Department of Insurance Amends Rating Plan Manual and Statistical Plan

The Texas Commissioner of Insurance has adopted amendments to the National Council on Compensation Insurance Retrospective Rating Plan Manual for Workers Compensation and Employers Liability Insurance––Revisions to the Retrospective Rating Plan Manual Rule 3-A in Texas. The Commissioner also adopted amendments to NCCI’s Statistical Plan for Workers Compensation and Employers Liability Insurance––Injury Description Codes for Adverse Reaction to Vaccination for COVID-19 and Other Diseases.

The revised manual eliminates the requirement to submit a copy of the Texas Notice of Election of Retrospective Rating Plan to the Department. Instead, carriers will be required to maintain a copy of the notice and make it available to the Department on requite.

The retrospective rating plan manual changes apply to new and renewal policies effective on or after October 1, 2021. Changes to the injury codes that the Department approved apply to claims with an accident date on or after December 1, 2020.

The updated statistical plan adds nature of Injury Code “38” for an adverse reaction to a vaccination or inoculation and Cause of Injury Code “82” for non-impact injuries resulting from inhalation, absorption or ingestion of harmful substances or vaccines. These coding obligations have previously been recommended by the Department as guidance or advice to system stakeholders.

According to the Division, if a COVID-19 vaccination relates to an employee’s job, and it causes the employee to miss one or more days of work, you should file a First Report of Injury with DWC. Submitting a First Report of Injury to DWC does not mean that a COVID-19 vaccine reaction is work-related or that the insurance carrier is liable for payment. The Division does not clarify what it means when it states that a vaccination must “relate to an employee’s job” for purposes of this reporting. We advise employers to report vaccine injuries, as well as other injuries, when an employee reports any adverse reaction that the employee claims may be work related.

DWC states that carriers should report COVID-19 vaccine reaction claims using the new “nature of injury” code 38 – Adverse Reaction to a Vaccination or Inoculation combined with the “cause of injury” code 83 – Pandemic. Insurance carriers should also clearly indicate whether the claim involves a COVID-19 vaccine reaction in the incident description field by using language such as “COVID-19 vaccine reaction.” The Division specifically states that carriers should not report vaccine reaction claims using “nature of injury” code 83 – COVID-19.

The Department has also proposed to introduce a new edition of NCCI’s Basic Manual for Workers Compensation and Employers Liability Insurance. The Department describes this filing as a complete modernization of the Basic Manual. The latest filing has been proposed as a onetime “complete manual” filing to help make regulatory review and approval, and subsequent customer use, easier in the future.

The Department states that the filing will:

▪ improve format and structure;

▪ update rules, if applicable, to conform to statutory language; and

▪ provide clarity, if needed.

The Department states that the filing does not make any substantive changes to any rule or classification that would result in premium impact. The comment period ends on this proposed filing August 16, 2021.