What is the maximum amount the guaranty association will pay on a covered claim that is not workers compensation and is not an unearned premium claim?

Assessment

Yes, the Florida Workers’ Compensation Insurance Guaranty Association (FWCIGA) Board certified the need, and the Florida Office of Insurance Regulation (OIR) approved a 1.0% assessment effective January 1, 2020.

Prior to liquidation of Guarantee Insurance Company (GIC), the Association was in the best financial position since its inception in 1997.  Through good stewardship of assets coming from older insolvencies, no assessment has been needed since 2005 - 14 years.  GIC was liquidated November 27, 2017 resulting in over 2,100 claims and $141 million in liabilities to the Association.

Most guaranty association assessments are based upon a fixed percentage of prior year premiums as reported in an insurer’s statutory annual statement.  Insurers pay a percentage of prior year premiums to the guaranty association and are allowed to surcharge policyholders or receive some form of tax credit depending on state law.  Florida’s assessment is based on a uniform assessment surcharge rate applied to actual premium billed.  Insurers remit assessments either upfront or as surcharges are collected, depending on the Association’s funding needs.  Collections and remittances are reconciled annually.

Under Section 631.914, Florida Statutes, OIR, upon certification by the Board, shall assess member insurers to the extent necessary to secure funds for payment of covered claims.  In 2016, the Florida Legislature passed Senate Bill 828 giving OIR and FWCIGA additional flexibility in its assessment process.

Major changes under Senate Bill 828 include:

• Established an “Assessment Year” as a 12-month period beginning the 1st day of any calendar quarter (January, April, July and October),
• Created a uniform assessment percentage and surcharge period to be applied by all member insurers, thus eliminating the guaranty association assessment factor in the National Council on Compensation Insurance (NCCI) rate filing with the Office of Insurance Regulation (OIR),
• Allowed assessments to be payable prior to or after surcharges are collected, and
• Required insurers to file reconciliation reports with FWCIGA after the completion of an assessment year.

That determination is ultimately up to the Board and is based on the current and future cash needs of the Association.  Based on our current cash flow forecasts, a pass-through was approved for the 2020 assessment.

Member insurers will be given at least 90 days to implement and begin collecting surcharges.

Generally speaking, if a claim qualifies as a “covered claim” pursuant to Section 631.904, Florida Statutes, the premium from which it was derived is assessable premium. The law has not changed which lines of business are assessable by the FWCIGA.  FWCIGA covers claims on workers’ compensation policies defined in Section 631.904(2), Florida Statutes including excess workers’ compensation or any other employer liability coverage of a workers’ compensation policy.

Assessable premiums are based on Full Policy Premium Value which means the premium that would be charged after all applicable adjustments (drug free workplace credits, safety credits, experience modification factors, standard discounts, expense constraints, etc.) but without the premium adjustment resulting from the deductible clause of the policy.

Member insurers will remit and/or report surcharges collected and a signed remittance form within 30 days from the end of the reporting quarter. All insurers begin collecting and remitting assessments on the same date, as set forth in the levy order.

An assigned individual for each member insurer will receive a request via email to complete and sign the remittance form electronically. Assessment payment can be remitted via check or wire transfer.

Check
FWCIGA
P.O. Box 15159
Tallahassee, FL 32317

Wire
FWCIGA Operating Account
Acct #4729862433
Bank: Wells Fargo Bank, N.A.
ABA #121000248

ACH Payments
Account Name:  Florida Workers’ Compensation Insurance Guaranty Association
ACH Routing Number:  121000248
Account Number:  4729862433

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Yes, but each member insurer is required to complete a separate remittance form for each company in the group.  Please provide the NAIC number and assessment amount for each company included in the group either on the check remittance documentation or in the wire payment detail fields.

Yes, due to the length of time that may elapse between billing and the collection and audit of workers’ compensation premium for policies issued or renewed with effective dates during the assessment year, the Statute provides for an initial reconciliation at 120 days following the end of the assessment year and then annually thereafter for three years

At the conclusion of an assessment year, a reconciliation will be conducted to compare assessments remitted to FWCIGA to assessments calculated based on assessable premium reported.  If the reconciliation results in assessments due in excess of assessments remitted, members must remit additional funds to FWCIGA.  If the reconciliation results in assessment due less than assessments remitted to FWCIGA, the excess will be refunded to members.

Yes, the assessment percentage should be applied to all endorsements to policies effective during the assessment year.

