Form 315 - Workers' Compensation Special Compensation Fund - State Of Hawaii Insurance Division

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NEIL ABERCROMBIE
KEALI'I LOPEZ
GOVERNOR
DIRECTOR
BRIAN SCHATZ
GORDON I. ITO
LT. GOVERNOR
INSURANCE COMMISSIONER
STATE OF HAWAII
INSURANCE DIVISION
DEPARTMENT OF COMMERCE & CONSUMER AFFAIRS
P. O. BOX 3614
HONOLULU, HAWAI‘I 96811-3614
335 MERCHANT STREET, ROOM 213
HONOLULU, HAWAI‘I 96813
PHONE NO: (808) 586-2790
FAX NO: (808) 586-2806
December 3, 2012
TO:
INSURERS AUTHORIZED TO WRITE WORKERS' COMPENSATION INSURANCE
IN HAWAII
SUBJECT:
WORKERS' COMPENSATION SPECIAL COMPENSATION FUND
Section 386-152, Hawaii Revised Statutes, requires a levy to finance the
Special Compensation Fund when the cash balance of the fund falls below an
amount deemed necessary to meet the Fund's current and projected obligations.
The Director of Labor and Industrial Relations who administers the Special
Compensation Fund advises that the fund balance was insufficient to meet the
required level of funding as of December 31, 2012.
For 2013, the levy to be
%
assessed insurers writing Workers' Compensation insurance shall be 4.0
of
the 2012 gross premiums.
In accordance with the above, you are to report on the enclosed Form 315, the
gross premiums written from Workers' Compensation insurance issued during
2012 and show the amount of levy due and payable.
Checks should be made
payable to “DEPARTMENT OF COMMERCE AND CONSUMER
AFFAIRS (“DCCA”), STATE OF
HAWAII.”
TO BE FILED ON OR BEFORE MARCH 15, 2013
ONLY insurers reporting workers' compensation gross
premiums written are required to file Form 315.
IF THE WORKERS' COMPENSATION PREMIUMS ARE $0, THE FORM
IS NOT REQUIRED.
NOTE: The Hawaii Insurance Division does accept ACH Credit payments.
Please contact Susan Hansen at
shansen@dcca.hawaii.gov
for more
information.

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