|
P N 04 99 01 1
<br /> (Ed.02-22)
<br /> National Specialty Insurance Company
<br /> Call: Next First Insurance Agency,Inc.
<br /> Toll-free: 1-855-222-5919
<br /> Fax: (650)644-0332
<br /> Mail:P.O.Box 60787 Palo Alto,CA 94306
<br /> After you send your Complaint and Request for Action,we have 30 days to send you a written notice indicating whether your
<br /> written request will be reviewed. If we agree to review your request,we must conduct the review and issue a decision granting
<br /> or rejecting your request within 60 days after sending you the written notice granting review. If we decline to review your
<br /> request, if you are dissatisfied with the decision upon review, or if we fail to grant or reject your request or issue a decision
<br /> upon review,you may appeal to the Insurance Commissioner as described in paragraph II.C., below.
<br /> B. Disputing the Actions of the WCIRB. If you have been aggrieved by any decision, action, or omission to act of the WCIRB,
<br /> you may request, in writing,that the WCIRB reconsider its decision, action, or omission to act.You may also request, in
<br /> writing, that the WCIRB review the manner in which its rating system has been applied in connection with the insurance
<br /> afforded or offered you. For requests related to classification disputes, the reporting of experience, or coverage issues,your
<br /> initial request for review must be received by the WCIRB within 12 months after the expiration date of the policy to which the
<br /> request for review pertains, except if the request involves the application of the Revision of Losses rule. For requests related to
<br /> your experience modification,your initial request for review must be received by the WCIRB within 6 months after the
<br /> issuance, or 12 months after the expiration date, of the experience modification to which the request for review pertains,
<br /> whichever is later, except if the request for review involves the application of the Revision of Losses rule. If the request
<br /> involves the Revision of Losses rule,the time to state your appeal may be longer. (See Section VI, Rule 7 of the ERP).
<br /> You may commence the review process by sending the WCIRB a written Inquiry.Written Inquiries should be sent to:WCIRB,
<br /> 1901 Harrison Street, 17th Floor, Oakland, CA 94612,Attn: Customer Service.Customer Service can be reached at
<br /> 888.229.2472(phone),415.778.7272(fax)and customerservice(dwcirb.com (email).
<br /> If you are dissatisfied with the WCIRB's decision upon an Inquiry, or if the WCIRB fails to respond within 90 days after receipt
<br /> of the Inquiry,you may pursue the subject of the Inquiry by sending the WCIRB a written Complaint and Request for Action.
<br /> After you send your Complaint and Request for Action, the WCIRB has 30 days to send you written notice indicating whether
<br /> your written request will be reviewed. If the WCIRB agrees to review your request, it must conduct the review and issue a
<br /> decision granting or rejecting your request within 60 days after sending you the written notice granting review. If the WCIRB
<br /> declines to review your request, if you are dissatisfied with the decision upon review, or if the WCIRB fails to grant or reject
<br /> your request or issue a decision upon review,you may appeal to the Insurance Commissioner as described in paragraph II.C.,
<br /> below.Written Complaints and Requests for Action should be forwarded to:WCIRB, 1901 Harrison Street, 17th Floor,
<br /> Oakland,CA 94612,Attn: Complaints and Reconsideration.The WCIRB's contact information is 888.229.2472(phone),
<br /> 415.371.5204(fax)and customerservice(dwcirb.com (email).
<br /> C. California Department of Insurance—Appeals to the Insurance Commissioner.After you follow the appropriate dispute
<br /> resolution process described above, if(1)we or the WCIRB decline to review your request, (2)you are dissatisfied with the
<br /> decision upon review,or(3)we or the WCIRB fail to grant or reject your request or issue a decision upon review,you may
<br /> appeal to the Insurance Commissioner pursuant to CIC Sections 11737, 11752.6, 11753.1 and Title 10, California Code of
<br /> Regulations, Section 2509.40 et seq.You must file your appeal within 30 days after we or the WCIRB send you the notice
<br /> rejecting review of your Complaint and Request for Action or the decision upon your Complaint and Request for Action. If no
<br /> written decision regarding your Complaint and Request for Action is sent,your appeal must be filed within 120 days after you
<br /> sent your Complaint and Request for Action to us or to the WCIRB. The filing address for all appeals to the Insurance
<br /> Commissioner is:
<br /> Administrative Hearing Bureau
<br /> California Department of Insurance
<br /> 1901 Harrison Street, 3rd Floor Mailroom
<br /> Oakland, CA 94612
<br /> 415.538.4243
<br /> You have the right to a hearing before the Insurance Commissioner, and our action, or the action of the WCIRB, may be
<br /> 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 available
<br /> at the WCIRB to assist you in obtaining and evaluating the rating, policy, and claims information referenced in I.A.and I.B.,
<br /> above.The ombudsman may advise you on any dispute with us,the WCIRB, or on an appeal to the Insurance Commissioner
<br /> pursuant to Section 11737 of the Insurance Code.The address of the policyholder ombudsman is WCIRB, 1901 Harrison
<br /> Street, 17th Floor, Oakland, CA 94612,Attn: Policyholder Ombudsman. The policyholder ombudsman can be reached at
<br /> 415.778.7159(phone),415.371.5288(fax)and ombudsman(o),wcirb.com (email).
<br /> B. California Department of Insurance—Information and Assistance. Information and assistance on policy questions can be
<br /> obtained from the Department of Insurance Consumer HOTLINE, 800.927.HELP(4357)or insurance.ca.gov. For questions
<br /> and correspondence regarding appeals to the Administrative Hearing Bureau, see the contact information in paragraph II.C.
<br /> This notice does not change the policy to which it is attached.
<br /> PN0499011 2of2
<br /> (Ed.02-22)
<br />
|