Rules and Regulations of the State of Georgia
 

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  1. In the address bar, type about:config and press Enter.
  2. Click "I'll be careful, I promise" if a warning message appears.
  3. In the search box, search for javascript.enabled
  4. Toggle the "javascript.enabled" preference (right-click and select "Toggle" or double-click the preference) to change the value from "false" to "true".
  5. Click on the "Reload current page" button of the web browser to refresh the page.
  • 1. In the address bar, type about:config and press Enter.
  • 2. Click "I'll be careful, I promise" if a warning message appears.
  • 3. In the search box, search for javascript.enabled
  • 4. Toggle the "javascript.enabled" preference (right-click and select "Toggle" or double-click the preference) to change the value from "false" to "true".
  • 5. Click on the "Reload current page" button of the web browser to refresh the page.




ie Internet Explorer

  1. On web browser menu click "Tools" icon and select "Internet Options".
  2. In the "Internet Options" window select the "Security" tab.
  3. On the "Security" tab click on the "Custom level..." button.
  4. When the "Security Settings - Internet Zone" dialog window opens, look for the "Scripting" section.
  5. In the "Active Scripting" item select "Enable".
  6. When the "Warning!" window pops out asking "Are you sure you want to change the settings for this zone?" select "Yes".
  7. In the "Internet Options" window click on the "OK" button to close it.
  8. Click on the "Refresh" button of the web browser to refresh the page.
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 Internet Explorer < 9
  1. On web browser menu click "Tools" and select "Internet Options"
  2. In the "Internet Options" window select the "Security" tab.
  3. On the "Security" tab click on the "Custom level..." button.
  4. When the "Security Settings - Internet Zone" dialog window opens, look for the "Scripting" section.
  5. In the "Active Scripting" item select "Enable".
  6. When the "Warning!" window pops out asking "Are you sure you want to change the settings for this zone?" select "Yes".
  7. In the "Internet Options" window click on the "OK" button to close it.
  8. Click on the "Refresh" button of the web browser to refresh the page.
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chrome Google Chrome

  1. On the web browser menu click on the "Customize and control Google Chrome" and select "Settings".
  2. In the "Settings" section click on the "Show advanced settings..."
  3. Under the the "Privacy" click on the "Content settings...".
  4. When the dialog window opens, look for the "JavaScript" section and select "Allow all sites to run JavaScript (recommended)".
  5. Click on the "OK" button to close it.
  6. Close the "Settings" tab.
  7. Click on the "Reload this page" button of the web browser to refresh the page.
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opera Opera

  • 1. a) Click on "Menu", hover mouse on the "Settings" then hover mouse on the "Quick preferences" and mark the "Enable Javascript" checkbox.
  • 1. b) If "Menu bar" is shown click on the "Tools", hover mouse on the "Quick preferences" and mark the "Enable Javascript" checkbox.
1. a) opera10 a 1. b) opera10 b




safari Apple Safari

