Mo. Code Regs. Ann. tit. 20, § 500-6.960
PURPOSE: This rule is to formalize the plan of operation for a new Workers’ Compensation residual market, known as the Alternative Residual Market Plan. The regulation also specifies the procedures for the transition to the Alternative Residual Market Plan from the Workers’ Compensation Insurance Plan previously filed by the National Council on Compensation Insurance, Inc. and approved as of October 14, 1993. Pursuant to section 287.896, RSMo, Alternative Residual Market Plan will provide for the equitable apportionment among all insurers authorized to write Workers’ Compensation and employers’ liability insurance in Missouri of insurance which may be afforded applicants who are in good faith entitled to such insurance, but who are unable to procure such insurance through ordinary methods. The Alternative Residual Market Plan will guarantee insurance coverage and quality loss prevention and control services to employers seeking coverage through the plan. The plan will provide such insurance at actuarially sufficient premium rates agreed to by the Department of Insurance. The plan will also provide that the processing of applications, the conduct of safety engineering and other loss control services and the handling of claims for the plan shall be accomplished within the state of Missouri or adjoining states. Under the Alternative Residual Market Plan, the Department of Insurance shall contract with an entity (the contract carrier) to issue Workers’ Compensation and employer’s liability policies for a one-year period to eligible employers seeking such coverage. If losses on the policies issued pursuant to this contract produce a deficit as defined herein, all insurers writing Workers’ Compensation insurance in Missouri are required to reimburse the contract carrier in accordance with the Missouri Aggregate Excess of Loss Reinsurance Mechanism. The Alternative Residual Market Plan replaces the prior WCIP. The Alternative Residual Market Plan and any future modification thereof is subject to the approval of the director of the Missouri Department of Insurance, provided, however, that such amendments shall not change the performance standards required of the contract carrier during the period of the contract, except where mutually agreed to by the contract carrier and the department.
EDITOR’S NOTE: The following material is incorporated into this rule by reference: 1) Missouri Department of Insurance, Requests for Proposals for an Alternative Residual Market Plan for the Missouri Workers’ Compensation System (Re-bid Amended) (Jefferson City, MO: Missouri Department of Insurance, January 13, 1995); 2) NCCI’s Workers Compensation Insurance Plan (WCIP), Exhibit III, Workers Compensation and Employers Liability, National Council on Compensation Insurance (effective February 9, 1993); and 3) NCCI’s Definition of Allocated Loss Adjust Expense (Item U-1292) Memorandum Government, Consumer and Industry Affairs, National Council on Compensation Insurance (Boca Raton, FL: National Council on Compensation Insurance, December 7, 1992). In accordance with section 536.031(4), RSMo. The full text of material incorporated by reference will be made available to any interested person at the Office of the Secretary of State and the headquarters of the adopting state agency.
(1) Definitions.
Compensation residual market mechanism which shall commence insurance operations on or after July 1, 1995, replacing the residual market mechanism known as the Workers’ Compensation Insurance Plan (WCIP).
(8) of this rule.
(U) Workers’ Compensation insurance means—
and occupational disease including liability under the Longshore and Harbor Workers’ Compensation Act, as amended, and the Federal Coal Mine Health and Safety Act of 1969, as amended. By policy endorsement approved by the department, the contract carrier may specify the circumstances under which such coverage shall be defined for those employees of a Missouri employer who are temporarily engaged in employment-related activities for the employer outside the boundaries of the state of Missouri;
in connection with a Workers’ Compensation policy; and
by the director, including those approved after being recommended by the advisory board of the Missouri Aggregate Excess of Loss Reinsurance Mechanism.
(2) Rules for Eligibility and Assignment.
