West Virginia Code of State Rules Agency 115 - Risk And Insurance Management
Overview of Agency 115 — Risk and Insurance Management
Agency 115 establishes rules for the West Virginia Board of Risk and Insurance Management (BRIM). BRIM oversees the state's insurance programs and risk management activities, including:
Protecting state property and assets.
Administering insurance for state agencies, public entities, and qualifying organizations.
Reducing risk through insurance, safety programs, and claims management.
The authority for BRIM comes from West Virginia statutes, mainly:
Chapter 29, Article 12 – authorizes BRIM to manage risk for state agencies.
Chapter 33, Article 30 – provides guidance on public and medical liability insurance programs.
Agency 115 translates these statutory powers into operational rules, covering insurance procurement, claims procedures, cancellations, and participation requirements.
Key Provisions
1. Definitions and General Administration
Establishes terms like agency, insurance policy, producer of record, claim, and insured entity.
Clarifies how BRIM interacts with state agencies and private insurers.
Provides procedural authority for issuing, renewing, and canceling insurance policies.
2. Public Entities Insurance Program
Rules here govern how cities, counties, schools, and other public entities participate in BRIM insurance programs.
Main Points:
Producer of Record Requirement:
Each public entity must work with an appointed insurance agent (producer) when obtaining or renewing coverage. BRIM can deny coverage if the entity bypasses this requirement.
Cancellation and Nonrenewal Rules:
BRIM may cancel or refuse to renew coverage if:
Premiums are unpaid.
Fraud or misrepresentation occurs.
Risk levels become unacceptably high.
Program rules are violated.
Eligibility for coverage is lost.
3. Medical Liability and High-Risk Programs
These rules govern medical professional liability insurance for healthcare providers.
BRIM sets coverage limits, underwriting rules, and premium rates.
Determines which providers may be covered based on risk.
Administers claims handling, reinsurance, and tail coverage (coverage for incidents after a policy ends).
4. Claims Reporting Requirements
Insured entities must promptly notify BRIM of any incident or potential claim.
Timely reporting ensures claims are processed correctly and prevents disputes over coverage.
Case Law Context
Several court cases provide insight into how Agency 115 is applied:
Frye v. Erie Insurance Company (2024)
Addressed mine subsidence coverage.
Court emphasized BRIM acts as a reinsurer, not the direct insurer.
Highlighted the interaction between BRIM’s rules and private insurance contracts.
Higginbotham v. Clark (1993)
Court considered retroactive cancellation of mine subsidence coverage.
Determined that BRIM actions could be reviewed by the state insurance commissioner, showing that Agency 115 rules are subject to procedural oversight.
Zaleski v. West Virginia Physicians’ Mutual Insurance (2007)
Concerned nonrenewal of medical liability insurance.
Court ruled that affected providers are entitled to due process when BRIM declines coverage or nonrenews policies.
Takeaway: While BRIM has regulatory authority under Agency 115, its actions are subject to legal and procedural checks to protect insured entities.
Key Principles Under Agency 115
Risk Management:
BRIM’s programs are designed to reduce financial losses for state agencies and public entities.
Insurance Administration:
The agency standardizes procurement, coverage, and claims processes.
Fair Procedures:
Adverse actions (cancellations, nonrenewals) must include written notice and appeal opportunities.
Integration with Statutes:
Rules supplement statutory law and provide detailed procedures to enforce the state’s risk and insurance policies.
Practical Implications
Public entities must strictly follow BRIM’s procedures to maintain coverage.
Insurance cancellations or nonrenewals can be appealed if BRIM fails to comply with procedural requirements.
Courts have held that BRIM’s decisions can be reviewed to ensure compliance with statutory authority and due process protections.
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