Workers’ Compensation Reinsurance Association Reinsurance Agreement (Effective January 1, 2007)
This agreement is between the Workers’ Compensation Reinsurance Association (WCRA) and its member insurers or self-insurers. It sets the terms under which the WCRA provides reinsurance for Minnesota workers’ compensation liabilities that exceed a member’s selected retention limit. Members must comply with all relevant statutes, the WCRA Plan, and Operating Rules, and pay required premiums. The agreement outlines coverage scope, claims management, premium adjustments, and procedures for dispute resolution and termination. It is effective January 1, 2007, and incorporates by reference the WCRA’s governing documents and Minnesota law.
ASSOCIATION

NATURE AND SCOPE OF AGREEMENT | ||||
A. The Purpose | 1 | |||
B. Parties | 1 | |||
C. Definitions | 1 | |||
D. Agreement Incorporates by Reference the Plan and the Operating Rules | 1 | |||
PART ONE: Reinsurance Agreements | 1 | |||
A. Liability of Association | 1 | |||
B. Members Duties | 1 | |||
PART TWO: Retention Limits | 2 | |||
PART THREE: Reinsurance Provided by Association Exclusive | 2 | |||
PART FOUR: Coverage | 2 | |||
A. General Scope | 2 | |||
B. Per Occurrence Basis | 2 | |||
C. Claims Expenses | 2 | |||
D. Assessments | 3 | |||
E. Effective Date | 3 | |||
PART FIVE: Premiums | 3 | |||
A. Annual Premium | 3 | |||
B. Billing of Premium | 3 | |||
C. Offset | 4 | |||
D. Annual Adjustment of Premium | 4 | |||
E. Interim Adjustment of Premium | 4 | |||
F. Surplus Distributions and Deficiency Assessments | 4 | |||
G. Premiums for Unfunded Coverage | 4 | |||
H. Premium Audits | 4 | |||
PART SIX: Reimbursement Procedure for Indemnification of Ultimate Losses in Excess of a Members Retention Limit | 5 | |||
PART SEVEN: Management of Claims and Losses | 5 | |||
A. Claims | 5 | |||
B. Claims Audits | 6 | |||
C. Reporting Requirements | 6 | |||
D. Legal Proceedings | 7 | |||
PART EIGHT: Subrogation, Salvage, and Third Party Recoveries | 7 | |||
PART NINE: Recoveries Under The Terrorism Risk Insurance Extension Act of 2005 | 7 | |||
PART TEN: Resolution of Disputes | 8 | |||
PART ELEVEN: Insolvency | 8 | |||
PART TWELVE: Termination | 9 |
Effective January 1, 2007
A. | The Purpose The purpose of this Reinsurance Agreement (the Agreement) is to set forth the basic conditions of the reinsuring agreement between the Workers Compensation Reinsurance Association (Association) and the Member. This Agreement is authorized by the Associations Enabling Act (Minnesota Statutes §§ 79.34-79.40); (the Enabling Act); its Plan of Operation (the Plan); and its Operating Rules. | |
Ref: Plan, Article VI.L. |
B. | Parties This Agreement is solely between the Member and the Association. All affiliated insurers or self-insurers within a holding company system shall be considered a single entity for purposes of the exercise of all rights and duties of membership in the Association. Nothing in this Agreement shall establish any rights in favor of any third party. Nothing in this Agreement shall create any liability or responsibility on the part of the Association for actions of the Member or other members. Nothing in this Agreement shall limit the Members liability to employers, employees and others under Minn. Stat. Chs. 79 and 176 and other Minnesota law. | |
Ref: Minn. Stat. § 79.34. subd. 1. Plan, Article VI.E.l., and VI.N. |
C. | Definitions To the extent defined in the Plan or in Operating Rules, the words used in this Agreement shall have the meanings given them by the Plan and the Operating Rules. | |
Ref: Plan, Article I. |
D. | Agreement Incorporates by Reference the Plan and the Operating Rules This Agreement incorporates by reference the Plan and the Operating Rules as they may from time to time be amended. The provisions of the Enabling Act, Plan, and Operating Rules shall be controlling over any conflicting provisions of this Agreement. | |
Ref: Plan, Article IX.E. |
A. | Liability of Association The Association shall reinsure the Members Minnesota workers compensation liability and shall indemnify the Member for 100 percent of the amount of statutory ultimate loss arising out of each occurrence compensable under Minn. Stat. Ch. 176 to the extent that the ultimate loss exceeds the Members retention limit in effect at the time of the loss occurrence and subject to the terms and conditions of the Enabling Act, the Plan, and the Operating Rules. | |
Ref: Minn. Stat. § 79.34, subd. 2. Plan, Article VIA. |
