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§ 1000.4. Deductible options

Purdon's Pennsylvania Statutes and Consolidated StatutesTitle 77 P.S. Workers’ Compensation

Purdon's Pennsylvania Statutes and Consolidated Statutes
Title 77 P.S. Workers' Compensation (Refs & Annos)
Chapter 6. Procedure (Refs & Annos)
Administration, Coverages and Agreements
77 P.S. § 1000.4
§ 1000.4. Deductible options
(a) An insurer issuing a workers' compensation and employers' liability insurance policy shall offer, upon request, as part of the policy or by endorsement, deductibles optional to the policyholder for benefits payable under the policy, subject to approval by the commissioner and subject to underwriting by the insurer consistent with the principles in clause (b). The commissioner shall promulgate at least three (3) plans with varying deductible options, the least amount of which shall be no less than one thousand dollars ($1,000) nor more than two thousand five hundred dollars ($2,500). The commissioner's authority to promulgate any such plans shall not preclude an insurer from negotiating a deductible in excess of the largest deductible plan herein authorized, subject to approval by the commissioner and subject to underwriting by the insurer consistent with the principles in clause (b).
(b) The following standards shall govern the commissioner's promulgation and an insurer's offer of deductible plans:
(1) Claimants' rights are properly protected and claimants' benefits are paid without regard to any such deductible.
(2) Appropriate premium reductions reflect the type and level of any deductible approved by the commissioner and selected by the policyholder.
(3) Premium reductions for deductibles are determined before application of any experience modification, premium surcharge or premium discount.
(4) Recognition is given to policyholder characteristics, including size, financial capabilities, nature of activities and number of employes.
(5) If the policyholder selects a deductible, the policyholder is liable to the insurer for the deductible amount in regard to benefits paid for compensable claims.
(6) The insurer pays all of the deductible amount applicable to a compensable claim to the person or provider entitled to benefits and then seeks reimbursement from the policyholder for the applicable deductible amount.
(7) Failure to reimburse deductible amounts by the policyholder to the insurer is treated under the policy in the same manner as nonpayment of premiums.
(c) An insurer issuing a workers' compensation and employers' liability insurance policy may offer an endorsement for deductible or retrospective rating plans for groups of five (5) or more employers, subject to approval by the commissioner and subject to underwriting by the insurer consistent with the principles in clause (b).
(d) The following standards shall govern the commissioner's authorization of an insurer's offer of a group deductible or retrospective plan endorsement:
(1) Individual workers' compensation and employers' liability insurance policies will be issued for each member of the group.
(2) Each member will be held jointly and severally liable for the payment of premiums or deductible amounts with regard to benefits paid for compensable claims of the group as a whole.

Credits

1915, June 2, P.L. 736, No. 338, art. IV, § 448, added 1993, July 2, P.L. 190, No. 44, § 19, effective in 60 days. Amended 1996, June 24, P.L. 350, No. 57, § 21, effective in 60 days.
77 P.S. § 1000.4, PA ST 77 P.S. § 1000.4
Current through the end of the 2023 Regular Session. Some statute sections may be more current, see credits for details.
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