Existing group

Your responsibility

To continue to sponsor an existing retrospective rating group

You must:

• Complete, sign and return the Group Retrospective Rating Agreement form by the date indicated on the agreement form.

Note: If you do not want to change plans, maximum premium ratio or coverage periods, you do not need to send in a new application for group retrospective rating for each new coverage period. L&I will assume the same plan, maximum premium ratio and coverage period. If your organization wants to change plans, maximum premium ratio or coverage period, you will need to submit a new "Application for Group Retrospective Rating" by the due date indicated on the application form. In the event that a sponsoring organization wants to change their business or industry category, they must notify L&I either by letter or by completing a new "Application for Group Retrospective Rating" by the due date indicated on the application form.

• Submit a completed and signed "Application for Group Membership and Authorization for Release of Insurance Data" form for each new proposed member.

Note: These applications can be submitted throughout the coverage period. See employer group member requirements for detail of when enrollment begins. If the sponsoring organization changes plans, maximum premium ratios or coverage period, they must secure new applications from each member or get pre-approval from L&I if a different method will be used to serve notice to members of the change.

• Provide L&I an annual written report that highlights workplace safety accomplishments of the group during the past coverage year and identifies areas that the group has targeted for improvement during the next coverage period.

Note: The written annual safety report is due in the Tumwater office no later than the last day of the month prior to the beginning of the coverage period. If the due date falls on a weekend or holiday, the safety report will be due on the next business day. If you fail to submit the required written report when due, it will result in disqualification of the group. If this occurs, the sponsoring organization can requalify to sponsor the group but must satisfy the requirements applicable to new groups found in WAC 296‑17‑90409 and 296‑17‑90410.

Sample annual safety report

Past years accomplishments: During the past year the association identified a leading cause of injury for our members was related to the lifting of resident clients. The association, working with professionals and manufacturers in the field, identified equipment that eliminates most of the hazards associated with lifting clients. Working with the Department of Labor & Industries, our association initiated a pilot program at a number of member facilities using the newly identified equipment. Comprehensive training on equipment use and safety was given to all employees at these facilities. Although the program is experimental at this time and only been in place for five months, we have seen a reduction in back injuries of 20 percent. Projected plans: The members will implement a zero lift program at each facility in the next twelve months. We anticipate that this will reduce the number of back injuries for our members by 50 percent. The association will further evaluate member losses associated with back sprains and strains and work with industry experts to further reduce these types of injuries.

• Supply L&I with a surety bond or assignment of savings if requested to do so.

Our responsibility

Upon receipt of the required forms and the annual safety report

We will:

• Verify that the sponsoring organization's L&I industrial insurance account is in good standing at the time of reenrollment.
• Verify that the individual employer member L&I industrial insurance accounts are in good standing at the time of reenrollment.
• Provide written feedback on the sponsoring organization's annual safety report and if applicable request revisions to the report.

Note: The department will notify the sponsoring organization of any concerns or needed changes to the safety report within thirty days of submission of the plan. The sponsoring organization is to submit a response and/or revised safety report as applicable within sixty days of our notification to them of our concerns or needed changes or as otherwise agreed upon by the department.

• Notify the sponsoring organization in writing of our decision to reenroll the group and the group members.
• Notify the sponsoring organization in writing of our decision to deny reenrollment to the group or group members.

We may:

• Request the sponsoring organization to post a surety bond or assignment of savings in the amount of the difference between the projected standard premium of the group and the maximum premium under the plan selected.

Our responsibility

If we require a surety bond or assignment of savings

We will:

• Notify you in writing of this decision.

[Statutory Authority: RCW 51.18.010(1) (www.leg.wa.gov). 02-23-089, § 296-17-90411, 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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