B. | Members Duties The Member shall comply with all requirements of the Enabling Act, Plan, and Operating Rules. These requirements include, but are not limited to, the following: The Member shall reinsure its Minnesota workers compensation liability with the Association, pay all benefits for losses reinsured by the Association that are covered by the terms and conditions of the original policies issued to the Members insureds, belong to the Association, accept indemnification from the Association, report to the Association claims for benefits that may involve liability to the Association, and take all actions necessary to limit the liabilities of the Association. Any member choosing to hire a third -party administrator (TPA) to administer any portion of its WCRA member duties is required to notify |
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the WCRA and complete a WCRA TPA Member Authorization Agreement. | ||
Ref: Minn. Stat. § 79.34, subds. 1 and 2. Plan, Article III. and Article VI.A.and B. |
Plan, Article VI.A.
Minn. Dept. of Commerce, Bulletin 95-7
A. | General Scope The reinsurance provided by the Association shall cover only benefits under Minn. Stat. Ch. 176 which are paid by the Member, provided that for losses incurred on or after January 1, 1984, the reinsurance provided shall cover benefits paid by the Member under the workers compensation law of another state when the injured worker is eligible for benefits under Minn. Stat. § 176.041, subds. 2 or 3, but elects to receive benefits under the workers compensation statute of such other state, as provided in Minn. Stat. § 79.34 subd. 7. Any amounts paid by a Member pursuant to Minn. Stat. §§ 176.183; 176.221, subd. 1; 176.225; and 176.82 shall not be included in ultimate loss and shall not be indemnified by the Association. Employers liability coverage is not provided by the Association. The Association does not cover claims under the Federal Employers Liability Act, the Jones Act, the Longshoremens and Harbor Workers Compensation Act, or any other federal law. | |
Ref: Minn. Stat. § 79.34, subds. 2 and 7. Minn. Stat. § 176.041, subds. 2 and 3. Plan,Article VI. |
B. | Per Occurrence Basis Coverage shall be provided on a per occurrence basis, as determined by the Association, except as otherwise provided by statute, including, in the case of occupational disease, where coverage is provided on a per person per occurrence basis. | |
Ref: Minn. Stat. § 79.34, subd. 2. Plan, Article I.R. and Article VI. |
C. | Claims Expenses Claims expenses, assessments, damages and penalties shall not be indemnified by the Association. Claims expenses include |
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investigation and legal expenses, court costs, interest and penalties. Expenses subject to indemnification include expenditures incurred in the preparation and development of a rehabilitation plan submitted to the Department of Labor and Industry and in the provision of rehabilitation services rendered in accordance with such a rehabilitation plan. | ||
Ref: Minn. Stat. § 79.34, subd. 2. Plan, Article I.G. Operating Rule for Clarification of the Definition of Claims Expenses |
D. | Assessments Assessments, including Special Compensation Fund assessments under Minn. Stat. §§ 176.129 and 176.131, shall not be reimbursed by the Association. | |
Ref: Minn. Stat. §§ 176.129 and 79.34,subd. 2. Plan, Article VI.K. |
E. | Effective Date Coverage shall be effective as of 12:01 A.M. on the date that the Members authority to either insure or self-insure workers compensation liabilities is approved by the Minnesota Department of Commerce. In no case shall the Association be liable for benefits for occurrences taking place prior to October 1, 1979. The Association shall have no liability for death benefits where an injury prior to October 1, 1979, causes or contributes to death on or after October 1, 1979. Effective January 1, 1984, certain benefits paid pursuant to the workers compensation laws of other states will be covered, as provided in Part Four A. of this Agreement. | |
Ref: Minn. Stat. § 79.34, subds. 1, 2 and 7. |
