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<chapter num="12" heading="Responsibilities of Insurers" title_num="14" subtitle_num="09">
  <regulation prefix="Regulation" num=".01" heading="Definitions.">
    <paragraph num="A.">
      <text>In this chapter, the following term has the meaning indicated.</text>
    </paragraph>
    <paragraph num="B.">
      <text>Terms Defined.</text>
      <paragraph num="(1)">
        <text>“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.</text>
      </paragraph>
      <paragraph num="(2)">
        <text>“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.</text>
      </paragraph>
      <paragraph num="(3)">
        <text>“Insurance policy” means a policy or binder for workers' compensation insurance under Labor and Employment Article, Title 9, Annotated Code of Maryland.</text>
      </paragraph>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".02" heading="Notices of Insurance, Cancellation, Reinstatement, and Election of Coverage.">
    <paragraph num="A.">
      <text>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.</text>
    </paragraph>
    <paragraph num="B.">
      <text>Notice of Cancellation.</text>
      <paragraph num="(1)">
        <text>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.</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Time for Filing.</text>
        <paragraph num="(a)">
          <text>Cancellation by Insurer.</text>
          <paragraph num="(i)">
            <text>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.</text>
          </paragraph>
          <paragraph num="(ii)">
            <text>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.</text>
          </paragraph>
        </paragraph>
        <paragraph num="(b)">
          <text>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.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="C.">
      <text>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.</text>
    </paragraph>
    <paragraph num="D.">
      <text>Notice of Insurance, Cancellation, and Reinstatement — Form and Content. A notice of insurance, cancellation, or reinstatement shall contain all the following information:</text>
      <paragraph num="(1)">
        <text>The employer's name;</text>
      </paragraph>
      <paragraph num="(2)">
        <text>All names under which the employer trades;</text>
      </paragraph>
      <paragraph num="(3)">
        <text>All nontemporary business addresses of the employer in Maryland;</text>
      </paragraph>
      <paragraph num="(4)">
        <text>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;</text>
      </paragraph>
      <paragraph num="(5)">
        <text>The insurance policy number; and</text>
      </paragraph>
      <paragraph num="(6)">
        <text>The policy period.</text>
      </paragraph>
    </paragraph>
    <paragraph num="E.">
      <text>Notice of Election of Inclusion or Exemption of Coverage.</text>
      <paragraph num="(1)">
        <text>A person may elect to be a covered employee by filing a notice of election with the Commission and with the insurer.</text>
      </paragraph>
      <paragraph num="(2)">
        <text>The following types of persons may elect to be covered employees:</text>
        <paragraph num="(a)">
          <text>Pursuant to Labor and Employment Article, §9-227(b), Annotated Code of Maryland, sole proprietors; and</text>
        </paragraph>
        <paragraph num="(b)">
          <text>Pursuant to Labor and Employment Article, §9-219(b), Annotated Code of Maryland, partners.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(3)">
        <text>A person may elect to be exempt from coverage as an employee by filing a notice of election with the Commission and the insurer.</text>
      </paragraph>
      <paragraph num="(4)">
        <text>The following types of persons may elect to be exempted from coverage:</text>
        <paragraph num="(a)">
          <text>Pursuant to Labor and Employment Article §9-206(b)(1), officers of a closed corporation;</text>
        </paragraph>
        <paragraph num="(b)">
          <text>Pursuant to Labor and Employment Article §9-206(b)(2) and (c), officers of a corporation, other than closed corporation;</text>
        </paragraph>
        <paragraph num="(c)">
          <text>Pursuant to Labor and Employment Article §9-206(b)(3) and (4), officers of a farm corporation or professional services corporation; and</text>
        </paragraph>
        <paragraph num="(d)">
          <text>Pursuant to Labor and Employment Article §9-206(b)(5), members of a limited liability company.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(5)">
        <text>If an employer changes insurers, a person shall file a new notice of election with the Commission and with the new insurer.</text>
      </paragraph>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".03" heading="Handling and Adjusting Disputed Claims.">
    <paragraph num="A.">
      <text>An insurer that provides workers' compensation insurance in Maryland shall have in the State competent individuals who:</text>
      <paragraph num="(1)">
        <text>Handle and adjust each disputed workers' compensation claim for the insurer;</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Have authority to resolve claims without having to routinely contact an out-of-State representative of the insurer; and</text>
      </paragraph>
      <paragraph num="(3)">
        <text>Possess the knowledge and experience to handle and adjust each disputed claim.</text>
      </paragraph>
    </paragraph>
    <paragraph num="B.">
      <text>If an insurer files issues to dispute a claim, the filing shall be done in the State by competent individuals who:</text>
      <paragraph num="(1)">
        <text>Handle and adjust each disputed workers' compensation claim for the insurer;</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Have authority to resolve claims without having to routinely contact an out-of-State representative of the insurer; and</text>
      </paragraph>
      <paragraph num="(3)">
        <text>Possess the knowledge and experience to handle and adjust each disputed claim.</text>
      </paragraph>
    </paragraph>
    <paragraph num="C.">
      <text>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).</text>
    </paragraph>
    <paragraph num="D.">
      <text>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.</text>
    </paragraph>
