Q. Can an insurance agent or an insurance company
promise or guarantee the payment of a future dividend?
A. No. It is a misdemeanor for an insurance
company, agent or a broker to promise the payment of future
workers’ compensation dividends. Under California law, the
insurance company’s board of directors or other governing
body must review the overall loss experience of the workers’
compensation business since its last dividend declaration.
his governing body then determines whether the insurer has
a surplus from which dividends may lawfully be paid. Such
dividends must be declared by resolution adopted after expiration
of the policy term. This declaration should specify the dividend
plans, formulas or schedules to be applied. Any person who
makes or causes to be made any knowingly false or fraudulent
material statement or material representation for the purpose
of obtaining or denying workers’ compensation benefits or
payments is guilty of a felony.
Q. What if I disagree with the classifications
assigned or rates applied to my business?
A. First, talk to your insurance agent or
broker or the insurance company. If you disagree with their
explanation, you may direct your complaint to the WCIRB (at
its San Francisco address listed in Exhibit II). However,
you must submit a statement of facts in writing, within twelve
months after the expiration date of the policy in question,
including the name of your firm, the name of your insurance
carrier and the details of your complaint. The WCIRB will
investigate your complaint, contact the insurance carrier,
and advise you of its findings within 45 days.
Q.
What if I do not agree with the WCIRB’s decision?
A. You may direct an appeal to the Classification
and Rating Committee in care of the WCIRB, and request a hearing.
Hearings are held monthly, alternating between San Francisco
and Los Angeles. You can write to the WCRIB to schedule a
hearing date. The committee members will vote on each appeal
after they have heard the case.
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