(C) The following rules will govern the insuring of employers who are in good faith entitled to Workers’ Compensation insurance as defined herein, but who are unable to procure such insurance through ordinary methods. Any employer insured under the A.R.M. Plan shall receive at least the same quality of service as is available to those employers who are voluntarily insured. This includes, but is not limited to, safety engineering, loss control, claims handling, employee classification and reserving practices. Any dispute arising hereunder shall be subject to section (8) of this rule.
filed with the contract carrier by the employer or its representative on a form approved by the department.
absence of clear and convincing evidence to the contrary. An employer is not in good faith entitled to insurance if any of the following circumstances exist, at the time of application or thereafter, or other evidence exists that such employer is not in good faith entitled to insurance:
self-insured employer is aware of pending bankruptcy proceedings, insolvency, cessation of operations, or conditions that would probably result in occupational disease or cumulative injury claims from exposure incurred while the employer was self-insured;
in force, knowingly refuses to meet reasonable health and safety requirements designed to remove an imminent threat of serious bodily harm;
obligation for Workers’ Compensation premium on previous insurance about which there is no formal dispute; or
tive and/or the producer knowingly makes a material misrepresentation on the application by omission or otherwise, including any of the following: estimated annual premium, estimated payroll, offers of Workers’ Compensation insurance, nature of business, name or ownership of business, previous insurance history, or outstanding premium obligation of the employer.
A.R.M. plan, consistent with plan rules, in accordance with the following procedures:
completed application to the contract carrier with a certified, cashier’s, or agency check payable to the contract carrier for the estimated annual or deposit premium as computed by the producer, or determined by contacting the contract carrier prior to submission of the application. The employer or its representative shall also include with and as a part of the application a copy of the employer’s latest filed federal employer 941, 941E, 942 or 943 form or equivalent federal or state verifiable current payroll record, for example, unemployment wage report. The application form, as approved by the department, shall indicate the employer’s agreement to authorize its current carrier to release any safety and loss information described in subsection (3)(E) of this rule to the contract carrier. For all employers other than those formerly self-insured, coverage will be bound at 12:01 a.m. on the first day following the postmark time and date on the envelope in which the application is mailed, including the estimated annual or deposit premium, or the expiration of existing coverage, whichever is later. If there should be no postmark, coverage will be effective 12:01 a.m. of the date of receipt by the contract carrier unless a later date is requested. Those applications hand delivered to the contract carrier will be effective as of 12:01 a.m. the date following receipt by the contract carrier unless a later date is requested;
insured, coverage will be bound at 12:01 a.m. not later than sixty (60) days following the postmark time and date on the envelope in which the application is mailed including the estimated annual or deposit premium, or the expiration of existing coverage, whichever is later. If there should be no postmark, coverage will be effective 12:01 a.m. not later than sixty (60) days following the date of receipt by the contract carrier unless a later date is requested. Those applications hand delivered to the contract carrier will be effective 12:01 a.m. not later than sixty (60) days following the date of receipt by the contract carrier, unless a later date is requested;
the above, the contract carrier shall issue a binder with copies to the producer, insured, and appropriate state agency; and
approved by the department, the contract carrier may specify the circumstances under which coverage may be bound as the result of the filing of an application by facsimile.
this Plan unless all Workers’ Compensation premium obligations on any previous insurance have been met by the employer, unless a formal dispute regarding such payments has been made. If, subsequent to policy issuance, the insured employer does not meet all Workers’ Compensation insurance premium obligations under a previous policy or under a present policy, the contract carrier retains the right to cancel a policy currently in force under the A.R.M. Plan.
of one (1) year, unless insurance for a shorter term has been requested or unless a longer period is authorized by the department. A copy of the policy declarations and all endorsements, properly stamped A.R.M. Plan, will be retained by the contract carrier.
contract carrier determines that an employer is not entitled to insurance, or has failed to comply with reasonable safety requirements, or has violated any of the terms and conditions under which the insurance was issued, and after providing opportunity for cure, the contract carrier shall initiate cancellation by filing the reason with the employer relations consultant for approval prior to issuing a cancellation. Approval shall not be required for cancellation for nonpayment of premium. The contract carrier shall be fully informed of all cancellations and of any reestablishment of eligibility or of entitlement by an insured employer. Any insured employer so canceled must reestablish eligibility or must demonstrate entitlement before any further assignment can be made under the A.R.M. Plan.
