
The employer’s federal identification number or, if the employer is not required to have a federal identification number, the last four digits of the employer’s social security number;
(5)
The insurance policy number; and
(6)
The policy period.
E.
Notice of Election of Inclusion or Exemption of Coverage.
(1)
A person may elect to be a covered employee by filing a notice of election with the Commission and with the insurer.
(2)
The following types of persons may elect to be covered employees:
(a)
Pursuant to Labor and Employment Article, §9-227(b), Annotated Code of Maryland, sole proprietors; and
(b)
Pursuant to Labor and Employment Article, §9-219(b), Annotated Code of Maryland, partners.
(3)
A person may elect to be exempt from coverage as an employee by filing a notice of election with the Commission and the insurer.
(4)
The following types of persons may elect to be exempted from coverage:
(a)
Pursuant to Labor and Employment Article §9-206(b)(1), officers of a closed corporation;
(b)
Pursuant to Labor and Employment Article §9-206(b)(2) and (c), officers of a corporation, other than closed corporation;
(c)
Pursuant to Labor and Employment Article §9-206(b)(3) and (4), officers of a farm corporation or professional services corporation; and
(d)
Pursuant to Labor and Employment Article §9-206(b)(5), members of a limited liability company.
(5)
If an employer changes insurers, a person shall file a new notice of election with the Commission and with the new insurer.
Regulation .03 Handling and Adjusting Disputed Claims.LinkCopy Citation
A.
An insurer that provides workers' compensation insurance in Maryland shall have in the State competent individuals who:
(1)
Handle and adjust each disputed workers' compensation claim for the insurer;
(2)
Have authority to resolve claims without having to routinely contact an out-of-State representative of the insurer; and
(3)
Possess the knowledge and experience to handle and adjust each disputed claim.
B.
If an insurer files issues to dispute a claim, the filing shall be done in the State by competent individuals who:
(1)
Handle and adjust each disputed workers' compensation claim for the insurer;
(2)
Have authority to resolve claims without having to routinely contact an out-of-State representative of the insurer; and
(3)
Possess the knowledge and experience to handle and adjust each disputed claim.
C.
Within 10 days of an insurer filing issues to dispute a claim, the insurer shall have an attorney complete and file an entry of appearance form in accordance with COMAR 14.09.04.01C(2).
D.
Each insurer shall register with the Commission the contact information for a designated representative who can identify the competent individual handling and adjusting each disputed claim.
E.
Upon inquiry, the designated individual shall provide the name, address, telephone number, and email address of the competent individual handling and adjusting a claim within 2 business days.
F.
If any of the information in §D of this regulation changes, the insurer shall notify the Commission immediately.
G.
An insurer that provides workers' compensation insurance in Maryland shall establish a toll-free telephone number through which an insured or claimant, or a representative of an insured or claimant, may make direct telephone inquiries during regular business hours.
H.
An insurer that provides workers’ compensation insurance in Maryland shall register with CompHub to file and receive papers with the Commission.
Regulation .04 Failure to Comply.LinkCopy Citation
A.
Fine.
(1)
An insurer found in violation of Regulation .03 of this chapter may be fined up to $1,000 per offense.
(2)
Each day a violation is continued after the first fine is a separate offense.
B.
Revocation of Self-Insurance Approval. A violation of Regulation .03 of this chapter that jeopardizes prompt and fair compensation of a Maryland workers' compensation claim may be grounds for the revocation of an employer's self-insurance approval under Labor and Employment Article, §9-403(e)(1), Annotated Code of Maryland.
Regulation .05 Hearing Procedure.LinkCopy Citation
A.
Notice of Agency Action.
(1)
If the Commission has reasonable cause to believe that an insurer has violated Regulation .03 of this chapter, the Commission shall give reasonable notice of the alleged violation and the action the Commission proposes to take.
(2)
The notice shall state:
(a)
The facts that are asserted;
(b)
If the facts cannot be stated in detail when the notice is given, the issues that are involved;
(c)
The potential penalty that could be imposed;
(d)
That the recipient has a right to request a hearing;
(e)
That any request for a hearing shall be in writing and received by the Commission within 20 days of the date of the notice; and
(f)
That if a hearing is not requested within the time allowed, the Commission shall render its decision on the basis of its own investigation.
B.
Notice of Hearing.
(1)
If a hearing is requested, the Commission shall mail a notice of the hearing 20 days before the date set for the hearing.
(2)
The notice shall state:
(a)
The date, time, place, and nature of the hearing;
(b)
That the insurer may submit a written statement 5 days before the hearing;
(c)
That the insurer may present oral argument at the hearing;
(d)
That the insurer may call witnesses and submit documents or other evidence relative to the issues contained in the notice; and
(e)
That the insurer may agree to the evidence and waive its right to appear at the hearing.
C.
Postponement.
(1)
An insurer may request a postponement in writing 5 days before the hearing.
(2)
If an insurer fails to appear at a hearing, and has not requested a postponement, the Commission may either:
(a)
Proceed with the hearing; or
(b)
Make its decision on the record before it.
D.
Disposition. A hearing may not be adjourned or continued except upon order of the Commission.
Regulation .06 Penalty for Failure to Submit Required Case Payment Report.LinkCopy Citation
A.
The Commission may assess against an insurer a fine not to exceed $1,000 for any unexcused failure to file a case payment report as required under Labor and Employment Article, §9-313(b), Annotated Code of Maryland.
B.
Schedule of Assessments. The schedule of assessments established by the Commission is as follows:
C.
In calculating the imposition of an assessment on an insurer, each failure to submit a required report or the submission of an inaccurate or incomplete report is considered a separate violation subject to assessment.
Regulation .07 Appeal.LinkCopy Citation
An appeal from a decision made under this chapter shall be made on the record in accordance with Maryland Rule 7-206.1(b).
Regulation .08 Report of Payroll.LinkCopy Citation
A.
In accordance with Labor and Employment Article, §9-316(g), Annotated Code of Maryland, each insurer shall file an annual report of insured payroll to the Commission electronically and as directed by the Commission.
B.
Any unexcused failure to file an accurate annual report of insured payroll to the Commission as required under Labor and Employment Article, §9-316(g), Annotated Code of Maryland, may result in an inaccurate assessment, delays in any refund due as a result of inaccurate reporting, or both.
Chapter annotations
Authority: Insurance Article, §19-406; Labor and Employment Article, §§9-309, 9-404, 9-405, 9-409, 9-410, and 9-744; Annotated Code of Maryland
History: Effective date: March 3, 2014 (41:4 Md. R. 303)
History: Regulation .02 amended effective October 18, 2021 (48:21 Md. R. 890)
History: Regulation .02A amended effective March 12, 2018 (45:5 Md. R. 288)
History: Regulation .02B amended effective January 7, 2016 (42:26 Md. R. 1596)
History: Regulation .02D amended effective February 24, 2020 (47:4 Md. R. 263)
History: Regulation .03A, B amended effective March 12, 2018 (45:5 Md. R. 288)
History: Regulation .03C, D amended effective October 18, 2021 (48:21 Md. R. 890)
History: Regulation .03H adopted effective October 18, 2021 (48:21 Md. R. 890)
History: Regulation .07 amended effective October 18, 2021 (48:21 Md. R. 890)
History: Regulation .08 adopted effective October 18, 2021 (48:21 Md. R. 890)