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S T A T E   O F   M A I N E

WORKERS' COMPENSATION BOARD

27 State House Station

Augusta, Maine  04333-0027

FAX (207) 287‑7198

TEL (207) 287‑7086

 

MEMORANDUM

 

Date Sent:  Aug 28 2009

 

           TO:     Parties Interested in Board Rulemaking

 

   SUBJECT:     Adopted Rules

Rule Chapter 3(5) - Electronic Filing of Proof of Coverage

 

 

 

The Maine Workers' Compensation Board has adopted the attached rules.  The effective date of the rules is August 22, 2009.

 

 

AGENCY CONTACT PERSON:    John C. Rohde, General Counsel

                    AGENCY NAME:     Workers' Compensation Board

                             ADDRESS:     27 State House Station

                                                   Augusta, Maine  04333-0027

                         TELEPHONE:     207-287-7086

                                  EMAIL:     John.Rohde@Maine.gov

 

 

Please Note:       Most offices will only receive one copy of this notification.  Please ensure that copies are distributed to your staff.  Thank you.

If you no longer wish to receive these mailings, please contact:

Lynne McKenney, Secretary Associate Legal

Workers' Compensation Board

27 State House Station

Augusta, Maine  04333-0027

Tel:  (207) 287-7086 / Fax:  (207) 287-7198

Email:  Lynne.McKenney@Maine.gov

It would be helpful if you would include the three digit code located on the upper right corner of the mailing label when writing or calling.


                                                                                                                                                  MAPA-4

                     Notice of Agency Rule-making Adoption

 

 

AGENCY:  WORKERS’ COMPENSATION BOARD

 

 

CHAPTER NUMBER AND TITLE:  Rule Chapter 3(5) - Electronic Filing of Proof of Coverage

 

 

ADOPTED RULE NUMBER: 

(LEAVE BLANK - ASSIGNED BY SECRETARY OF STATE)

 

 

CONCISE SUMMARY  (UNDERSTANDABLE BY AVERAGE CITIZEN):

 

This rule requires electronic filing by insurance companies of notice of new, renewal, or endorsement of any workers’ compensation policy.

 

 

 

 

 

 

 

 

 

EFFECTIVE DATE  (TO BE FILLED IN BY SECRETARY OF STATE):

 

 

AGENCY CONTACT PERSON:      John C. Rohde, General Counsel

                          AGENCY NAME:      Workers’ Compensation Board

                                    ADDRESS:      27 State House Station

Augusta, Maine  04333n0027

                               TELEPHONE:      207-287-7086

                                           EMAIL:      John.Rohde@Maine.gov

 

                                      Please approve bottom portion of this form and

                                              assign appropriate MFASIS number.

 

APPROVED FOR PAYMENT                                                       DATE:                     

Authorized signature

 

FUND             AGENCY           ORG            APP           JOB             OBJT             AMOUNT

 

014                 90C                    2001            01

 


90-351              WORKERS' COMPENSATION BOARD

 

Chapter 1:        PAYMENT OF BENEFITS

 

*          *          *          *          *

 

§ 10.     Notice of Workers' Compensation Insurance

 

            Insurance companies shall file with the Board a Notice of Workers' Compensation Insurance (WCB-1A) within 14 days after issuance, renewal, or endorsement of any workers' compensation policy to an employer. A copy of the Notice of Workers' Compensation Insurance (WCB-1A) must be mailed to the employer within 14 days after issuance, renewal, or endorsement of the workers' compensation policy.

 

*          *          *          *          *

 

 

90-351              WORKERS' COMPENSATION BOARD

 

Chapter 3:        FORM FILING

 

 

*          *          *          *          *

 

§ 5.      Electronic filing of proof of coverage

 

1.         General

 

A.        (1)        Unless a waiver has been granted pursuant to subsection (1)(B) of this section, insurance companies shall file with the Board notice of the issuancenew, renewal, or endorsement of any workers’ compensation policy to an employer using International Association of Industrial Accident Boards and Commissions (“IAIABC”) Proof of Coverage Release 2.1.

 

            (2)        For notices filed within the 52-week period immediately following the effective date of this rule, the required notice must be filed with the Board no later than 14 days from the transaction effective date for issuance, renewal or add endorsement.  However, if a transaction is submitted and rejected within the initial 14 day period, the notice will not be considered late if it is resubmitted and accepted by the Board within 30 days after the TR acknowledgement code is sent by the Board.  Transactions initially submitted later than 14 days after issuance, renewal or endorsement shall be considered late even if resubmitted and accepted by the Board within 30 days after the TR acknowledgement code is sent by the Board.

 

            (3)        For notices filed after the period specificied in subsection (1)(A)(2) of this section, the required notice must be filed with the Board no later than 14 days after issuance, renewal or endorsement.

