50.53—Loss certifications.
(a) General.
When an insurer has
paid aggregate insured losses that exceed its
insurer deductible, the insurer may make claim
upon Treasury for the payment of the Federal share
of compensation for its insured losses. The
insurer shall file an Initial Certification of
Loss, on a form prescribed by Treasury, and
thereafter such Supplementary Certifications of
Loss, on a form prescribed by Treasury, as may be
necessary to receive payment for the Federal share
of compensation for its insured losses.
(b)
Initial Certification of
Loss. An insurer shall use its best efforts to
file with the Program the Initial Certification of
Loss within 45 days following the last calendar
day of the month when an insurer has paid
aggregate insured losses that exceed its insurer
deductible. The Initial Certification of Loss will
include the following:
(1)
A bordereau, on a form prescribed by
Treasury, that includes basic information about
each underlying insured loss. For purposes of this
section, a “bordereau” is a
report of basic information about an insurer's
underlying claims that, in the aggregate,
constitute the insured losses of the insurer. The
bordereau will include, but may not be limited
to:
(iii)
A calculation of the aggregate insured
losses sustained by the insurer above its insurer
deductible for the Program Year; and
(iv)
The amount the insurer claims as the
Federal share of compensation for its aggregate
insured losses.
(2)
A certification that the insurer is in
compliance with the provisions of section 103(b)
of the Act and this part, including certifications
that:
(i)
The underlying insured losses listed on the
bordereau filed pursuant to § 50.53(b)(1) either:
Have been paid by the insurer; or will be paid by
the insurer upon receipt of an advance payment of
the Federal share of compensation as soon as
possible, consistent with the insurer's normal
business practices, but not longer than five
business days after receipt of the Federal share
of compensation;
(ii)
The underlying claims for insured losses
were filed by persons who suffered an insured
loss, or by persons acting on behalf of such
persons;
(iii)
The underlying claims for insured losses
were processed in accordance with appropriate
business practices and the procedures specified in
this subpart;
(iv)
The insurer has complied with the
disclosure requirements of §§ 50.10 through 50.19,
and the cap disclosure requirement of § 50.15, for
each underlying insured loss that is included in
the amount of the insurer's aggregate insured
losses; and
(v)
The insurer has complied with the mandatory
availability requirements of §§ 50.20 through
50.24.
(3)
A certification of the amount of the
insurer's “direct earned premium” as defined in §
50.5(d), together with the calculation of its
“insurer deductible” as defined in § 50.5(g)
(provided this certification was not submitted
previously with the Initial Notice of Insured Loss
specified in § 50.52 ).
(4)
A certification that the insurer will
disburse payment of the Federal share of
compensation in accordance with this subpart.
(5)
A certification that if Treasury has
determined a Pro rata Loss
Percentage (PRLP) (see § 50.92 ), the insurer has
complied with applying the PRLP to insured loss
payments, where required.
(c)
Supplementary Certification of
Loss. If the total amount of the Federal share
of compensation due an insurer for insured losses
under the Act has not been determined at the time
an Initial Certification of Loss has been filed,
the insurer shall file monthly, or on a schedule
otherwise determined by Treasury, Supplementary
Certifications of Loss updating the amount of the
Federal share of compensation owed for the
insurer's insured losses. Supplementary
Certifications of Loss will include the
following:
(d) Supplementary information.
(b)
ition to the information required in paragraphs
(b) and (c) of this section, Treasury may require
such additional supporting documentation as
required to ascertain the Federal share of
compensation for the insured losses of any
insurer.
(e)
State Residual Market Insurance
Entities and State Workers' Compensation
Funds. A State residual market insurance
entity or State workers' compensation fund
described in § 50.35 shall provide the
Certifications of Loss described in §§ 50.53(b)
and 50.53(c) for all its insured losses to each
participating insurer at the time it provides the
allocated dollar value of the participating
insurer's proportionate share of insured losses.
In addition, at such time the State residual
market insurance entity or State workers'
compensation fund shall provide the certification
described in § 50.53(b)(2) to Treasury.
Participating insurers shall treat the allocated
dollar value of their proportionate share of
insured losses from a State residual market
insurance entity or State workers' compensation
fund as an insured loss for the
purpose of their own reporting to Treasury in
seeking the Federal share of compensation.