Workers' compensation insurance is complex. The rules and the processes involved are prescribed by law and often contain language that is difficult to understand. The Ombudsman is familiar with and can clearly describe the relevant rules and procedures to you.
The Ombudsman can help you obtain, evaluate and understand workers' compensation insurance information pertaining to loss experience, claims, classification assignments, experience modifications and other factors that impact your policy premium. The Ombudsman will also work with you to explain rules and decisions as well as the rights and options of all parties involved.
If you have a dispute, the Ombudsman can act as an intermediary between you and your insurance company and/or the WCIRB by clarifying the issues and putting you in contact with the appropriate individuals to resolve your dispute.
The objective is to facilitate a resolution of the issues by ensuring that all parties are fully informed and understand each others' positions. The Ombudsman is not permitted to be an advocate for any of the parties involved nor does the Ombudsman have direct authority to implement changes.
The Policyholder Ombudsman is available to speak to employers and employer associations to help them better understand the workers’ compensation insurance system, in order to prevent issues from arising and to provide information to facilitate dispute resolution.
California state law defines the Policyholder Ombudsman's position as an employee of the WCIRB working in an independent associate capacity. The position receives guidance from an oversight committee comprised of an insurer, an employer representative and a representative of the California Department of Insurance, who chairs the committee.
California law established the Office of the Policyholder Ombudsman in Section 11752.6(g) of the Insurance Code.
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. The procedures for resolving disputes with the WCIRB may be found in the California Workers' Compensation Experience Rating Plan—1995, California Workers' Compensation Uniform Statistical Reporting Plan—1995, Miscellaneous Regulations for the Recording and Reporting of Data—1995 and Title 10 of the California Code of Regulations at Sections 2509.40 et seq.
Workers Compensation Insurance Rating Bureau
1901 Harrison St., 17th Floor
Oakland CA 94612
Attn: Policyholder Ombudsman
Email: [email protected]
Learn about the importance of recordkeeping for the division of payroll and dual wage classifications.
Learn about the classification requirements for Clerical Office Employees, Outside Salespersons and Clerical Telecommuter Employees, as well as the application of the standard exception classifications.
Learn why it's important for the insurance company to conduct an audit, the impact of unaudited payroll on the experience modification and about working with the insurance company to complete the audit.
Gain a better understanding of the WCIRB dispute process, the insurer dispute process and the appeal process. We’ll also discuss some resources to help you navigate the dispute process.