 

B.        (1)        The Board, at its discretion by majority vote of its membership, may grant an insurer a waiver of the filing requirements of this section if the insurer establishes to the satisfaction of the Board that compliance with these requirements would cause undue hardship. For purposes of this section, undue hardship means significant difficulty or expense.  Requests for waivers must be submitted in writing and addressed to the Chair of the Workers’ Compensation Board, 27 State House Station, Augusta, Maine 04333‑0027.

 

(2)        Individual waiver. An individual notice of Proof of Coverage can be filed by paper or fax if the Executive Director or the Executive Director's designee finds that the insurer was prevented from complying with this section because of circumstances beyond the control of the insurer.  A decision by the Executive Director or the Executive Director's designee may be appealed to the Board of Directors.  The appeal must be in writing; must set forth the reasons why the appealing party believes the decision should be reversed; and must be filed within 7 (seven) days of the date of the decision appealed from.

 

2.         Definitions

 

A.        Application acknowledgement codes. A code used to identify whether or not a transaction has been accepted by the Board. A sender will receive one of the following codes after submitting a transaction:

 

(1)        HD.  The transmission was rejected and the Proof of Coverage is not filed.

 

(2)        TA (Transaction accepted). The transaction was accepted and the Proof of Coverage is filed.

 

(3)        TE (Transaction accepted with errors). The transaction was accepted with errors and the Proof of Coverage is filed. The error or errors will be identified in the acknowledgement transmission that is sent by the Board. All identified errors must be corrected within 14 days after the date the acknowledgement transmission was sent by the Board.

 

(4)        TR (Transaction rejected). The entire transaction has been rejected and the Proof of Coverage is not filed.

 

(5)        TW and TN.  These application acknowledgement codes are not used.

 

B.        Data element. A single piece of information (for example, policy effective date). Each data element is assigned a name and a number. Except as modified in this rule, data element names and numbers are as defined in IAIABC Proof of Coverage Release 2.1, Data Dictionary June 1, 2007 Edition (Appendix XI).

 

C.        Data element requirement code. A code used to designate whether or not a data element has to be included in a transaction. Each data element is assigned one of the following data element requirement codes:

 

(1)                    M (Mandatory). The data element must be present and must be in a valid format or the transaction will be rejected.

 

(2)                    MC (Mandatory/Conditional). The data element is mandatory if the conditions defined in the Maine Workers’ Compensation Board Proof of Coverage Release 2.1 Conditional Requirement Table (Appendix X) exist.

 

(3)                    E (Expected). The data element is expected when a transaction is submitted. The transaction will be accepted without the data element and the notice of Proof of Coverage is filed but is incomplete. The entity submitting the transaction will receive a message indicating the transaction was accepted with errors and identifying the missing or incorrect data element or elements. The notice of Proof of Coverage must be completed by submitting the missing or corrected data element or elements within 14 days after the error message is sent by the Board or prior to any subsequent submission for the same policy, whichever is sooner.

 

(4)                    EC (Expected/Conditional). The data element is expected if the conditions defined in the Maine Workers’ Compensation Board Proof of Coverage Release 2.1 Conditional Requirement Table (Appendix X) exist. The transaction will be accepted without the data element and the notice of Proof of Coverage is filed but is incomplete. The entity submitting the transaction will receive a message indicating the transaction was accepted with errors and identifying the missing or incorrect data element or elements. The notice of Proof of Coverage must be completed by submitting the missing or corrected data element or elements within 14 days after the error message is sent by the Board or prior to any subsequent submission for the same policy, whichever is sooner.

 

(5)                    IA (If Available). The data element should be sent if available. If the data element is sent, the Workers’ Compensation Board may edit the data to ensure valid value and format. A filing will not be rejected if the only error is a missing data element designated IA.

 

(6)                    NA (Not Applicable). The data element does not apply to the triplicate code and does not have to be sent. The Board will not edit these data elements.

 

(7)                    R (Restricted).

 

(8)                    F or FT (Fatal Technical). Data elements that must be sent. If a data element designated F is not present and in a valid format, the filing will be rejected.

 

(9)                    X (Exclude). The data element does not apply to the triplicate code and does not have to be sent. The Board will not edit these data elements.

 

D.        Record.  A defined group of data elements that is identified by the transaction set identifier.

 

E.         Report.  A report is equivalent to a transaction.

 

F.         Transaction.  The communication of data that represents a single business event.  A transaction consists of one or more records.

 

G.        Triplicate code.  The triplicate code defines the specific purpose for which the transaction is being sent.  It is a combination of the Transaction Set Purpose Code (DN0300), Transaction Set Type Code (DN0334) and Transaction Reason Code (DN0303).

 

3.         Requirements for filing using IAIABC Proof of Coverage Release 2.1

 

A.        Triplicate code.  One of the triplicate codes contained in the MWCB Proof of Coverage Element Requirement Table shall be used when transmitting Proof of Coverage.

 

B.        Data element requirements.  Data element requirements are as set forth in the Maine Workers’ Compensation Board IAIABC Proof of Coverage Release 2.1 Element Requirement Table contained in Appendix IX of this rule.