A.R.M. Plan shall be written utilizing the classifications, forms, rates and rating data set forth in the contract carrier’s RFP response or as otherwise approved by the director.
expiration date of insurance, the contract carrier shall send a renewal proposal or notice of impending expiration of coverage to the insured and the insured’s producer. Upon receipt of the required premium, the policy shall be renewed and a copy of policy information page and all endorsements, properly stamped A.R.M. Plan, retained by the contract carrier.
agrees to have its Workers’ Compensation and employer’s liability insurance provided by an insurer other than the contract carrier on a voluntary basis may do so at any time. The contact carrier shall cancel coverage on a pro rata basis as of the effective date of the voluntary insurer’s insurance.
operations in states other than Missouri must 20 CSR 500-6
notify the contract carrier regarding the need for insurance in such additional states in accordance with section (6) of this rule.
licensed producer and, with respect to any renewal of the contract carrier, may change the designated producer by notice to the contract carrier prior to the date of such renewal or, with the consent of the contract carrier, at any other time. The contract carrier shall pay a fee to the producer designated by the employer on new and renewal policies effective (July 1, 1995) and thereafter upon payment of all premium due under the policy. The fee shall be based on the state standard premium and paid at the rate as set forth in the contract carrier’s RFP response.
(3) Participation.
(C) No less than ninety (90) days before the date on which the coverage under the A.R.M. Plan shall commence, the Department of Insurance or its designee shall, by bulletin or other notification, specify to each insurance carrier authorized to write Workers’ Compensation insurance in Missouri the date upon which the responsibility for providing Workers’ Compensation insurance through the residual market shall shift from the WCIP to the A.R.M. Plan.
for each WCIP policy which would otherwise renew during the following year, that the policy’s WCIP servicing carrier or direct assignment carrier shall provide the insured employer with no less than sixty (60) calendar day’s notice that coverage under the WCIP policy will terminate and that, should the employer desire coverage under the successor A.R.M. Plan, the employer will be required to submit a new application to the A.R.M. Plan contract carrier. The director may waive the requirement of a new application for employers serviced by the contract carrier under the WCIP and may approve a shorter notification period for out-of-state employers receiving Missouri coverage under the WCIP through the WCIP’s associated interstate assignment mechanism.
shall be specified by the department and shall include a discussion of the availability of coverage in the voluntary market. The A.R.M. Plan contract carrier may offer voluntary market coverage to any employer.
(4) Deficit Administration.
(A) A deficit under the A.R.M. Plan shall be handled as follows:
accordance with section 287.896, RSMo, while the plan shall be designed to provide Workers’ Compensation and employer’s liability insurance at premium rates which are actuarially sufficient to cover losses and reasonable operating expenses, the plan must also provide a system to distribute any deficit experienced by the plan. Under this rule, a deficit as defined under the A.R.M. Plan has occurred whenever the amount of losses and allocated loss adjustment expenses paid by the contract carrier, when divided by the amount of premium collected by the contract carrier, produces a percentage greater than or equal to one hundred fifteen percent (115%) for the policies issued during the one (1)-year period of the contract. An insurer licensed to write Workers’ Compensation coverage in Missouri shall be assessed for the amount of such deficit in proportion to the share of the voluntary market premium written by such insurer, in accordance with the provisions of the Missouri Aggregate Excess of Loss Reinsurance Mechanism, set forth in Exhibit A. Failure of a insurer to pay its proper assessment shall be grounds for discipline of the insurer by the department, and for legal action by the contract carrier or the advisory board to recover such unpaid assessment owed under this rule;
the existence of a deficit, the A.R.M. Plan contract carrier and its affiliated insurers shall, at a minimum, segregate their Missouri voluntary market Workers’ Compensation financial experience and business transactions from their Missouri residual market financial experience and business transactions;
the existence of a deficit and the assessment thereof to insurers based on their Missouri voluntary Workers’ Compensation insurance premium is as described in the Missouri Aggregate Excess of Loss Reinsurance Mechanism;
least annually by the contract carrier as to its actuarial estimate as to the likelihood of a deficit. Such estimates shall include a valuation of the probability of any future deficits based on amounts already incurred, determined by an evaluation procedure approved by the department; such an evaluation procedure may be recommended to the department by the advisory board. Should a deficit be indicated by the actuarial estimate, a projection as to when assessments are expected to begin under the terms of the Missouri Aggregate Excess of Loss Reinsurance Mechanism is also to be provided to the department by the contract carrier;
administrator of the Missouri Aggregate Excess of Loss Reinsurance Mechanism, under the oversight of an advisory board appointed by the director of insurance after consultation with the NCCI and other interested parties. Subject to the direction and approval of this advisory board, the NCCI, as reinsurance administrator, shall perform as described in the Missouri Aggregate Excess of Loss Reinsurance Mechanism (Exhibit A), including the following:
requirement to participate in the Missouri Aggregate Excess of Loss Reinsurance Mechanism, and informing the director of insurance of any insurer who informs the NCCI that they are unwilling to participate in said Mechanism.
mechanism;
oversight activities requisite to ensuring appropriate performance by the contract carrier; and
ry board; and
distinguish the extent to which it is an A.R.M Plan deficit assessment or a WCIP assessment.
