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Chapter 8. Office of the Director
Subchapter 2. Administration of Self-Insurance Plans
Article 13. Group Self Insurance

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§15482.2. Interim Certificates to Group Members.

(a) The Manager may issue an Interim Certificate of Consent to Self Insure to a new member of an existing private group self insurer upon receipt of a qualifying Request for Interim Certificate and the filing fee as provided in Section 15491(a)(3). The Interim Certificate of Consent to Self Insure will be issued for a period not to exceed 180 days. A Certificate of Consent to Self Insure to replace the Interim Certificate shall not be issued unless a completed application and accompanying documents required by Section 15482.1 and the application fee required by Section 15491 are submitted to the Manager within 180 days of the effective date of the Interim Certificate. However, the Manager may extend the Interim Certificate for an additional period of up to 90 days upon a showing of good cause by the Interim Self Insurer.

(b) To qualify for issuance of an Interim Certificate to its group members, the existing private group self insurer must demonstrate the following:

  (1) The core members of the group self insurer must document that they meet the financial requirements as set forth in Section 15472(a);  

  (2) The private group self insurer holding the Master Certificate of Consent to Self Insure must be a group self insurer in good standing, and shall not be prohibited from adding new members pursuant to Section 15477(b)(5).  

(c) A Request for an Interim Certificate for Group Member (Form A 4-7 (11-08)) on behalf of the new group member shall be submitted by the Group Administrator to the Manager. The request shall be in writing and shall include the following information regarding the proposed new group member:

  (1) The proposed group member's full legal name, state of incorporation, and Federal Tax Identification Number;  

  (2) The requested effective date of the Interim Certificate;  

  (3) The annual payroll of the proposed group member during the last 12-months through at least the last quarter, an estimate of the payroll for the next 12 month period, and an estimate of the proposed group member's annual group contributions to the group self insurer;  

  (4) The proposed member's NAICS code, experience modification, and a description of the type of business it conducts.  

  (5) A signed statement from the Group Administrator certifying that the proposed group member meets the homogeneity and underwriting requirements of the group self insurer and that the group self insurer shall be financially responsible to pay all workers' compensation claims arising out of the period of time of the Interim Certificate.  

(d) Upon receipt of a written request for an Interim Certificate from a private group self insurer that meets the requirements of this section, the Manager shall issue the Interim Certificate within 14 days. If the request is incomplete or does not comply with this section, the Group Administrator for the group self insurer will be notified within 14 days of receipt of the request.

(e) Before an Interim Certificate may be replaced with a Certificate of Consent to Self Insure with no expiration date, the Interim Self Insurer must submit within 180 days of the effective date of the Interim Certificate of Consent a complete and accurate Application Form as provided in Section 15482.1.

(f) Each group member issued an Interim Certificate of Consent to Self Insure shall subject to the following provisions:

  (1) If an Interim Certificate is revoked before the expiration date or allowed to expire without issuance of a permanent Affiliate Certificate of Consent to Self Insure pursuant to subsection (e), the Interim Certificate holder shall provide proof of workers' compensation insurance to the Manager and to the group self insurer no later than 60 days after the date of revocation by the department. The group self insurer shall remain liable for all compensation liabilities of the employer until the effective date of the insurance coverage, the expiration date of the Interim Certificate, or the 60th day any Notice of Intent to Revoke the Certificate issued by the Manager, whichever comes first. The employer shall remain liable for payment of contributions and assessments as required by the group self insurer for the employer's period of coverage as a member of the group self insurer.  

  (2) The Manager shall notify the Labor Commissioner if any employer granted membership in a private group self insurer under an Interim Certificate of Consent to Self Insure is subsequently denied an Affiliate Certificate of Consent to Self Insure by the Manager and after 45 days from such denial has not produced proof of coverage for workers' compensation liabilities to the Manager in the form of a binder, certificate of insurance or policy.  

     Note: Authority cited: Sections 54, 55 and 3702.10, Labor Code. Reference: Sections 59, 3700, 3702.5 and 3702.10, Labor Code.  

1. New section filed 3-2-2009; operative 3-2-2009 pursuant to  GovernmentCode section 11343.4 (Register 2009, No. 10).

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