STATE OF NEW JERSEY
DEPARTMENT OF BANKING AND INSURANCE
60 PARK PLACE, NEWARK, NJ 07102
(973) 622-6014
GROVER E. CZECH, ESQ.
FREDERICK A. HUBER
Executive Director
Associate Executive Director
June 13, 2005
MANUAL AMENDMENT BULLETIN #427
To All Bureau Members and Subscribers:
Re:
Changes to Manual Rules
The Commissioner of Banking and Insurance has approved the following changes to the New
Jersey Workers Compensation and Employers Liability Insurance Manual (Manual). The changes are
effective July 1, 2005 on a new and renewal basis.
FORMS
Amend 3:2 to include an amended New Jersey Limited Other States Insurance Endorsement
(WC 29 03 09 A). This endorsement, which is attached as Exhibit I, is amended to clarify wording in
the previous version of this endorsement that was deemed to be confusing or not sufficiently clear as to
its intent.
The “Index – Policy Forms and Endorsements” has been revised to include the amended
endorsement. The revised Index is attached as Exhibit II.
With respect to policy forms, your attention is called to 3:2-1 of the Manual wherein it is
stipulated that they must be filed in duplicate with the Rating Bureau before being placed in use.
PREPARATION AND AUDITING OF POLICIES
Amend 3:3-40.1 as follows:
PRESENT
40.1 Spouse of Individual Proprietor or
Partner
. The payroll of a spouse of an
individual proprietor or spouse of a partner in a
partnership employed to perform work in
connection with the business operations of the
insured shall be included in the statement of
payroll and a premium charged thereon subject
to a maximum average individual payroll of one
thousand eight hundred fifty ($1,850) per week
and a minimum average of four hundred sixty
($460) per week. The maximum average and
minimum average payroll required by this rule
shall be subject to pro rata adjustment where the
spouse does not devote full time to the risk
subject to audit.
PROPOSED
40.1 Spouse of Individual Proprietor or
Partner.
The payroll of a spouse of an
individual proprietor
, a spouse of a partner in
a partnership or a spouse of a principal owner
of a Limited Liability Company
employed to
perform work in connection with the business
operations of the insured shall be included in
the statement of payroll and a premium
charged thereon subject to a maximum
average individual payroll of one thousand
eight hundred fifty ($1,850) per week and a
minimum average of four hundred sixty
($460) per week. The maximum average and
minimum average payroll required by this rule
shall be subject to pro rata adjustment where
the spouse does not devote full time to the risk
subject to audit.
Manual Amendment Bulletin #427
Similar to an individual proprietor or a partner in a partnership, owners of Limited Liability
Companies have the option of including or excluding themselves from the policy coverage. Presently,
the Manual rule in 3:3-40.1 provides for inclusion of payroll, subject to the payroll limitations applying
to Executive Officers of corporations, of an actively working spouse of an individual proprietor or
partner for premium determination purposes. The Manual rule in 3:3-40.1 must be amended to provide
for the inclusion of payroll of an actively working spouse of a principal owner of a Limited Liability
Company for premium determination, subject to the payroll limitations to Executive Officers of
corporations.
APPROVED MANAGED CARE PROGRAM
Amend 3:10B as follows:
PRESENT
4. Notification in Writing.
A member carrier
utilizing an approved managed care program
shall notify the Rating Bureau in writing on the
form prescribed for that purpose if it intends to
apply a premium reduction. A copy of the form
is shown in 8. below. The form and attachments
stipulated therein, where applicable, must be
completed and signed.
8. Forms Required
APPLICATION
FOR AN
APPROVED MANAGED CARE PROGRAM
PREMIUM REDUCTION
(Application Form not shown)
PROPOSED
4. Notification in Writing.
A member carrier
utilizing an approved managed care program
shall notify the Rating Bureau in writing on the
form prescribed for that purpose if it intends to
apply a premium reduction. A copy of the form
is shown in
9.
below. The form and attachments
stipulated therein, where applicable, must be
completed and signed.
8. New Jersey Workers Compensation
Insurance Plan.
An Approved Managed Care
Program Premium Reduction shall not be
offered or available to any risk written through
the New Jersey Workers Compensation
Insurance Plan.