(B) Advisory Board.
posed of at least nine (9) but no more than thirteen (13) members, appointed by the director as follows:
who write Workers’ Compensation insurance in Missouri’s voluntary market, and who are representative of the interests of such carriers;
director, with consideration given to members recommended by the advisory board.
to oversee the NCCI in its administration of the Missouri Aggregate Excess of Loss Reinsurance Mechanism, and to assist and advise the director regarding the execution of this mechanism by the contract carrier and the member insurers required to be reinsurers under this mechanism. The advisory board may consider any matter referred to it by the reinsurance administrator or the director which relates to the operation of the mechanism;
serve a term of two (2) years, but may serve additional terms;
more than one (1) position on the board. All advisory board members shall serve until their successors are designated by the director. Any vacancy on the advisory board, by resignation or otherwise, shall be filled by a representative of the member’s insurer or organization, until a replacement is appointed; and
son or by proxy, shall hold an annual meeting at which it shall elect a chairperson. The advisory board shall hold such additional meetings as necessary whenever requested by the chairperson, the director or upon petition of three (3) advisory board members.
(5) Contract Carrier.
(6) Interstate Assignments.
(8) Dispute Resolution Procedure.
(B) Appeals from employers and insureds on plan matters regarding individual employer disputes shall be within the jurisdiction of the mechanism established to handle such appeals under the applicable insurance laws, including section 287.335, RSMo. All other disputes shall be handled as follows:
operation of the A.R.M. Plan, excluding individual employer disputes and those arising under the Missouri Aggregate Excess of Loss Reinsurance Mechanism (mechanism), the employer relations consultant will review the matter and render a written decision with an explanation of the reasons for the decision within thirty (30) days after receipt of all the information necessary to make the decision. Any party affected by a decision made by the employer relations consultant may seek a de novo review by the regulator by requesting such review, in writing, within thirty (30) days after the date of such decision. In reviewing any such matter, the department shall decide the dispute in accordance with the state law, regulation and policy and in the interests of the reasonable and proper administration of the A.R.M. Plan. The regulator’s decision shall be final, subject to court review.
pute arises under the mechanism, the reinsurance administrator designated under the mechanism shall first review the matter and render a written decision to the complaining party with an explanation of the reasons for the decision within thirty (30) days after receipt of all the information necessary to make the decision. Any party affected by the decision may seek a review by the advisory board established under the mechanism by requesting such review, in writing, within thirty (30) days of the date of the decision by the reinsurance administrator under the mechanism. The advisory board must then review the matter and render its written decision pursuant to the procedures set forth in the mechanism. Any party affected by a decision of the advisory board may seek a de novo review by the director by requesting such a review in writing within thirty (30) days of the date of the board’s decision.
(9) Rate Monitoring.
(11) Confidentiality of Information.
(B) Detailed information, whether provided orally, in writing, via computer media, or by other means, given to agents, agencies, brokers, insurers, or their clients, required to properly evaluate, underwrite and insure risks under the A.R.M. Plan, shall be provided by such persons and entities to the contract carrier for the evaluation, underwriting and insurance purposes. In consideration of the disclosure of such information, the contract carrier agrees to and shall comply with the following provisions:
confidence and shall not, except as directed by the insured, disclose to any third party, or use for the benefit of any third party, such detailed information, regardless of any third party, such detailed information, regardless of the form or format of the disclosure; such information shall be used by the contract carrier solely for the evaluating, underwriting and insuring of Workers’ Compensation and employer’s liability insurance coverage under the A.R.M. Plan, and not for any other purpose without the prior approval of the agency of record;
sonable measures necessary to protect the confidentiality of such information in its possession from disclosure to any other third party, except as directed by the insured;
or indirectly request, encourage, or advise any employers who have acquired or seek to acquire coverage through the A.R.M. Plan to utilize the services of any specific insurance agent, agency, broker, insurer or group of insurers for Workers’ Compensation and employer’s liability insurance coverage; and
other person, firm or entity any rights that would circumvent or violate the provisions of paragraphs (11)(B)1. 3.