90-351

Maine Workers' Compensation Board

 

Rule Chapter 3, Section 4 Electronic Filing

 

List of Appendices

 

     I.     Maine Workers' Compensation Board (MWCB)

            Claims Release 3 (CR 3), First Report of Injury (FROI),

            Element Requirement Table, Revised 01/25/2007

 

    II.     MWCB CR 3, Subsequent Report of Injury (SROI),

            Element Requirement Table

 

  III.     MWCB CR 3, FROI, Conditional Requirement Table

 

   IV.     MWCB CR 3, SROI, Conditional Requirement Table

 

    V.     Proprietary EDI, FROI, File Layout Table

 

   VI.     Proprietary EDI, FROI, Element Requirement Table

 

VII.     Proprietary EDI, FROI, Error Message Table

 

VIII.     IAIABC CR 3, Data Dictionary, 06/01/2006 Edition with 12/01/2006 Supplement

 

  IX.     MWCB Proof of Coverage Element Requirement Table

Introduction to Appendix IX

 

    X.     MWCB Proof of Coverage Conditional Requirement Table

 

  XI.     IAIABC Proof of Coverage Release 2.1 Data Dictionary, 06/01/07 Edition

 


Rule-Making Fact Sheet

                                                            (5 MRSA  § 8057-A)

 

AGENCY:  WORKERS’ COMPENSATION BOARD

 

NAME, ADDRESS, PHONE NUMBER OF AGENCY CONTACT PERSON:

 

John C. Rohde, General Counsel, Workers’ Compensation Board, 27 State House Station, Augusta ME  04333-0027  TEL:  208-287-7086;

Email: John.Rohde@Maine.gov

 

CHAPTER NUMBER AND RULE TITLE:  Rule Chapter 3(5) - Electronic Filing of Proof of Coverage

 

STATUTORY AUTHORITY:  39-A M.R.S.A. § 152(2), 152(2-A) and 401(3)

 

DATE AND PLACE OF PUBLIC HEARING:  Monday, June 8, 2009, 9:00 a.m.,

Workers' Compensation Board, Central Office, AMHI Complex, Deering Building, First Floor, Room 170, Hospital Street, Augusta, Maine

 

COMMENT DEADLINE:  Thursday, June 18, 2009, 5:00 p.m.

 

PRINCIPAL REASON OR PURPOSE FOR PROPOSING THIS RULE:

Requiring electronic filing of proof of coverage will help ensure that the Board’s coverage records are up-to-date and accurate.  This will help the Board ensure that all employers are complying with the requirement to secure workers’ compensation coverage for their employees.

 

 

ANALYSIS AND EXPECTED OPERATION OF THE RULE:

For the first 52 weeks after the rule is effective, notices must be filed with 14 days of issuance, renewal or endorsement; but, if the original notice is filed within 14 days and rejected, the notice will not be considered late if it is refilled within 30 days after the Board rejected the original filing.

 

After this one-year period, all filings must be made within 14 days after issuance, renewal or endorsement.

 

FISCAL IMPACT OF THE RULE:   

 

  FOR RULES WITH FISCAL IMPACT OF $1 MILLION OR MORE, ALSO INCLUDE:

ECONOMIC IMPACT, WHETHER OR NOT QUANTIFIABLE IN MONETARY TERMS:

INDIVIDUALS OR GROUPS AFFECTED AND HOW THEY WILL BE AFFECTED:

BENEFITS OF THE RULE:

 

                                            Note:  If necessary, additional pages may be used.


CHAPTER 3 § 5

Electronic Filing of Proof of Coverage

 

BASIS STATEMENT

 

            The amendment to Chapter 3 requires electronic filing by insurance companies of notice of the issuance, renewal or endorsement of any workers’ compensation policy.

 

SUMMARY OF COMMENTS

 

            Commentators 1 and 2 support the draft rule except that they believe the employer Unemployment Insurance data element should be Expected instead of Mandatory.  Commentator 1 states that insurers do not have access to UI numbers directly, that the numbers can change over time, and, that it is important to not block the filing of proof of coverage because without an accepted proof of coverage, First Reports of Injury and Notices of Controversy cannot be filed.

RESPONSE: The UIAN must be mandatory to ensure integrity of the database; FROIs are accepted without POC filings; this rule was drafted through consensus-based rulemaking.

 

            Commentators 2 believes the grace period in section 5(1)(A)(2) should be made permanent.

RESPONSE:  The grace period should give ample time to make sure everyone adapts to the process and can be revisited later if need be; this rule was drafted through consensus-based rulemaking.

 

            Commentator 3 believes fines for failing to submit accurate UI numbers should be indefinitely suspended.

RESPONSE:  The fines are in place to ensure compliance with the rule; and this rule was drafted through consensus-based rulemaking.

 

 

 

COMMENTATORS

 

1.  Acadia Insurance Company; Dan Swift, AVP & Assistant General Counsel.

 

2.  American Insurance Association; John P. Murphy, Vice President.

 

3.  Workers’ Compensation Coordinating Council; Martha F.H. Mayo, Executive         Director.