  1. On the web browser menu click on the "Edit" and select "Preferences".
  2. In the "Preferences" window select the "Security" tab.
  3. In the "Security" tab section "Web content" mark the "Enable JavaScript" checkbox.
  4. Click on the "Reload the current page" button of the web browser to refresh the page.
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<xmp>.</xmp> <form name="form1" method="post" action="120-2-36?urlRedirected=yes&amp;data=admin&amp;lookingfor=120-2-36" id="form1"> <input type="hidden" name="__VIEWSTATE" id="__VIEWSTATE" value="/wEPDwUKLTY5ODkwOTM2Nw8WAh4Ec3BhbQIGFgJmD2QWAgIFDw8WAh4EVGV4dAUFMyArIDNkZGQ+47dXtdKmX4D5puRBdKQCCiLesA==" /> <input type="hidden" name="__VIEWSTATEGENERATOR" id="__VIEWSTATEGENERATOR" value="EEBB6393" /> <input type="hidden" name="__EVENTVALIDATION" id="__EVENTVALIDATION" value="/wEWCAK2xZnfDQLniKOhBALV5cpNAoa5iIEFAoznisYGAsrv5u0MAsrv4u0MAsrv3u0MqejKKDZGqwJC/RfdE1XXbQuaHWk=" /> <div class='popup'> <div class='cnt223'> <div style="margin-bottom:6px;"> <img alt="Rules and Regulations of the State of Georgia" src="/images/new.gif"/> </div> <div class="header"> Terms and Conditions of Agreement for Access to Rules and Regulations of the State of Georgia Website </div> <div class="scroll"> <p>(Note: certain features of this site have been disabled for the general public to prevent digital piracy. If you are an entitled government entity pursuant the Georgia Administrative Procedures Act, <a target="_new" href="http://links.casemakerlegal.com/states/GA/books/Code_of_Georgia/browse?ci=25id=gasos&amp;codesec=50-13-7&amp;title=50&amp;#50-13-7(d)">O.C.G.A.§ 50-13-7(d)</a> contact the State of Georgia's Administrative Procedures Division at 678-364-3785 to enable these features for your location.)</p> <p>To access this website, you must agree to the following: </p> <p> These terms of use are a contract between you and/or your employer (if any), and Lawriter, LLC. </p> <p> You agree that you will not copy, print, or download anything from this website for any commercial use. </p> <p> You agree not to use any web crawler, scraper, or other robot or automated program or device to obtain data from the website.</p> <p> You agree that you will not sell, will not license, and will not otherwise make available in exchange for anything of value, anything that you download, print, or copy from this site.</p> <p> You agree that you will not copy, print, or download any portion of the regulations posted on this site exceeding a single chapter of regulations for sale, license, or other transfer to a third party, except that you may quote a reasonable portion of the regulations in the course of rendering professional advice.</p> <p> If you violate this agreement, or if you access or use this website in violation of this agreement, you agree that Lawriter will suffer damages of at least $20,000. </p> <p> THIS WEBSITE AND ITS CONTENT ARE PROVIDED "AS IS." THE STATE OF GEORGIA AND LAWRITER EXPRESSLY DISCLAIM ALL WARRANTIES, INCLUDING THE WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, AND NON-INFRINGEMENT AND ARE NOT LIABLE TO ANY PERSON FOR ANY ERRORS IN INACCURACIES CONTAINED IN THIS WEBSITE. </p> <p> If you accept these terms enter the information below and click “I AGREE”.</p> </div> <table border="0" style="width: 810px"> <tr> </tr> <tr> <td style="vertical-align: text-top; width: 243px;"> Full Name:</td> <td style="width: 532px; vertical-align:super;"> <input name="firstName" type="text" id="firstName" class="txt" /> <span id="lbl_fname"><font color="Red"></font></span> </td> </tr> <tr><td style="width: 243px"> Human verification: <b> <span id="lblStopSpam">3 + 3</span>&nbsp;= </b></td><td style="width: 532px"> <input name="captcha" type="text" id="captcha" class="txt" /> <span id="lbl_captcha"><font color="Red"></font></span> &nbsp; <input name="sum" type="hidden" id="sum" value="6" /> </td></tr> </table> <input type="submit" name="Button1" value="I AGREE" id="Button1" disabled="disabled" /> <span id="alrtmsg"><font color="Red"></font></span> <input name="v1" type="hidden" id="v1" /> <input name="v2" type="hidden" id="v2" /> <input name="v3" type="hidden" id="v3" /> <p>Privacy Policy: the above information is for internal use only as related to this agreement and will not be sold or distributed.