AUTHORITY: sections 287.896 and 374.045, RSMo (1994).* Emergency rule filed June 15, 1995, effective July 1, 1995, expired Oct. 28, 1995. Original rule filed April 3, 1995, effective Sept. 30, 1995. *Original authority: 287.896, RSMo (1993) and 374.045, RSMo (1967), amended 1993. Exhibit A MISSOURI AGGREGATE EXCESS OF LOSS REINSURANCE MECHANISM issued to Travelers Indemnity Company of Missouri (hereinafter referred to as the “Contract Carrier”) by THE SUBSCRIBING REINSURERS (hereinafter referred to collectively as the “Reinsurers”) WHEREAS, the Contract Carrier and each of the Reinsurers, as a requirement of being licensed to write Workers’ Compensation in Mis- souri, are participants in the Missouri Alternative Residual Market (A.R.M.) Plan, effective July 1, 1995; and WHEREAS, pursuant to the A.R.M. Plan, the Missouri Aggregate Excess of Loss Reinsurance Mechanism is provided for as the means for the determination of the existence of a deficit and the assessment thereof; and WHEREAS, pursuant to the A.R.M. Plan, The National Council on Compensation Insurance, Inc. (NCCI) is appointed as the agent for the purposes of entering into and administering the provisions of this Mechanism (“Reinsurance Administrator”), under the oversight of an Advisory Board appointed by the Director of Insurance; and WHEREAS, pursuant to the A.R.M. Plan and the Amended 12/94 RFP related thereto, the Contract Carrier has entered into a contract (“Contract Carrier Agreement”) to provide certain policies of workers compensation, occupational disease, employers liability or other insurance (“Workers Compensation Insurance”) as defined in the A.R.M. Plan (“Policies”) to risks designated as assigned risks under the A.R.M. Plan; and WHEREAS, the Contract Carrier is obliged to write Policies for such assigned risks provided such policies commence during a one year period specified in the Contract Carrier Agreement (“Contract Period”) and any renewals thereof; and WHEREAS, such policies will be for durations specified by the A.R.M. Plan and the Contract Carrier Agreement (“Policy Period”); and WHEREAS, pursuant to the Contract Carrier Agreement, the Contract Carrier has agreed to be responsible for paid losses and paid allo- cated loss adjustment expenses up to and including 115% of the collected premiums on the Policies (“Contract Carrier Retention”); and WHEREAS, the Contract Carrier wishes to cede and the Reinsurers, including the Contract Carrier in its capacity as a participating com- pany under this Aggregate Excess of Loss Reinsurance Mechanism, agree to accept aggregate excess of loss reinsurance in excess of the Contract Carrier’s Retention of 115% of collected premium; and WHEREAS, the Reinsurers agree to share in the aggregate excess of loss reinsurance for the Contract Period pro rata according to their respective shares of voluntary Workers Compensation Insurance premium in Missouri; and WHEREAS, the Contract Carrier Agreement may relieve the Reinsurers of other obligations for assigned risks; and WHEREAS, “Losses” shall mean paid losses and paid allocated loss adjustment expenses under the Policies, and the terms losses and allocated loss adjustment expenses are as defined in the NCCI Workers’ Compensation Statistical Plan in effect in Missouri on July 1, 1995. NOW THEREFORE, in consideration of and in reliance upon the premises and the mutual promises contained herein, the Contract Car- rier and Reinsurers agree as follows: ARTICLE I REINSURERS’ PARTICIPATION A. For the Contract Period under the Contract Carrier Agreement, the Contract Carrier shall cede and the Reinsurers shall accept all of the contract carrier’s liability for Losses under the Policies in excess of the Contract Carrier’s Retention of 115% of collected premium. Losses shall be paid to the Contract Carrier upon evidence of payment by the Contract Carrier and verification by the reinsurance administrator. B. If the Contract Period does not run concurrently with a calendar year, each successive twelve month period in the Contract Period shall be assigned to the calendar year in which that twelve month period commenced for purposes of determining the pro rata share of paid losses and paid allocated loss adjustment expenses in excess of the Contract Carrier’s Retention for each of the Reinsurers. If the Contract Period runs concurrently with a calendar year, each successive twelve month period shall be assigned to said calendar year. C. Each Reinsurer’s proportion of liability in excess of the Contract Carrier’s Retention, including Reinsurance Administrator expenses, shall be determined by the Reinsurer’s Voluntary Workers Compensation Insurance written premiums in the state of Missouri in relation to the total Voluntary Workers Compensation Insurance written premiums in Missouri