|
rrv uw as u t u
<br />(Ed. 01-11)
<br />B. Disputing the Actions of the WCIRB. If you have been aggrieved by any decision, action, or omission to act of
<br />the WCIRB, you may request, in writing, that the WCIRB reconsider its decision, action, or omission to act. You
<br />may also request, in writing, that the WCIRB review the manner in which its rating system has been applied in
<br />connection with the insurance afforded or offered you. For requests related to classification disputes, the reporting
<br />of experience, or coverage issues, your initial request for review must be received by the WCIRB within 12
<br />months after the expiration date of the policy to which the request for review pertains, except if the request
<br />involves the application of the Revision of Losses rule. For requests related to your experience modification, your
<br />initial request for review must be received by the WCIRB within 6 months after the issuance, or 12 months after
<br />the expiration date, of the experience modification to which the request for review pertains, whichever is later,
<br />except if the request for review involves the application of the Revision of Losses rule. If the request involves the
<br />Revision of Losses rule, the time to state your appeal may be longer. (See Section VI, Rule 14 of the ERP).
<br />You may commence the review process by sending the WCIRB a written Inquiry. Written Inquiries should be sent
<br />to: WCIRB, 525 Market Street, Suite 800, San Francisco, Califomia 94105-2767, Attention: Customer Service.
<br />Customer Service can be reached by telephone at 1-888-229-2472, and by fax at 415-778-7272.
<br />If you are dissatisfied with the WCIRB's decision upon an Inquiry, or if the WCIRB fails to respond within 90 days
<br />after receipt of the Inquiry, you may pursue the subject of the Inquiry by sending the WCIRB a written Complaint
<br />and Request for Action. After you send your Complaint and Request for Action, the WCIRB has 30 days to send
<br />you written notice indicating whether or not your written request will be reviewed. If the WCIRB agrees to review
<br />your request, it must conduct the review and issue a decision granting or rejecting your request within 60 days
<br />after sending you the written notice granting review. If the WCIRB declines to review your request, if you are
<br />dissatisfied with the decision upon review, or if the WCIRB fails to grantor reject your request or issue a decision
<br />upon review, you may appeal to the insurance commissioner as described in paragraph II.C., below. Written
<br />Complaints and Requests for Action should be forwarded to: WCIRB, 525 Market Street, Suite 800, San Francisco,
<br />Califomia 94105-2767, Attention: Complaints and Reconsiderations. The WCIRB's telephone number is
<br />1-888-229-2472, and the fax number is 415-371-5204.
<br />C California Department of Insurance -Appeals to the Insurance Commissioner. If, after you follow the
<br />appropriate dispute resolution process described above, we or the WCIRB decline to review your request, if you
<br />are dissatisfied with the decision upon review, or if we or the WCIRB fail to grant or reject your request or issue a
<br />decision upon review, you may appeal to the insurance commissioner pursuant to CIC Sections 11737, 11752.6,
<br />11753.1 and Title 10, California Code of Regulations, Section 2509.40 et seq. You must file your appeal within 30
<br />days after we or the WCIRB send you the notice rejecting review of your Complaint and Request for Action or the
<br />decision upon your Complaint and Request for Action. If no written decision regarding your Complaint and Request
<br />for Action is sent, your appeal must be filed within 120 days after you sent your Complaint and Request for Action
<br />to us or to the WCIRB. The filing address for all appeals to the insurance commissioner is:
<br />Administrative Hearing Bureau
<br />California Department of Insurance
<br />45 Fremont Street, 22nd Floor
<br />San Francisco, California 94105
<br />You have the right to a hearing before the insurance commissioner, and our action, or the action of the WCIRB,
<br />may be affirmed, modified, or reversed.
<br />III. RESOURCES AVAILABLE TO YOU IN OBTAINING INFORMATION AND PURSUING DISPUTES
<br />A. Policyholder Ombudsman. Pursuant to California Insurance Code Section 11752.6, a policyholder ombudsman is
<br />available at the WCIRB to assist you in obtaining and evaluating the rating, policy, and claims information
<br />referenced in I.A. and I.B., above. The ombudsman may advise you on any dispute with us, the WCIRB, or on an
<br />appeal to the insurance commissioner pursuant to Section 11737 of the Insurance Code. The address of the
<br />policyholder ombudsman is WCIRB, 525 Market Street, Suite 800, San Francisco, California 94105-2767, Attention:
<br />Policyholder Ombudsman. The policyholder ombudsman can be reached by telephone at 415-778-7159 and by fax
<br />at 415-371-5288.
<br />B. California Department of Insurance -Information and Assistance. Information and assistance on policy
<br />questions can be obtained from the Department of Insurance Consumer HOTLINE, 1-800-927-HELP (4357) or
<br />http://www.insurance.ca.gov. For questions and correspondence regarding appeals to the Administrative Hearing
<br />Bureau, see the contact information in paragraph II.C. This notice does not change the policy to which it is
<br />attached.
<br />©2004 by the Workers' Compensation Insurance Rating Bureau of Califomia. All Rights Reserved.
<br />From the WCIRB's California Workers' Compensation Insurance Forms Manual ©2001 22 of 28
<br />
|