9. Forms Required
APPLICATION
FOR AN
APPROVED MANAGED CARE PROGRAM
PREMIUM REDUCTION
(
See Exhibit III
)
This section of the Manual has been amended to provide for a new rule and revisions to
two current rules. The new rule is included in 3:10B-8. This rule prohibits the use of an Approved
Managed Care Program Premium Reduction in policies written through the New Jersey Workers
Compensation Insurance Plan (Plan). The “Application for an Approved Managed Care Program
Premium Reduction” form, that was previously included in 3:10B-8, has been revised and is now
included in 3:10B-9. The Application form, filed with the Bureau by insurers that opt to offer Approved
Managed Care Program Premium Reductions, was revised to include a statement indicating that an
Approved Managed Care Premium Reduction is not applicable to policies written through the Plan.
Finally, the rule in 3:10B-4 has been revised to account for the renumbering of the Application form.
Grover E. Czech, Esq.
Executive Director
GEC:njl
Att.
Manual Amendment Bulletin #427
Exhibit I
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 29 03 09 A
NEW JERSEY LIMITED OTHER STATES INSURANCE ENDORSEMENT
Part Three - Other States Insurance
is amended to read:
A.
How This Insurance Applies
1. We will pay promptly, when due, the benefits required of you by the workers' compensation law
of any state not listed in Item 3.A. of the Information Page, if all of the following conditions are
met:
a.
The employee claiming benefits was employed under a contract of hire made in a state listed
in Item 3.A. of the Information Page and was, at the time of injury, principally employed in
a state listed in Item 3.A. of the Information Page; and
b.
The employee claiming benefits is not claiming benefits in a state where, at the time of
injury, (i) you have other workers' compensation coverage, or (ii) you were, by virtue of the
nature of your operations in that state, required by that state's law to have obtained separate
workers' compensation insurance coverage, or (iii) you are an authorized self-insurer or
participant in a self-insured group plan; and
c. The duration of the work being performed by the employee claiming benefits in a state other
than those listed in item 3.A. of the Information Page is temporary.
2. If we are not permitted to pay the benefits directly to persons entitled to them under
circumstances described in item 1 above, we will reimburse you for the benefits required to be
paid.
3. This insurance does not apply to fines or penalties arising out of your failure to comply with the
requirements of the workers' compensation law.
IMPORTANT NOTICE!
If you hire any employees outside of New Jersey to work principally outside of New Jersey or you begin operations in
any state other than New Jersey, you must obtain insurance coverage in that state and do whatever else may be
required under that state’s law, as this Limited Other States Endorsement does not satisfy the requirements of that
state’s workers’ compensation law.
This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.
(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)
Endorsement Effective
Policy No.
Endorsement No.
Insured
Premium $
Insurance Company
Countersigned by
Notes:
1.
Servicing carriers and direct assignment carriers must attach this endorsement to all policies issued through the New
Jersey Workers’ Compensation Insurance Plan. Voluntary carriers may, as an option, elect to attach this endorsement to
any policy showing New Jersey in Item 3.A. of the Information Page.
2.
Enter “See Endorsement WC 29 03 09 A” in Item 3.C. of the Information Page.