during the calendar year in which the Contract Period commences, subject to verification by the Reinsurance Administrator. D. Except as otherwise provided in the A.R.M. Plan and this Mechanism, the Reinsurers shall have no obligation for Losses within Contract Carrier’s Retention. ARTICLE II OBLIGATIONS OF CONTRACT CARRIER A. The Contract Carrier shall make available such of its own staff, office space, facilities and equipment as are necessary for the performance of its obligations under this Mechanism and the Contract Carrier Agreement. The Contract Carrier shall perform its services, exercise its powers, and perform all of its duties in accordance with the terms of the A.R.M. Plan, this Mechanism, the Contract Carrier Agreement, and such Performance Standards as may be established from time to time pursuant to the A.R.M. Plan. B. The Contract Carrier shall process, adjust, settle, compromise, defend, litigate and pay claims arising out of the Policies. The Contract Carrier shall establish and maintain such claim reserves as are reasonable and proper. It shall also maintain complete, orderly and accurate claim files, records and accounts in accordance with generally accepted insurance principles. C. The Contract Carrier shall comply with the financial reporting requirements and procedures established from time to time by the Advisory Board and approved by the Director of Insurance pursuant to the Plan, with the advice and recommendations of the Reinsurance Administrator. D. The Contract Carrier shall report to the Reinsurers through the Reinsurance Administrator, as soon as possible, and, in any event, within ten (10) calendar days, any change in its ability to perform its obligations as a Contract Carrier hereunder. E. The Contract Carrier agrees that it will comply with all of the terms and conditions of the A.R.M. Plan, this Mechanism, the Contract Carrier Agreement, and any rules or procedures promulgated thereunder. ARTICLE III COMMENCEMENT AND TERMINATION A. This Mechanism shall apply to Missouri which has adopted the Missouri Alternative Residual Market Plan and shall be effective with respect to the individual Contract Carrier Agreement and the Contract Period as provided herein. This Mechanism shall continue in force during the current contract year and subsequent contract years until terminated as provided in this Article. B. This Mechanism may be terminated at any time by mutual agreement between the Reinsurers, acting through the Reinsurance Administrator, and the Contract Carrier with the approval of the Director of Insurance. C. This Mechanism will be terminated at the expiration or termination of the Contract Carrier Agreement. D. This Mechanism may be terminated by a Reinsurer only upon surrender of its authority to write workers’ compensation in Missouri. The Reinsurance Administrator will inform the Director of Insurance of any reinsurer that terminates its participation in this Mechanism. E. This Mechanism shall terminate automatically without further notice as to Contract Periods which have not yet commence upon the filing of a petition or conservation, liquidation, rehabilitation, bankruptcy or similar law for the relief of debtors of the Contract Carrier. F. If the Reinsurance Administrator determines that the contract carrier is not in compliance with any provision of the A.R.M. Plan, this Mechanism, the Contract Carrier Agreement, or any rules or procedures promulgated thereunder, or any performance standards, it shall notify the Contract Carrier and the Director of Insurance of such noncompliance. The Director of Insurance shall have the right to take appropriate action as specified in the A.R.M. Plan or the Contract Carrier Agreement. G. Reinsurance hereunder shall remain in full force and effect until all losses under the Policies have been settled and satisfied or otherwise resolved. This Mechanism shall be effective only for Policies issued pursuant to the A.R.M. Plan, by the Contract Carrier. ORIGINAL CONDITIONS A. All reinsurance under this Mechanism shall be subject to the same rates, terms, conditions and waivers, and to the same modifications and alterations as the Policies, except as otherwise provided in the Mechanism. B. Nothing herein shall in any manner create any obligations or establish any rights against the Reinsurers in favor of any third party or any persons not parties to this Mechanism. C. The provisions of this Mechanism shall continue unchanged with each renewal contract period, except for revisions necessary to be consistent with the terms of each renewal contract. LOSS IN EXCESS OF POLICY LIMITS/EXTRA CONTRACTUAL OBLIGATIONS A. In the event the Contract Carrier pays an amount of loss in excess of its policy limits under the Policies, but otherwise within the terms of a Policy (hereinafter called “loss in excess of policy limits”) including but not limited to any punitive, exemplary, compensatory or consequential damages, resulting from the alleged improper conduct of the insured, 100% of the loss in excess of the policy limits as well as the loss adjustment expense incurred in connection therewith shall be added to the Contract Carrier’s loss, if any, under the Policy involved, and the sum thereof shall be subject to this Mechanism. B. Any loss in excess of policy limits shall be deemed to have occurred on the same date as the loss covered or alleged to be covered under the Policy. C. Notwithstanding anything stated herein, this Mechanism shall not apply to any loss incurred by the Contract Carrier as a result of any willful misconduct or any fraudulent and/or criminal act by an employee, officer or director of the Contract Carrier acting individually or collectively or in collusion with any individual or corporation or any other organization or party involved in the presentation, defense or settlement of any loss covered hereunder. A. The Contract Carrier shall be solely responsible for the collection of all premiums on all risks assigned to it. Reinsurers shall have no responsibility for the Contract Carrier’s premiums, uncollected premiums, return premiums, or similar items. B. Reinsurers shall not receive any portion of the premiums on the Policies assigned to the Contract Carrier. LOSSES AND LOSS ADJUSTMENT EXPENSES A. Loss shall be reported by the Contract Carrier in the format and manner specified in Article X below. B. All loss settlements made by the Contract Carrier, whether under strict contract conditions or by way of compromise, shall be binding unconditionally upon the Reinsurers. SALVAGE AND SUBROGATION In the event that the Contract Carrier recovers any money by way of subrogation or otherwise, other than from the Reinsurers, on a claim for which the Contract Carrier has been reimbursed by the Reinsurers, the Contract Carrier shall reimburse the Reinsurers for amounts paid by the Reinsurers on account of such claim, but not more than the total amount so recovered less expenses incurred in securing such recovery. 20 CSR 500-6 ARTICLE IV TERRITORY ARTICLE V ARTICLE VI ARTICLE VII PREMIUM ARTICLE VIII ARTICLE IX REPORTS AND REMITTANCES A. Within 45 days after the end of each calendar quarter, the Contract Carrier shall report to the Reinsurers, through the Reinsurance Administrator, premiums, Losses, and other amounts for the Contract Period in such detail as the Advisory Board shall reasonably require. B. Any amounts paid by the Contract Carrier and recoverable from Reinsurers shall be remitted by the Reinsurers, through the reinsurance administrator, as promptly as possible after receipt and verification of the Contract Carrier’s report. Any remittance shall be paid within 30 days of the invoice mailing, or within other reasonable time periods established by the Advisory Board. The Contract Carrier or the Reinsurers shall have and may exercise at any time, and from time to time, the right to offset any balance or balances whether on account of premiums or on account of losses or obligations otherwise due from one party to the other or any affiliate thereof in their capacities as Reinsurers and Contract Carrier under the terms of this Mechanism. All limits hereunder are expressed in United States dollars and all premium and loss payments shall be made in United States currency. For the purposes of this Mechanism amounts paid or received by the Contract Carrier in any other currency shall be converted into United States dollars at the rates of exchange at which such transactions are converted on the books of the Contract Carrier. ERRORS AND OMISSIONS Inadvertent delays, errors or omissions made in connection with this Mechanism or any transaction hereunder shall not relieve either party from any liability which would have attached had such delay, error or omission not occurred, provided that such error or omission will be rectified as soon as possible after discovery. PREMIUM TAXES AND ASSESSMENTS The Contract Carrier shall be fully liable for the payment of any and all premium taxes and loss based taxes or assessments. ACCESS TO RECORDS The Contract Carrier shall permit the Reinsurers, through either the Reinsurance Administrator or the Director of Insurance, full and free access during normal business hours to the Contract Carrier’s premises, records and personnel for the purposes of auditing and reviewing the Contract Carrier’s performance hereunder upon ten (10) calendar days written notice to the Contract Carrier by either the Reinsurance Administrator or the Director of Insurance. In the event of a termination of the Contract Carrier Agreement and/or this Mechanism, this provision shall