</p> </div> </div> </form> <html> <head runat="server"> <title>GA - GAC</title> <link href="_files/main.css" media="all" rel="Stylesheet" type="text/css" /> <link href="_files/treeview_old.css" media="all" rel="Stylesheet" type="text/css" /> <link href="/_files/popup.css" media="all" rel="stylesheet" type="text/css" /> <script type="text/javascript" src="/_files/treeview.js"></script> <script type="text/javascript" src="/_files/jquery-1.8.0.min.js"></script> <script type="text/javascript" src="/_files/jquery-1.10.2.js"></script> <script type="text/javascript" src="/_files/popup.js"></script> <script type="text/javascript" src="http://code.jquery.com/jquery-1.8.2.js"></script> <script type="text/javascript" src="https://ajax.googleapis.com/ajax/libs/jquery/1.8/jquery.min.js" /> <script type="text/javascript" src="/_files/jquery.popup.js"></script> <script type="text/javascript" src="/_files/jquery.popup.min.js"></script> <script type="text/javascript" src="/_files/ValidateForm.js"></script> <script src="https://code.jquery.com/jquery-1.11.3.js"></script> <link href="/_files/enablejs.css" rel="Stylesheet" type="text/css" /> <link href="/_files/forJavascript.css" rel="Stylesheet" type="text/css" /> <style type="text/css"> .collapse{background-image:url('/images/expcoll_right.png');} .expand{background-image:url('/images/expcoll_down.png');} </style> <script type="text/javascript"> $(document).ready(function(){ $("#History-parent").click(function(){ $("#History-Childs").toggle(); if ($('#History-parent img').hasClass('expand')) { $('#History-parent img').addClass('collapse'); $('#History-parent img').removeClass('expand'); $('#History-parent img').attr('src', '/images/expcoll_right.png'); } else { $('#History-parent img').removeClass('collapse'); $('#History-parent img').addClass('expand'); $('#History-parent img').attr('src', '/images/expcoll_down.png'); } }); $("#History-Childs").hide(); var tocnode=document.getElementById('toc-children'); if (tocnode != null) { if(tocnode.childNodes.length != 0) { document.getElementById("doc-content").style.width="72%"; document.getElementById("toc").style.width="21%"; document.getElementById("toc").style.padding="10px"; } else { document.getElementById('toc').style.display="none"; } } }); function fnsetRDVal(id) { if (id=="y") { document.getElementById("y").value="yes" document.getElementById("n").value="" } else { document.getElementById("n").value="no" document.getElementById("y").value="" } } </script> <script type="text/javascript"> function TermsCon() { var overlay = $('<div id="overlay"></div>'); overlay.show(); overlay.appendTo(document.body); $('.popup2').show(); $('#btnAgree').click(function () { $('.popup2').hide(); $("#overlay").hide(); overlay.appendTo(document.body).remove(); }); $("#btnprint").click(function () { var contents = $("#popupterms").html(); var frame1 = $('<iframe />'); frame1[0].name = "frame1"; frame1.css({ "position": "absolute", "top": "-1000000px" }); $("body").append(frame1); var frameDoc = frame1[0].contentWindow ? 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If you are an entitled government entity pursuant the Georgia Administrative Procedures Act, <a target="_new" href="http://links.casemakerlegal.com/states/GA/books/Code_of_Georgia/browse?ci=25id=gasos&amp;codesec=50-13-7&amp;title=50&amp;#50-13-7(d)">O.C.G.A.§ 50-13-7(d)</a> contact the State of Georgia's Administrative Procedures Division at 678-364-3785 to enable these features for your location.)</p> <p>To access this website, you must agree to the following: </p> <p> These terms of use are a contract between you and/or your employer (if any), and Lawriter, LLC. </p> <p> You agree not to use any web crawler, scraper, or other robot or automated program or device to obtain data from the website. </p> <p> You agree that you will not sell or license anything that you download, print, or copy from this website.</p> <p> THIS WEBSITE AND ITS CONTENT ARE PROVIDED "AS IS." THE STATE OF GEORGIA AND LAWRITER EXPRESSLY DISCLAIM ALL WARRANTIES, INCLUDING THE WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, AND NON-INFRINGEMENT AND ARE NOT LIABLE TO ANY PERSON FOR ANY ERRORS IN INACCURACIES CONTAINED IN THIS WEBSITE. </p> <p> By accessing and/or using this website, you agree to the terms and conditions above. If you do not agree to the terms and conditions above, you must cease accessing and/or using this website and destroy all material obtained from this website without your agreement. </p> </div> </div> <div class="modal-footer"> <input type="button" name="btnAgree" value="Close" id="btnAgree" class="btn-blue noprint" /> <input type="button" name="btnprint" value="Print" id="btnprint" class="btn-blue noprint" /> </div> </div> </div> <div id="main" class="noprint"> <!--class="noprint"--> <div id="header" class="noprint"> <div class="container"> <div class="terms"> NOTICE OF TERMS OF USE OF THIS WEBSITE. 