Yes, the assessment percentage should be applied to all premium adjustments to policies incepting during the assessment year.  Given the time period required to conduct premium audits, the reconciliation period may extend 24 to 36 months beyond the 12-month assessment year.

FWCIGA’s recommendation is to round assessment surcharge similar to other premium amounts listed on the information page of the policy.

NCCI confirms in Circular 02-FL-2018 that the assessment surcharge is not reportable.

FWCIGA’s position is the audit noncompliance charge can be premium (subject to surcharge) or non-premium (not subject to surcharge) depending on the basis for the charge. If the noncompliance charge is made pursuant to Section 440.381(5), the amount is not premium according to the NCCI and would not be subject to surcharge.  If the noncompliance charge is made pursuant to Section 440.381(8), it is premium and therefore subject to the assessment surcharge.

No, FWCIGA only covers workers’ compensation and excess workers’ compensation written by admitted carriers.  Surplus lines policies are not covered and therefore not subject to surcharge.

Pursuant to Section 631.914(1)(a), Florida Statutes, the policyholder surcharge is computed and levied based on the full policy premium before credits or discounts for deductibles are applied. Sections 631.914(1) and 631.916, Florida Statutes, provide the FWCIGA Board the authority to administer assessments pursuant to the plan of operation.  The Plan of Operation defines full policy premium and premium subject to surcharge as follows:

“Full Policy Premium” means direct written premium after all applicable adjustments  (drug free workplace credit, safety credits, experience modification factor, standard discounts, expense constants, etc.), but prior to the application of discounts or credits resulting from any deductible clause (small, intermediate or large) in the policy.  Full policy premium includes premium adjustments relating to audits and class code changes but excludes premium adjustments relating to any deductibles and/or retrospective rating credits made in subsequent periods on policies beginning during the Assessment Year subject to the Policy Surcharge.

Yes, the policy surcharge is added to the Estimated Annual Premium (below the line) and collected by member insurers for remittance to the Association. FWCIGA Bulletin 2019-01 provides four examples for how to calculate the policy surcharge.  The first example assumes a policy with no deductible credit.  The second example shows how to calculate surcharge for a policy with small/intermediate deductible credit.  Third and fourth examples show how to calculate surcharge for policies with deductible credits applied to either the modified premium or standard premium. Because policy systems and rating plans may vary significantly, we do not attempt to provide specific guidance to cover all scenarios. Our goal is to provide general guidance to allow implementation across differing policy systems while ensuring consistent application by all member insurers.

Yes, initially. All members companies authorized to write workers’ compensation will receive a remittance form after the end of the first quarter. There will be a checkbox on the form for members to confirm if they are not writing workers’ compensation during assessment year. All they will need to do is enter zeros for collected premium and surcharges and check the box so we know not to send future remittance forms.

From FWCIGA's standpoint, anyone authorized to sign on behalf of the member company may complete and sign the Quarterly Surcharge Remittance form.

FWCIGA is part of a non-profit, state-based, statutorily-created system that pays certain outstanding claims of insolvent workers’ compensation insurance companies and self-insurance funds.  By paying these claims, guaranty associations protect policyholders and claimants.

Guaranty associations are active in every state, the District of Columbia, Puerto Rico and the Virgin Islands.  State laws require that licensed property and casualty insurance companies belong to the guaranty associations in every state where they are licensed to do business.

A guaranty association system also exists in Florida for the life, health and annuity insurance industry and individual self insured’s; but they operate independently from the property and casualty system.  This information concerns only the workers' compensation insurance guaranty associations.

Guaranty associations ease the burden on policyholders and claimants of the insolvent insurer by immediately stepping in to assume responsibility for most policy claims following liquidation. The coverage guaranty associations provide is fixed by the policy or state law; they do not offer a “replacement policy.”

By virtue of the authority given to the guaranty associations by state law, they are able to provide two important benefits:  prompt payment of covered claims and payment of the full value of covered claims up to the limits set by the policy or state law.

FWCIGA is administered by a board that is elected by the guaranty association members (that is, all companies writing licensed business in that state), the Florida Consumer Advocate, a Chief Financial Officer appointee and a Governor appointee.  There is oversight authority by the Florida Department of Financial Services, who reviews the association’s plan of operation, and may also audit a guaranty association.  In Florida the appointment to the guaranty association board is subject to the approval of the Chief Financial Officer.