A. | Annual Premium The Member shall pay an annual premium, together with any premium surcharges, for the reinsurance coverage provided by the Association at the rate determined by the Board of Directors of the Association (Board of Directors) and approved by the Minnesota Commissioner of Labor and Industry (Commissioner). Estimated premium shall be calculated in accordance with procedures established in the Operating Rule for Determination of Exposure Base. The estimated exposure base for a Member may be revised after six months of the coverage year if the member verifies that its current annualized six month exposure base is at least fifteen percent higher or lower than its estimated exposure base. When the actual exposure base figures for the billing year become available, the actual premium shall be calculated. A premium adjustment shall be made as provided in Part Five D. of this Agreement. | |
Ref: Minn. Stat. § 79.35(d). Plan, Article VI.D. Operating Rule for Determination of Exposure Base |
B. | Billing of Premium The estimated premium shall be billed on an annual or quarterly basis, and shall be payable within 30 days of the date of mailing of the premium notice, with late payments subject to interest charges established by the Board of Directors. | |
Ref: Plan, Article VI.D.3. |
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C. | Offset The Association may offset indemnification payable to the Member against premium payable by the Member. Premiums payable shall not be offset by the Member against indemnification claimed by the Member. | |
Ref: Plan, Article VI.D.3.c. | ||
D. | Annual Adjustment of Premium The Association shall annually provide to the Member a statement indicating adjustments for previous years premium. Amounts due the Association as a result of the adjustment shall be paid by the Member within 30 days of the date of mailing of the adjusted premium notice, with late payments subject to interest charges established by the Board of Directors. Amounts due the Member shall be credited to the Members premium account with the Association, and any credit premium balance shall be refunded to the Member within 30 days, provided, however, that the Member has no additional premiums due and unpaid in the year the refund is to be made. If the Member has additional premiums due and unpaid in the year the refund is to be made, the Association may apply any credit premium balance against the due and unpaid premium. | |
Ref: Plan, Article VI.D.2.b. Operating Rule for Determination of Exposure Base Operating Rule for Annual and Audit Premium Adjustment Refunds | ||
E. | Interim Adjustment of Premium A Member who ceases doing business in Minnesota or a self-insurer Member who ceases to be an approved self-insurer may request an interim adjustment of estimated annual premium. | |
Ref: Operating Rule for Interim Adjustment of Estimated Annual Premium | ||
F. | Surplus Distributions and Deficiency Assessments The Board of Directors may declare a distribution of surplus or assessment of deficiencies in the form of member excess or deficient premiums or policyholder excess surplus or deficiencies. Such distributions or assessments may result from statutory changes, changes in the exposure base, or excess or deficient funds. Distributions of surplus and deficiency assessments shall be made as required by the Board of Directors in accordance with the Enabling Act, Plan and applicable Operating Rules as they have been interpreted by the courts. | |
Ref: Minn. Stat. § 79.34, subd. 2a and §79.361. Plan, Article VI.D.l.d. and VI.O. | ||
G. | Premiums for Unfunded Coverage In the event that benefits paid or expected to be paid on any claims in a calendar year exceed the prefunded limit in effect at the time the loss was incurred, the Association shall calculate and charge to all Members an additional premium for that year sufficient to cover the payments in excess of the prefunded limit. The premium shall be charged and collected in the same manner as the annual premium. | |
Ref: Minn. Stat. § 79.35(d). Operating Rule for Calculation and Charging of Premium for Unfunded Layers | ||
H. | Premium Audits The Association may inspect and audit any Members records to determine the accuracy of the premium calculation. The Member shall timely provide all information requested and shall in all respects cooperate fully in providing information during the course of an audit. | |
Ref: Plan, Article VI.D.4. |
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Operating Rule for Reimbursement Procedures
A. | ClaimsThe Member shall have the primary responsibility for the investigation, management, and defense of all claims. The Member may settle and compromise disputed claims that are within the terms and conditions of the original policies issued by the Member and are consistent with the claims procedures established by the Association. |
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Plan, Article VI.F.