EXHIBIT II
INDEX
POLICY FORMS AND ENDORSEMENTS APPLICABLE IN NEW JERSEY
STANDARD VERSION IDENTIFIER IDENTIFIER± Workers Compensation and Employers Liability Insurance Policy... WC 00 00 00 A Information Page (With New Jersey Requirements)... WC 00 00 01 B
FEDERAL COVERAGES AND EXCLUSIONS
Defense Base Act Coverage Endorsement ... WC 00 01 01 A Federal Employers' Liability Act Coverage Endorsement ... WC 00 01 04
Longshore and Harbor Workers' Compensation Act Coverage Endorsement ... WC 00 01 06 A Outer Continental Shelf Lands Act Coverage Endorsement ... WC 00 01 09 A Notification Endorsement of Pending Law Change to Terrorism Risk Insurance Act of 2002... WC 00 01 12
New Jersey Voluntary Compensation Federal Employers' Liability Act Coverage Endorsement ... WC 29 01 01
MARITIME COVERAGES AND EXCLUSIONS
Maritime Coverage Endorsement ... WC 00 02 01 A Voluntary Compensation Maritime Coverage Endorsement ... WC 00 02 03
OTHER COVERAGE AND EXCLUSIONS
Alternate Employer Endorsement... WC 00 03 01 A Designated Workplaces Exclusion Endorsement ... WC 00 03 02
Insurance Company as Insured Endorsement... WC 00 03 04 Joint Venture as Insured Endorsement ... WC 00 03 05
Rural Electrification Administration Endorsement ... WC 00 03 09 A New Jersey Workers Compensation and Employers Liability Coverage for Residence Employees Endorsement ... WC 29 03 02 A New Jersey Employee Leasing Labor Contractor Endorsement ... WC 29 03 03
New Jersey Employee Leasing Client Exclusion Endorsement... WC 29 03 04 New Jersey Employee Leasing Labor Contractor Exclusion Endorsement... WC 29 03 05
New Jersey Part Two Employers Liability Endorsement... WC 29 03 06 A New Jersey Sole Proprietor and Partners Coverage Endorsement ... WC 29 03 07
New Jersey Limited Other States Insurance Endorsement... WC 29 03 09 AÌ
New Jersey Workers Compensation Insurance Plan Eligibility Endorsement... WC 29 03 10
PREMIUM
Anniversary Rating Date Endorsement ... WC 00 04 02 Experience Rating Modification Factor Endorsement ... WC 00 04 03 Pending Rate Change Endorsement... WC 00 04 04 Policy Period Endorsement... WC 00 04 05 Rate Change Endorsement... WC 00 04 07 Premium Due Date Endorsement ... WC 00 04 19
Terrorism Risk Insurance Act Endorsement... WC 00 04 20 A New Jersey Premium Discount Endorsement: Schedule Y...±±WC 29 04 06 R New Jersey Premium Discount Endorsement: Schedule X...±±WC 29 04 07
New Jersey Approved Managed Care Program Endorsement ... WC 29 04 09 A New Jersey Construction Classification Premium Adjustment Endorsement ... WC 29 04 10
RETROSPECTIVE PREMIUM
Retrospective Premium Endorsement - One Year Plan... WC 00 05 03 A Retrospective Premium Endorsement - Three Year Plan... WC 00 05 04 A Retrospective Premium Endorsement Aviation Exclusion ... WC 00 05 08
Retrospective Premium Endorsement Changes... WC 00 05 09 A Retrospective Premium Endorsement Non-Ratable Catastrophe Element or Surcharge... WC 00 05 10
Retrospective Premium Endorsement Short Form ... WC 00 05 11
New Jersey Retrospective Premium Endorsement Part Two Employers Liability Insurance Excess Exclusion... WC 29 05 09 C New Jersey Retrospective Premium Endorsement - Long Term Construction Project ... WC 29 05 12 A New Jersey Retrospective Premium Endorsement - Large Risk Alternative Rating Option - One Year Rating Period... WC 29 05 13 C New Jersey Retrospective Premium Endorsement - Large Risk Alternative Rating Option - Three Year Rating Period ... WC 29 05 14 C New Jersey Retrospective Premium Endorsement - Large Risk Alternative Rating Option Long Term Construction Project ... WC 29 05 15 C New Jersey Large Risk - Large Deductible Endorsement... WC 29 06 01 A New Jersey Large Risk - Large Deductible Retrospective Adjustment Endorsement... WC 29 06 02 B New Jersey Large Risk – Large Deductible Aggregate Limit Endorsement ... WC 29 06 04
New Jersey Large Risk - Large Deductible Retrospective – Per Person Basis... WC 29 06 05
OTHER
Policy Information Page Endorsement ... WC 89 06 00 B New Jersey Participating Provisions Endorsement ... WC 29 06 03
NEW JERSEY NOTICES
New Jersey Notice of Cancellation... Form 116-B New Jersey Notice of Reinstatement ... Form 117-A
New Jersey Posting Notice ... Form 16NJ A New Jersey Posting Notice (Spanish)... Form 17NJ
New Jersey Notice of Election – Proprietors and Partners Workers Compensation and Employers Liability Insurance... Form PP-1 A ± Absence of a version identifier denotes original printing
±± The version identifier for these endorsements will be governed by revisions in verbiage or change in the Discount Percentages/Table of Rating Values forming a part of the endorsements