While many of the associations are based on a model set forth by the National Association of Insurance Commissioners (NAIC), there are differences in statutes that govern the associations and their operation from state to state, including the amount of coverage provided by the association.

The potential failure of insurance companies, like the potential failure of all businesses, is an unfortunate, but inevitable, part of doing business in a free-market system.  Since inception of the property and casualty guaranty association system, there have been about 600 insolvencies.  In all, the system has paid out about $24.2 billion.

FWCIGA is partially funded by assets of insolvent insurers.  Receivers marshal estate assets and reimburse FWCIGA for paid claims and administrative costs related to the FWCIGA’s claim paying activities.

The other source of funding is member company assessments.  FWCIGA’s assessments are capped at 2% for insurance companies and self-insurance funds net direct premium written in Florida.

FWCIGA’s assessments are computed and billed based on the immediate needs of the guaranty association that has claims it needs to pay.  Claim files come in from the insolvent insurance company; the adjusters review them, and set appropriate reserves on those files. (Reserves are the projected ultimate liability under terms of a given policy.)

In Florida the assessment cap is 2% of net direct-written premium.  FWCIGA cannot assess an insurance company or self-insurance fund more than the statutorily set cap on assessments.

Liquidation is similar to bankruptcy. When a company is liquidated, the Liquidator (also referred to as the Receiver), collects the assets of the company and verifies the liabilities such as claim payments and bills. The Liquidator then develops a plan to distribute the company’s assets according to the law and submits the plan to the Court for approval.

In most cases, an estate will not yield sufficient money to pay claims in full; and most are not able to pay claims in a timely manner.  For this reason, FWCIGA and other state guaranty associations step in (depending on the number of states in which the failed company wrote business) to cover certain claims.  The estate’s creditors not covered by the guaranty associations usually receive only partial payment on their claims.

Yes.

Most liquidation orders cancel all policies within a certain time period after liquidation, typically 30 days.

You will need to obtain coverage with another insurance company. However, we do not recommend any particular company. You may contact any licensed insurance agent to get the names of other insurers.

A covered claim is defined in the FWCIGA statute (F.S.631.904) as:…“Covered claim” means an unpaid claim, including a claim for return of unearned premiums, which arises out of, and is within the coverage of, and not in excess of, the applicable limits of an insurance policy to which this part applies, which policy was issued by an insurer and which claim is made on behalf of a claimant or insured who was a resident of this state at the time of the injury."

No.  FWCIGA is designed as a safety net to pay certain claims arising out of policies issued by licensed insurance companies and self-insurance funds.  FWCIGA does not pay non-policy claims or claims of individual self-insured’s, or other entities that are exempt from participation in the guaranty association system.

FWCIGA coverage is limited to licensed insurers and self-insurance funds (the members of the guaranty associations that, in turn, pay insolvency-related assessments.)  When a licensed insurance company or self-insurance fund becomes insolvent, the FWCIGA pays eligible claims; but a company does not have guaranty association coverage if it is writing non-admitted or unlicensed products, such as surplus lines or is a self-insurer covered in the non-admitted market.

These limits on guaranty association coverage are necessary to balance the need to provide a safety net to those who would be most harmed by the insolvency of their insurance company and keep the burden of providing the safety net at an acceptable level.

Yes.  FWCIGA limits the amount they pay to the amount of coverage provided by the policy.  However, FWCIGA does not limit benefits paid to injured workers and pays 100 percent of the statutorily defined workers’ compensation benefits. Employer liability claims are limited to the lesser of $300,000 or policy limits. For unearned premium claims, FWCIGA’s obligation is limited to $50,000 and covers only policies in force on the date of liquidation.

It varies, but claim payments usually begin as soon as possible once a company is ordered liquidated.  FWCIGA, coordinating with the receivers of the liquidating companies, works hard to avoid any interruption in periodic benefits that are being paid to claimants, such as workers’ compensation loss-of-wages payments.

The processing and payment of pending covered claims will be made by FWCIGA.

You may contact the Florida Workers’ Compensation Insurance Guaranty Association (FWCIGA) at;

PO Box 15159
Tallahassee, Florida 32317
(866) 909-9200 Toll Free
(850) 523-1887 FAX

FWCIGA will pay unearned premium claims after the Receiver completes its processing of the policy records and sends the unearned premium record to FWCIGA.  This may take several weeks or several months depending on the condition of the data at the insolvent insurance company.