    <paragraph num="E.">
      <text>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.</text>
    </paragraph>
    <paragraph num="F.">
      <text>If any of the information in §D of this regulation changes, the insurer shall notify the Commission immediately.</text>
    </paragraph>
    <paragraph num="G.">
      <text>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.</text>
    </paragraph>
    <paragraph num="H.">
      <text>An insurer that provides workers’ compensation insurance in Maryland shall register with CompHub to file and receive papers with the Commission.</text>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".04" heading="Failure to Comply.">
    <paragraph num="A.">
      <text>Fine.</text>
      <paragraph num="(1)">
        <text>An insurer found in violation of Regulation .03 of this chapter may be fined up to $1,000 per offense.</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Each day a violation is continued after the first fine is a separate offense.</text>
      </paragraph>
    </paragraph>
    <paragraph num="B.">
      <text>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.</text>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".05" heading="Hearing Procedure.">
    <paragraph num="A.">
      <text>Notice of Agency Action.</text>
      <paragraph num="(1)">
        <text>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.</text>
      </paragraph>
      <paragraph num="(2)">
        <text>The notice shall state:</text>
        <paragraph num="(a)">
          <text>The facts that are asserted;</text>
        </paragraph>
        <paragraph num="(b)">
          <text>If the facts cannot be stated in detail when the notice is given, the issues that are involved;</text>
        </paragraph>
        <paragraph num="(c)">
          <text>The potential penalty that could be imposed;</text>
        </paragraph>
        <paragraph num="(d)">
          <text>That the recipient has a right to request a hearing;</text>
        </paragraph>
        <paragraph num="(e)">
          <text>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</text>
        </paragraph>
        <paragraph num="(f)">
          <text>That if a hearing is not requested within the time allowed, the Commission shall render its decision on the basis of its own investigation.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="B.">
      <text>Notice of Hearing.</text>
      <paragraph num="(1)">
        <text>If a hearing is requested, the Commission shall mail a notice of the hearing 20 days before the date set for the hearing.</text>
      </paragraph>
      <paragraph num="(2)">
        <text>The notice shall state:</text>
        <paragraph num="(a)">
          <text>The date, time, place, and nature of the hearing;</text>
        </paragraph>
        <paragraph num="(b)">
          <text>That the insurer may submit a written statement 5 days before the hearing;</text>
        </paragraph>
        <paragraph num="(c)">
          <text>That the insurer may present oral argument at the hearing;</text>
        </paragraph>
        <paragraph num="(d)">
          <text>That the insurer may call witnesses and submit documents or other evidence relative to the issues contained in the notice; and</text>
        </paragraph>
        <paragraph num="(e)">
          <text>That the insurer may agree to the evidence and waive its right to appear at the hearing.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="C.">
      <text>Postponement.</text>
      <paragraph num="(1)">
        <text>An insurer may request a postponement in writing 5 days before the hearing.</text>
      </paragraph>
      <paragraph num="(2)">
        <text>If an insurer fails to appear at a hearing, and has not requested a postponement, the Commission may either:</text>
        <paragraph num="(a)">
          <text>Proceed with the hearing; or</text>
        </paragraph>
        <paragraph num="(b)">
          <text>Make its decision on the record before it.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="D.">
      <text>Disposition. A hearing may not be adjourned or continued except upon order of the Commission.</text>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".06" heading="Penalty for Failure to Submit Required Case Payment Report.">
    <paragraph num="A.">
      <text>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.</text>
    </paragraph>
    <paragraph num="B.">
      <text>Schedule of Assessments. The schedule of assessments established by the Commission is as follows:</text>
    </paragraph>
    <paragraph num="C.">
      <text>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.</text>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".07" heading="Appeal.">
    <text>An appeal from a decision made under this chapter shall be made on the record in accordance with Maryland Rule 7-206.1(b).</text>
  </regulation>
  <regulation prefix="Regulation" num=".08" heading="Report of Payroll.">
    <paragraph num="A.">
      <text>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.</text>
    </paragraph>
    <paragraph num="B.">
      <text>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.</text>
    </paragraph>
  </regulation>
  <annotations>
    <annotation type="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</annotation>
    <annotation type="History" subtype="Administrative History">Effective date: March 3, 2014 (41:4 Md. R. 303)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .02 amended effective October 18, 2021 (48:21 Md. R. 890)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .02A amended effective March 12, 2018 (45:5 Md. R. 288)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .02B amended effective January 7, 2016 (42:26 Md. R. 1596)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .02D amended effective February 24, 2020 (47:4 Md. R. 263)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .03A, B amended effective March 12, 2018 (45:5 Md. R. 288)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .03C, D amended effective October 18, 2021 (48:21 Md. R. 890)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .03H adopted effective October 18, 2021 (48:21 Md. R. 890)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .07 amended effective October 18, 2021 (48:21 Md. R. 890)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .08 adopted effective October 18, 2021 (48:21 Md. R. 890)</annotation>
  </annotations>
</chapter>