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California’s WCIRB Has New Policy Ombudsman in Place

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New Policy Ombudsman – Addie Wong

The new policy ombudsman for CA’s WCIRB is Addie Wong.   She was recently named the new ombudsman for the California Workers Compensation Insurance Rating Board (WCIRB). I thought I would add in her introduction letter and the functions of the Ombudsman position.

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Introduction Letter

California employers have a new workers’ compensation Policyholder Ombudsman. Ms. Addie Wong took over the Ombudsman position in March and has begun developing an outreach program aimed at raising awareness of the Ombudsman office and the services she offers to California employers.

Created as part of the 1993 reforms that led to open rating, the Policyholder Ombudsman is an independent position within the WCIRB and receives guidance from an oversight committee whose membership includes an insurer representative, an employer representative, and a representative from the California Department of Insurance.

The Ombudsman helps policyholders better understand the workers’ compensation system and their insurance policies, and the Ombudsman can be of assistance to policyholders in effectively resolving disputes with their insurers. “The Ombudsman’s job is to work directly with the policyholder and listen to his/her concerns and give voice to those concerns to the insurer.  

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The worker’s comp system is complex and employers sometimes aren’t aware of the resources that are available to them. Or, they may not understand why their insurer took a particular action. That’s where I can help,” remarked Mrs. Wong.

In the coming weeks, Ms. Wong will be reaching out to employer associations across the state making certain that policyholders are aware of the assistance she can provide. “I am excited about the opportunity to help California employers, especially small employers who may be struggling to understand the workers’ comp system. I think I can provide a valuable service.”

Functions

The Policyholder Ombudsman is available to employers (policyholders) to provide information and answers about the workers’ compensation system.

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Although agents, brokers, insurance companies, attorneys, and others may represent an employer, it is not within the scope of the Ombudsman’s duties to provide assistance to these parties. They should continue to make inquiries through traditional avenues.

Employers are always entitled to receive information from the WCIRB about their loss experience, claims, classification assignments, policy contracts, rating plans, rating systems, and other information affecting the policy premium.

The Policyholder Ombudsman may facilitate matters for you with the WCIRB or your insurer but cannot make decisions on behalf of the WCIRB or your insurer. Your contact with the Policyholder Ombudsman does not constitute initiation of any dispute resolution process with the WCIRB or with your insurer.

A Caveat

As mentioned in the preceding paragraph, there are certain tasks that must be undertaken with certain time limits. Your Workers Comp insurance policy will have all of the necessary steps to commence a dispute. As Ms. Wong has noted, it is better to work things out with your insurer directly.

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I have written many posts on Disputing Your Premium Audit and Bill. You may want to search this blog for the word dispute using the search box on the right side of the screen. The caveat is to know if you have a valid dispute – not my company’s:

  • X-Mod/E-Mod increased dramatically
  • Premium increased sharply
  • Insurance carrier accepted an invalid claim
  • Insurance carrier paid too much on a claim

As an employer, you need to have supporting documents and numbers that validate your concerns. If not, you could end up paying more premium than before the dispute and possibly ruin the relationship with your insurance carrier. 

I have found working with the rating agencies (NCCI, WCIRB, or independent state rating bureau) to be a good experience if the research had been done properly with supporting documentation. 

One recent inquiry came from a CA medical instrument manufacturer. They had felt some of their workers were misclassified. The carrier returned to do a re-audit that ended up increasing their prior years’ premium by 23% and will increase their future premiums.

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James Moore

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Mgmt Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

  • Risk and Insurance Management Society (RIMS)
  • Entrepreneur Magazine
  • Bloomberg Business News
  • WorkCompCentral.com
  • Claims Magazine
  • Risk & Insurance Magazine
  • Insurance Journal
  • Workers Compensation.com
  • LinkedIn, Twitter, Facebook and other social media sites
  • Various trade publications

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