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charset=UTF-16"> </HEAD> <div id="infobar"><a href="javascript:;" accesskey="r" Name="Route" title="Route" class="quickkey"><em class="mnemonic">R</em>oute </a>:<div class="searchtips" style="float:right;margin-right:10px;color: rgb(47, 79, 79);"> <a style="text-decoration:none;color: rgb(47, 79, 79);" title="search tips" name="searchtip" href="../help.aspx#searching" target="_blank"><em class="mnemonic">S</em>earch tips</a></div><ul class="breadcrumb"> <li><a href="/GAC" name="GAC" title="GAC">GA R&amp;R</a></li> <li>&raquo; <a href="/GAC/120" title="120">Department 120</a></li> <li>&raquo; <a href="/GAC/120-2" title="120-2">Chapter 120-2</a></li> <li>&raquo; Subject 120-2-36</li> </ul> </div> </div><div id="doc" class="container"> <div id="doc-content" class="content"> <h1><nllsubject>Subject 120-2-36 WORKERS' COMPENSATION INSURANCE STATISTICAL AGENT - FORMS AND RATING PLANS</nllsubject></h1> <h2><a href="/GAC/120-2-36-.01" name="120-2-36-.01" title="120-2-36-.01">Rule 120-2-36-.01 Statutory Authority</a></h2> <h2><a href="/GAC/120-2-36-.02" name="120-2-36-.02" title="120-2-36-.02">Rule 120-2-36-.02 Purpose</a></h2> <h2><a href="/GAC/120-2-36-.03" name="120-2-36-.03" title="120-2-36-.03">Rule 120-2-36-.03 Applicability</a></h2> <h2><a href="/GAC/120-2-36-.04" name="120-2-36-.04" title="120-2-36-.04">Rule 120-2-36-.04 Definitions</a></h2> <h2><a href="/GAC/120-2-36-.05" name="120-2-36-.05" title="120-2-36-.05">Rule 120-2-36-.05 Statistical Agent - Designation and Duties</a></h2> <h2><a href="/GAC/120-2-36-.06" name="120-2-36-.06" title="120-2-36-.06">Rule 120-2-36-.06 Insurers Required to Provide Statistics, Data and Information to Statistical Agent and Insured</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-36-.06(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> As a condition to continuing to transact insurance in the State of Georgia, every Insurer authorized to transact Worker's Compensation insurance shall provide to the authorized statistical agent worker's compensation data, statistics including loss ratios and all other relevant information. The foregoing shall be submitted in such a manner (including statistical plan and data collection procedures) as is required by the current statistical plan filed with and approved by the Commissioner by that authorized statistical agent.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-36-.06(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The Insurer shall verify with the Insured, the data to be submitted to the Statistical Agent who shall determine the experience modification factor. Verification of such data shall be accomplished in accordance with this regulation: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-36-.06(2)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The Insurer shall provide the Insured with a copy of the statistical data being submitted to the Statistical Agent. The statistical data shall be presented in a legible and understandable format. Technical terms shall be avoided wherever possible. It shall be permissible for the insurer to provide the unit statistical report, by whatever name called, in lieu of an independently created form, provided the unit statistical report is accompanied by a legible and understandable explanation of its format.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-36-.06(2)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The disclosure statement contained in Form GID-63 attached hereto and incorporated herein, or one substantially the same, shall be attached to the statistical data provided to the Insured. <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-36-.06(2)(b)1.">1.</a></td> <td valign="top" style="text-align:left" class="leftalign"> The disclosure shall provide a statement in bold face type, to be signed by an authorized representative of the Insured, that the statistical data has been reviewed and is accurate, and a representative of the Insurer has explained to the Insured's representative that the statistical data may affect the Insured's premium for Georgia Workers' Compensation insurance.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-36-.06(2)(b)2.">2.</a></td> <td valign="top" style="text-align:left" class="leftalign"> The disclosure shall indicate that the statistical data will be deemed accurate if the disclosure is not returned to the address provided by the Insurer within 30 days from the date mailed. <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-36-.06(2)(b)2.(i)">(i)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The Insurer shall deliver the statistical data and disclosure in person or by depositing the information in the United States mail to be dispatched by at least first-class mail to the last address of record of the Insured, and receiving the receipt provided by the United States Postal Service or such other evidence of mailing as prescribed or accepted by the United States Postal Service.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-36-.06(2)(b)2.(ii)">(ii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Statistical data that is deemed to be accurate will not in any way affect the right of the Insured to appeal to the Georgia Worker's Compensation Appeals Board.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-36-.06(2)(b)3.">3.