New group - Agreement finalized

Our responsibility

If we determine that your organization is qualified to sponsor a new retro group

We will:

• Send you a "Group Retrospective Rating Agreement" form that must be signed, completed and returned by the date indicated on the form.
• Send you a blank Application for Group Membership and Authorization for Release of Insurance Data form.

Note: You should make copies of the application form and give a copy to each proposed group member. L&I requires an application for each proposed member.

Your responsibility

When you receive the application forms

You must:

• Send L&I a signed and completed Application for Group Membership and Authorization for Release of Insurance Data form for each proposed group member.

Note: An owner, partner or corporate officer of each business must sign the Application for Group Membership form.

• Provide L&I with documentation to establish that at least fifty percent of the proposed group members have been members of the sponsoring organization for at least one year prior to the first day of the selected coverage period.

Note: The documentation must include the name of the employer member and the date they became a member of the organization.

• Supply L&I with a surety bond if requested to do so.

Note:If required the surety bond will be in an amount equal to the difference of the projected standard premium of the retro group and the maximum premium under the plan selected rounded to the nearest thousand dollar increment. If a bond is required it is to be in effect until the coverage period has been finalized. This includes the period related to the annual adjustments of the coverage period and periods covered by any appeal of that coverage period.

• Complete, sign and return to L&I by the due date indicated on the agreement a Group Retrospective Rating Agreement form*.

Note: The "Application for Group Retrospective Rating" form required in WAC 296‑17‑90409 and the "Group Retrospective Rating Agreement" required by this rule are separate forms. Both forms are required of a new group.

Example: * View the Group Retrospective Rating Agreement form.

• Send these required documents to L&I by the date indicated on the Group Retrospective Rating Agreement form.

Our responsibility

Upon receipt of required information

We will:

• Verify that the sponsoring organization has an active L&I industrial insurance account and that the account is in good standing at the time of enrollment.
• Verify that each proposed member has an active L&I industrial insurance account and that the account is in good standing at the time of enrollment.

Note: An employer with multiple L&I accounts must enroll all businesses that are of a similar business nature in retrospective rating. If we discover that an employer has multiple L&I accounts, we will notify the sponsoring organization of this fact. The sponsoring organization is required to obtain an application from the remaining accounts within thirty days of our notice or none of the employer's accounts will be enrolled in the group.

• Verify that the nature of business of each proposed member falls appropriately within the business/industry category selected by the organization.
• Verify that the proposed new group has a total group standard premium of at least $1.5 million for the initial coverage period.

Note: The group standard premium will be based on the standard premiums of the proposed group members' most current fiscal year (four quarters) of reporting.

• Verify that at least fifty percent of the proposed group members have been members of the sponsoring organization for at least one year prior to group sponsorship.

Note: All employers of the proposed retro group must be members of the sponsoring organization.

• Notify you of our decision in writing.

[Statutory Authority: RCW  51.18.010(1) (www.leg.wa.gov). 02-23-089, § 296-17-90410, filed 11/20/02, effective 1/1/03.]

This rule applies to retro coverage period(s) established prior to January 1, 2011.

The courts can take judicial notice of the Washington Administrative Code (WAC) only as published by the Office of the Code Reviser (www.leg.wa.gov). The text contained in this Web page may reflect minor changes when compared with the WAC.

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