The California Workers’ Compensation Insurance Rating Bureau (WCIRB: an independent entity that develops the statistics used in rate making) recommends a 16% increase in workers’ compensation insurance premiums for January 2009. [https://wcirbonline.org/wcirb/wcirb_wire/2008/2008_07.html] After several years of significant decreases due to workers’ compensation reforms, premiums are on the rise again. What actions can employers and small business owners take to keep premiums within reason?
1.) Participate in rate hearings. These hearings are typically held in the Fall to address rate changes going into effect the following January. The California Insurance Commissioner must hold public hearings to permit industry and individual challenges to proposed recommended pure premium rates, including any changes to rates set for individual classifications applicable to specific job categories (i.e. rates are highest for roofers and lowest for office workers based on the statistical risk of injury). To challenge such changes in rates, employers and industry representatives appear to make statements for the Insurance Commissioner to consider in addition to the statistical information provided by the WCIRB. If you want to make a public comment, here are some suggestions: a.) do the math- the most influential comments are backed up with statistical evidence; b.) consider hiring an attorney or representative to pitch your case both in writing and orally at the hearing; and c.) coordinate with other interested parties.
2.) File a complaint with the WCIRB and/or your insurer; if your complaint is denied file an appeal with the Department of Insurance Administrative Hearing Bureau (DOI AHB) regarding issues with the calculation of your premium. Although the AHB does not handle disputes over pure premium rates, it does handle disputes regarding the proper classification of employees, or other factors going into actual premium calculations. If going this route, consider hiring counsel. Technical issues of jurisdiction and timeliness derail too many of these appeals. Although the hearings are informal and counsel is not required, insurers are almost always represented by counsel and they typically win, perhaps because of their use of counsel. Whether you hire counsel or not, be sure to come prepared with witnesses and statistics to back up your claim.
Health Benefits Inspire Rush to Marry, or Divorce
With health insurance out of reach for many, obtaining coverage is factoring into the decision for more couples. FInd the full story at http://www.nytimes.com/2008/08/13/us/13marriage.html?ex=1376366400&en=536088d42d1c0193&ei=5124&partner=permalink&exprod=permalink
You’ve filed a claim with your insurer. They have opened a file and filled it with information regarding your claim, including things like an investigation report. The insurer’s decision to pay or not pay your claim is based on what’s in that file. Can you as the insured policyholder see that claim file? Of course you can, you say, because it’s MY file! Well, maybe…
First of all, you probably won’t see the file unless there is some sort of lawsuit entitling you to discovery. Insurance policies do not entitle insureds access to investigative reports or claims files created by the insurer. Typically an insurer will assert the file is a trade secret that policyholders are not entitled to see. The only information policyholders see is what the insurer decides to show them in the form of a denial letter, or letter of acceptance of the claim, or acceptance under a reservation of rights.
If a lawsuit has been filed for breach of the insurance contract, or for insurance bad faith, then the insurer will have to produce some of the claim file for you and your attorney’s review. The insurer must generally produce the claim file to its insured, but also may assert privileged information is protected from discovery, e.g. attorney work product. Application of the privilege to specific documents must be determined by the court. [2,022 Ranch v. Sup. Ct. (2003) 133 Cal. App. 4th 1377 at 1396-1397. Also Richardson v. Employer’s Liab. Assur. Co. (1972) 25 Cal. App. 3d 232, 242-243(disapproved on other grounds]. The 2,022 Ranch case was about whether the investigation report was discoverable. The court concluded that “evidence reflecting the factual investigation of 2,022 Ranch’s claim is subject to discovery. Only those communications reflecting the requesting of, or rendering of, legal advice are protected by the attorney-client privilege, and only the attorney’s legal impressions, conclusions, opinions, or legal research or theories are subject to the attorney work product privilege.” If the insurer won’t abide by these rules, then the insured has the option to seek an order from the court compelling production. It shouldn’t take the use of this legal crow bar to pry lose the important contents of the claim file, but sometimes it does. The good news is with some persistence, the important information in your claim file is available.
This blog has been prepared by Barbara Gallios, Attorney at Law, to provide information and commentary on recent legal developments of interest to the public. It is not intended to provide legal advice for a specific situation or to create an attorney-client relationship.