survive such termination and remain in full force and effect until all Losses under the policies issued by the Contract Carrier pursuant to the A.R.M. Plan have been satisfied or otherwise resolved. Further, the survival of this provision shall not alter, modify, diminish, or extinguish any outstanding rights or obligations of the parties that otherwise may exist upon such termination under the policies, the Contract Carrier Agreement and/or this Mechanism. ARTICLE X ARTICLE XI OFFSET ARTICLE XII CURRENCY ARTICLE XIII ARTICLE XIV ARTICLE XV A. In the event of the insolvency of the Contract Carrier this reinsurance shall be payable directly to the Contract Carrier or its liquidator, receiver, conservator or statutory successor on the basis of the liability of the Contract Carrier without diminution because of the insolvency of the Contract Carrier or because the liquidator, receiver, conservator or statutory successor of the Contract Carrier has failed to pay all or a portion of any claim. B. It is agreed, however, that the liquidator, receiver, conservator or statutory successor of the Contract Carrier shall give written notice to the Reinsurers of the pendency of a claim against the Contract Carrier indicating the contract or bond reinsured which claim would involve a possible liability on the part of the Reinsurers within a reasonable time after such claim is filed in the conversation or liquidation proceeding or in the receivership, and that during the pendency of such claim, the Reinsurers may investigate such claim and interpose at their own expense, in the proceeding where such claim is to be adjudicated, any defense or defenses that they may deem available to the Contract Carrier or its liquidator, receiver, conservator or statutory successor. C. The expense thus incurred by the Reinsurers shall be chargeable, subject to the approval of the Court, against the Contract Carrier as part of the expense of conservation or liquidation to the extent of a pro rate share of the benefit which may accrue to the Contract Carrier solely as a result of the defense undertaken by the Reinsurers. D. The reinsurance shall be payable by the Reinsurers to the Contract Carrier or its liquidator, receiver, conservator or statutory successor, except as provided by applicable law except (a) where this Mechanism specifically provides another payee of such reinsurance, in the event of the insolvency of the Contract Carrier and (b) where the Reinsurers, with the consent of the direct insureds, have assumed such policy obligations of the Reinsurers to the payees under such policies and in substitution for the obligations of the Contract Carrier to such payees. E. In the event any Reinsurer becomes insolvent, participation by such Reinsurer under this Mechanism shall be deeded terminated at the time such Reinsurer becomes insolvent. The outstanding liability of an insolvent reinsurer shall be assumed by and apportioned among the remaining reinsurers in the same manner for which other liabilities are apportioned. DISPUTES AND APPEALS In the event of any dispute with respect to this Mechanism, including without limitation, its application, scope or effect, it hereby is agreed mutually that such dispute shall be resolved pursuant to the provisions of Section (8) of the A.R.M. Plan. If determined by the Reinsurance Administrator, the Contract Carrier and the Reinsurers will provide such security for the benefit of the parties to this Mechanism, as determined by the Reinsurance Administrator. REINSURANCE ADMINISTRATOR The Reinsurance Administrator is recognized as the agent through whom some funds and communications relating hereto (including but not limited to notices, statements, reports of premium, losses and loss adjustment expense, salvage and loss settlements) shall be transmitted to all parties hereunder. The Reinsurers and the Contract Carrier acknowledge and agree that all administration for this Mechanism shall be performed by the Reinsurance Administrator and the Director of Insurance pursuant to the terms of this Mechanism, an Administration Agreement between the Reinsurers and the Reinsurance Administrator, the Contract Carrier Agreement, and the A.R.M. Plan. SUCCESSORS AND ASSIGNS This Mechanism shall be binding upon and inure to the benefit of the respective successors and assigns of the Contract Carrier and the Reinsurance Administrator; provided, however, that the Contract Carrier shall not assign or transfer any of its rights or obligations hereunder, by operation of law or otherwise, without the prior written consent of the Missouri Director of Insurance, with the advice and recommendations of the Advisory Board and the Reinsurance Administrator. 20 CSR 500-6 ARTICLE XVI INSOLVENCY ARTICLE XVII ARTICLE XVIII SECURITY ARTICLE XIX ARTICLE XX