</a></td> <td valign="top" style="text-align:left" class="leftalign"> The disclosure shall also provide a statement for an authorized representative of the Insured to dispute the accuracy of the data. The statement shall direct the Insured to clearly identify any discrepancies. The disputed data shall be furnished to the Insurer by the return date indicated on the disclosure statement. <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-36-.06(2)(b)3.(i)">(i)</a></td> <td valign="top" style="text-align:left" class="leftalign"> If the Insurer confirms the accuracy of the information provided by the Insured, the Insurer shall correct their records and proceed to furnish the amended data to the Statistical Agent.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-36-.06(2)(b)3.(ii)">(ii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> If the Insurer does not agree with the data provided by the Insured, the Insurer shall submit the Insurer's data to the Statistical Agent. <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-36-.06(2)(b)3.(ii)(I)">(I)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The Insurer shall notify the risk within 60 days of the original mail date that the experience modification factor will be promulgated from the information provided by the Insurer.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-36-.06(2)(b)3.(ii)(II)">(II)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The Insured shall be instructed, in detail, of their right to appeal to the Georgia Workers' Compensation Appeals Board.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-36-.06(2)(b)3.(ii)(III)">(III)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The Insurer's failure to respond to the Insured in the time prescribed shall be deemed an acknowledgement that the insured's records are accurate, and amendments are to be made before reporting the statistical data to the Statistical Agent.</td> </tr> </table> </td> </tr> </table> </td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-36-.06(2)(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Verification of data shall not be mandatory for insured who are not eligible for experience rating, however, the data and explanation shall be furnished to insureds upon request.</td> </tr> </table> </td> </tr> </table> <h2><a href="/GAC/120-2-36-.07" name="120-2-36-.07" title="120-2-36-.07">Rule 120-2-36-.07 Maintenance of Records by Authorized Statistical Agent(s)</a></h2> <h2><a href="/GAC/120-2-36-.08" name="120-2-36-.08" title="120-2-36-.08">Rule 120-2-36-.08 Filing of Rating Plans, Rating Systems and Underwriting Rules</a></h2> <h2><a href="/GAC/120-2-36-.09" name="120-2-36-.09" title="120-2-36-.09">Rule 120-2-36-.09 Standard Workers' Compensation Insurance Policy</a></h2> <h2><a href="/GAC/120-2-36-.10" name="120-2-36-.10" title="120-2-36-.10">Rule 120-2-36-.10 Filing of Standard Workers' Compensation Insurance Policy and Other Forms</a></h2> <h2><a href="/GAC/120-2-36-.11" name="120-2-36-.11" title="120-2-36-.11">Rule 120-2-36-.11 Filing of Annual Statistical Data</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-36-.11(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> As a condition to continuing to transact insurance in the State of Georgia, every insurer authorized to transact workers' compensation insurance shall file with the Insurance Commissioner, before March 1, of each year, an exhibit of its premium losses, expenses and investment income as of December 31 of the previous calendar year. Each insurer shall provide all information and data necessary to factually complete each blank space in such exhibit unless it is unequivocally clear that such blank has no application to the insurer. Each insurer shall supply true and correct answers to any and all interrogatories on the exhibit and shall supply, insert or attach to such exhibit all data, information and answers required or suggested by any note, footnote or lack of space in such forms. After supplying all answers, information or data necessary or proper to complete such form in every detail, each insurer shall cause its officers or employees specified in such exhibit to certify that the information is true and accurate in every detail.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-36-.11(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Any "designated carrier" for the workers' compensation insurance plan shall provide a separate report for their involuntary business.</td> </tr> </table> <h2><a href="/GAC/120-2-36-.12" name="120-2-36-.12" title="120-2-36-.12">Rule 120-2-36-.12 Severability</a></h2> <P>If any provision of this Regulation, or the application thereof, to any person or circumstance is held invalid by a court of competent jurisdiction, the remainder of the Regulation or the applicability of such provisions to other persons or circumstances shall not be affected.</P> <P>IMPORTANT</P> <P>DISCLOSURE STATEMENT</P> <P>_________________________</P> <P>Date of Mailing</P> <P>TO: Policy Holder Carrier's Return Address</P> <P>Attached, as required by Georgia Law, is a copy of the loss experience to be used in experience rating your workers compensation policy. The experience rating can cause your premiums to increase or decrease depending on the frequency end severity of losses.