Operating Rule for the Adjustment of Claims
B. | Claims Audits The Association may inspect and audit the Members records relating to all claims or related matters. The Member shall timely provide all information requested and shall in all respects cooperate fully in providing information during the course of an audit. | |
Ref: Minn. Stat. § 79.35(g). Plan, Article VI.F.3. |
C. | Reporting Requirements Members shall promptly notify the Association of any claim meeting any of the following reporting criteria. |
1. | Catastrophic Injury Criteria When a claimant has suffered a catastrophic injury as described in the following list, the Member shall notify the Association of the injury within 15 business days of notification of the injury to the Member. |
a) | Central Nervous System Injury |
1) | Spinal cord injury resulting in paraplegia or quadriplegia. | ||
2) | Brain damage affecting cognition and/or such conditions as permanent disorientation, behavior disorder, personality change, seizure disorder, sensorimotor deficits, aphasia, or coma. |
b) | Fatality, except for a no dependent exposure. | ||
c) | Third-degree burns covering 10 percent of the body, or second-degree burns covering 30 percent of the body, or if significant medical costs can be anticipated. | ||
d) | Amputations of a significant portion of one extremity or multiple amputations. |
2. | Serious Injury Criteria | ||
When a claimant has suffered a serious injury as described in the following list, the Member shall promptly notify the Association. |
a) | Impairment of total vision by 50 percent or more. | ||
b) | Peripheral nerve damage causing major muscle dysfunction or paralysis in an upper or lower extremity. | ||
c) | Serious internal injuries resulting from blunt, penetrating, or crushing injuries to the chest or abdomen. | ||
d) | Multiple fractures, or significant degloving injuries, involving more than one arm, hand, or leg, malunion, or significant shortening of the limbs. | ||
e) | Fracture of both heel bones (bilateral os calcis). | ||
f) | Occupational disease allegedly caused by working conditions or other job-related factors, including asbestosis, or chronic pulmonary disease, or other occupational disease which results in disability expected to last two years or more. |
3. | Claim Cost Criteria When a Member estimates that the total |
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incurred cost (payments and reserves for future payments) of a claim exceeds 50 percent of the retention limit which was in effect during the year when the loss was incurred, the Member shall promptly notify the Association. | ||
Ref: Plan, Article VIB.1. Operating Rule for Claim Reporting Procedure |
D. | Legal Proceedings The Association may intervene in legal proceedings under Minnesota Statutes Chapters 79 and 176 and in any other legal proceedings where the result of the proceeding is considered likely to affect the interests of the Association. The Association shall notify the affected Member prior to intervening. | |
Ref: Minn. Stat. § 79.36(f). Plan, Article VI.I. Operating Rule for Intervention in Legal Proceedings |
Plan, Article VI.E.3. and VI.H.
Operating Rule for the Adjustment of Claims
Operating Rule for Approval of Waivers of Subrogation
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Plan, Article VIII.
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Minn. Stat. § 176.185, subd. 8a.
Plan, Article III. A.2.
Plan, Article III.A.l.
WORKERS COMPENSATION REINSURANCE ASSOCIATION | ||||
By | /s/ Carl W. Cummins III | |||
Carl W. Cummins III | ||||
Its President | ||||
ATTEST | ||||
By | /s/ Cynthia M. Smith | |||
Cynthia M. Smith | ||||
Its Secretary | ||||
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