MEMORANDUM


TO: Members of the Georgia Self-Insurers Guaranty Trust Fund

FROM: John P. Reale, Administrator

DATE: December 1, 2012

RE: Important Changes, Notifications, and Reminders


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Please note the following changes to the 2013 Member Information Update Form:

1. Regarding Question #3 for Active Members, #3 for Cancelled Members

Please note, the parent company or holding company will not be considered a self-insured employer unless it has been approved for such status.

2. Regarding Question #15 for Active Members, #11 for Cancelled Members:

Additionally for those cases excluded, please identify, by name, those cases excluded and attach confirmation from SITF or Excess of 100% acceptance of the claim.

3. Regarding Question #16 for Active Members, #12 for Cancelled Members:

Additionally for those cases excluded, please identify, by name, those cases excluded and attach confirmation from SITF or Excess of 100% acceptance of the claim.

4. Regarding Question #17 for Active Members, #13 for Cancelled Members:

Additionally for those cases excluded, please identify, by name, those cases excluded and attach confirmation from SITF or Excess of 100% acceptance of the claim.

Also, please include the following: claimant’s name, the last for digits of the claimant’s social security number, date of injury, description of injury, medical paid to date, indemnity paid to date, and unpaid medical and indemnity reserves.

5. Regarding Question #19 for Active Members, #15 for Cancelled Members:

Please note, catastrophic is defined by O.C.G.A. §34-9-200.1 (g).

6. Regarding Question #24 for Active Members, #21 for Cancelled Members:

Please note, the captive endorsement and the bankruptcy/cancellation endorsement for excess are two separate endorsements.

7. Regarding Question #31 for Active Members, #28 for Cancelled Members:

Please note, if the financials are not available or included with the 2013 update form Items a, b and the financial certification are to be completed.

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