</P> <P>In accordance with the O.C.G.A. Section <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=34-9-136&amp;title=34#" target="_newtab">34-9-136</a>, please review the attached statement, sign below and return this form to our office. If you do not sign and return this form within 30 days from the mailing date, the date will be deemed correct for the purpose of calculating your experience rating modification factor end final premium. Your failure to respond shall not affect nor waive any of your rights to a future appeal.</P> <P>If you find an error in the attached material, please contact our office immediately at the indicated address:</P> <P><B>SIGN THE APPLICABLE STATEMENT BELOW</B></P> <P><B>AND RETURN REQUIRED STATEMENT</B></P> <P>I have reviewed the attached payroll and claims information and find it to be accurate. An insurance company representative has explained that this information may affect the premium charged for Workers' Compensation Insurance Coverage for my business.</P> <P>___________________________________________</P> <P>SIGNATURE &amp; TITLE</P> <P>(Authorized Representative of the Employer)</P> <P>I have reviewed the attached payroll and claims information. According to my records, the information is inaccurate. I have attached a copy of my records which I believe to be correct and a statement explaining the differences. I understand that if you, the insurance company, do not respond to me within 60 days of the date on your statement, you are agreeing with me that my records are correct and you will change your records accordingly.</P> <P>___________________________________________</P> <P>SIGNATURE &amp; TITLE</P> <P>(Authorized Representative of the Employer)</P> <P>(NOTE: Return by _______________)</P> <P>Date</P> <P>IF YOU ARE AN INDIVIDUAL WITH A DISABILITY AND WISH TO ACQUIRE THIS PUBLICATION IN AN ALTERNATIVE FORMAT, PLEASE CONTACT THE ADA COORDINATOR, PROPERTY &amp; CASUALTY DIVISION, OFFICE OF COMMISSIONER OF INSURANCE, NO 2 MARTIN LUTHER KING, JR. DRIVE, ATLANTA, GEORGIA 30334 (404) 656-2056, TDD # (404) 656-4031</P> </div> </div> </HTML> </div> <div id="toc" class="sidebar noprint"> <ul id="toc-children" class="children"><li><a href="/GAC/120-2-36-.01" name="120-2-36-.01" title="120-2-36-.01">Rule 120-2-36-.01 Statutory Authority</a></li><li><a href="/GAC/120-2-36-.02" name="120-2-36-.02" title="120-2-36-.02">Rule 120-2-36-.02 Purpose</a></li><li><a href="/GAC/120-2-36-.03" name="120-2-36-.03" title="120-2-36-.03">Rule 120-2-36-.03 Applicability</a></li><li><a href="/GAC/120-2-36-.04" name="120-2-36-.04" title="120-2-36-.04">Rule 120-2-36-.04 Definitions</a></li><li><a href="/GAC/120-2-36-.05" name="120-2-36-.05" title="120-2-36-.05">Rule 120-2-36-.05 Statistical Agent - Designation and Duties</a></li><li><a href="/GAC/120-2-36-.06" name="120-2-36-.06" title="120-2-36-.06">Rule 120-2-36-.06 Insurers Required to Provide Statistics, Data and Information to Statistical Agent and Insured</a></li><li><a href="/GAC/120-2-36-.07" name="120-2-36-.07" title="120-2-36-.07">Rule 120-2-36-.07 Maintenance of Records by Authorized Statistical Agent(s)</a></li><li><a href="/GAC/120-2-36-.08" name="120-2-36-.08" title="120-2-36-.08">Rule 120-2-36-.08 Filing of Rating Plans, Rating Systems and Underwriting Rules</a></li><li><a href="/GAC/120-2-36-.09" name="120-2-36-.09" title="120-2-36-.09">Rule 120-2-36-.09 Standard Workers' Compensation Insurance Policy</a></li><li><a href="/GAC/120-2-36-.10" name="120-2-36-.10" title="120-2-36-.10">Rule 120-2-36-.10 Filing of Standard Workers' Compensation Insurance Policy and Other Forms</a></li><li><a href="/GAC/120-2-36-.11" name="120-2-36-.11" title="120-2-36-.11">Rule 120-2-36-.11 Filing of Annual Statistical Data</a></li><li><a href="/GAC/120-2-36-.12" name="120-2-36-.12" title="120-2-36-.12">Rule 120-2-36-.12 Severability</a></li></ul> </div> </div> <!--content ends here--> <div id="footer" class="noprint"><span class="footer">Copyright &copy; 2019 Lawriter LLC - All rights reserved.</span>| <a href="mailto:support@casemakerlegal.com?subject=Rules and Regulations of the State of Georgia">Email Us</a> | 844-838-0769 | <a href="http://livechat.casemakerlegal.com/client.php?locale=en" target="_blank" onclick="if(navigator.userAgent.toLowerCase().indexOf('opera') != -1 && window.event.preventDefault)window.event.preventDefault();this.newWindow = window.open('http://livechat.casemakerlegal.com/client.php?locale=en&url='+escape(document.location.href)+'&referrer='+escape(document.referrer), 'webim','toolbar=0,scrollbars=0,location=0,status=1,menubar=0,width=640,height=480,resizable=1');this.newWindow.focus();this.newWindow.opener=window;return false;">Live Chat</a> </div> </div> </body> </html>