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Workers Compensation Insurance Premium Disputes

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Claim Handling Disputes

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Introduction

Until 1993 California workers compensation insurers often argued that how they handled, paid, and reserved claims was within their sole discretion. They maintained that so long as they satisfied the employer’s obligations under the workers compensation law, how claims were handled was largely ...

Posted Sunday, February 19, 2012

Claim Handling Not a WCIRB Appealable Issue

Violations of the commissioner’s workers compensation premium regulations fall within the WCIRB’s jurisdiction. Accordingly, for example, a claim that an insurer has failed to comply with the uniform statistical reporting plan’s requirements by improper reporting of claim data is a...

Posted Sunday, February 19, 2012

Insurer Accountability for Improper Claims-Handling

Numerous significant factors affecting the amounts of claim payments and reserves are clearly outside of insurers’ control. These include the amount of statutory benefits payable, the severity of injury, WCAB rulings, etc. However, in many other respects, payments—and especially reserves...

Posted Sunday, February 19, 2012

Legal Standards for Claims Reserves

Insurers have a clear legal obligation to maintain adequate reserves. Thus, an employer has no reasonable basis to seek, and an insurer would act irresponsibly and in violation of the law to maintain, intentionally understated reserves. The real issue, therefore, is how much is adequate? Statuto...

Posted Sunday, February 19, 2012

Third-Party Accountablity for Premium Increase

If a third party (i.e., not the employer) causes an employee injury, can that third party be held liable for the employer’s increased workers compensation premium?  In a word, "no." In Fischl v. Paller & Goldstein, 231 Cal. App. 3d 1299, 282 Cal. Rptr. 802 (1991) (rev. de...

Posted Sunday, February 19, 2012

Read My Book

Levine Book Levine on California Workers Compensation Premium and Insurance

A Comprehensive Practical and Legal Guide to Premium and Insurance Issues, Strategies, and Disputes