Please refer to the California Labor and Workforce Development Agency’s web page, Coronavirus 2019 (COVID-19) Resources for Employers and Workers.

Please refer to the California Department of Insurance web page, Information about Coronavirus (COVID-19).

For COVID-19 claims with accident dates on or after December 1, 2019 and with a required date of reporting on or after August 1, 2020, the California Insurance Commissioner has approved adoption of the national guidelines consistent with those approved by the Workers Compensation Insurance Organizations (WCIO) for: Nature of Injury: Report “83” (COVID-19); Cause of Injury: Report “83” (Pandemic); Catastrophe Number: Report “12” for all claims directly arising from a diagnosis of COVID-19. 

In addition, effective September 1, 2022, the Insurance Commissioner approved Nature of Injury code “38” for “adverse reaction to a vaccination or inoculation.”

The California Insurance Commissioner has approved rule changes for claims directly arising from a diagnosis of COVID-19 with an accident date on or after December 1, 2019. Those claims are excluded from the experience rating calculations of individual employers.

California Gov. Gavin Newsom issued a statewide stay-at-home order effective Thursday, March 19, 2020 (Executive Order N-33-20) and rescinded it on June 11, 2021 with Executive Order N-07-21. The questions below provide more details on the Special Regulatory Filing Decision and the effective dates of the rules included in that Decision.

See the following for more information:

• WCIRB Wire: COVID-19 Payroll Reporting Rules Changing with End of Stay-at-Home Order
• WCIRB Bulletin 2021-12 Coronavirus Disease 2019 (COVID-19) Payroll Reporting Rules
• California Coronavirus (COVID-19) Response page

When the WCIRB conducts a Test Audit and attempts to verify employee changes and payrolls during the statewide stay-at-home order, the WCIRB field representative will validate that the insurer’s audit documented payrolls that, during the period in question, were paid to employees who were either (1) on paid leave or (2) engaged exclusively in clerical office activities. As part of the Test Audit, the WCIRB field representative will ask the policyholder for any relevant documentation or payroll records, including but not limited to company memos or emails, payment codes reflected in payroll records, or employee time cards or time sheets. Insurers and policyholders are encouraged to work together on the manner in which changes to employee duties during the statewide COVID-19 stay-at-home order are documented.

The following rule applies only to payrolls paid between July 1, 2020 and July 11, 2021.

The California Insurance Commissioner approved rule changes to exclude from reported payroll payments made to employees while they are not performing duties of any kind in the service of the employer during the time that the California stay-at-home order is in place and for 30 days thereafter. This included pay to employees who are on paid sick or family leave. Excluding this payroll recognized the extraordinary circumstances resulting from the stay-at-home order and the fact that employees not engaged in work activities have virtually no work-related exposure. 

See the following for more information:

• WCIRB Wire: COVID-19 Payroll Reporting Rules Changing with End of Stay-at-Home Order

Please see the Special Regulatory Filing Decision.

Yes, the California Insurance Commissioner’s Special Regulatory Filing Decision stated that the dollar amounts that are excluded from an employer’s reportable payroll should be reported on the applicable policy’s Unit Statistical Report (USR) under code 0012. These excluded amounts will be used for data tracking purposes only and will not be used in the policyholder’s experience rating. This reporting rule applies only to amounts paid between July 1, 2020 and July 11, 2021.

The following rule applies only to payrolls paid between July 1, 2020 and August, 10 2021.

The California Insurance Commissioner has approved in his Special Regulatory Filing Decision that the payroll of employees whose job duties meet the definition of a Clerical Office Employee be assigned to Classification 8810, Clerical Office Employees, provided the employee’s payroll is not otherwise assignable to a standard classification that specifically includes Clerical Office Employees.

See the following for more information:

• WCIRB Wire: COVID-19 Payroll Reporting Rules Changing with End of Stay-at-Home Order

Please see the WCIRB’s overview of this issue on the Physical Audit Requirements web page.

California’s 2022 COVID-19 Supplemental Paid Sick Leave law, effective February 19, 2022, does not impact workers’ compensation payroll reporting. Payments made after July 11, 2021 for sick time related to COVID-19 are includable as part of total remuneration.

Link to the law: https://www.dir.ca.gov/dlse/COVID19resources/2022-COVID-19-SPSL-Poster.pdf

Yes, California law requires all employers to have coverage for their California employees. An employer can buy it from a licensed insurer. They can also choose to self-insure, if they meet the requirements set by the Department of Industrial Relations (DIR).

It is a criminal offense for an employer to be unlawfully uninsured regardless of whether or not an employee is injured. California Labor Code Section 3700.5 specifies that it is a misdemeanor punishable by either a fine not less than $10,000 or imprisonment in the county jail for up to one year, or both. In addition, the state issues penalties of up to $100,000 against illegally uninsured employers. If an employee is injured, the employer is responsible for paying all benefits and may be subject to additional liability.

Generally, insurance is optional for any business where the only employees are owners of the business. Consult your insurance agent or your attorney for your options.

Some employers, mainly large businesses, may opt for self-insurance if they are authorized to do so by the Department of Industrial Relations (DIR). Self-insured employers remain liable for all workers' compensation claims. See Labor Code Section 3700 et. seq. Contact your insurance agent or the state's Office of Self-Insurance Plans.

A WCIRB representative will visit an insured employer's place of business to gain a general understanding of the employer's business by interviewing a knowledgeable employee and touring the facility. Estimates of the number of employees doing each task and an estimate of their combined payroll will need to be provided. Note: Due to the COVID-19 pandemic, WCIRB field representatives are conducting inspections and test audits virtually. The field representatives are given a virtual tour of employer premises though videoconferencing tools.

Generally, there are two reasons a business is selected for an inspection: (1) it is subject to experience rating or (2) the insurer or agent/broker of record requested an inspection.

Yes. According to the California Insurance Code (Section §11750.3) and the California Workers' Compensation Uniform Statistical Reporting Plan—1995 (Part 3, Section VI), the WCIRB has the authority to inspect an insured business for classification purposes. However, if an employer is contacted at a time that is not convenient, arrangements can be made to perform the inspection at a later time. All information gathered during the inspection is confidential and is shared only with those who have a right to the information.

Not directly, but an employer can ask its insurer or agent/broker to request an inspection. There may be a charge for the inspection.

A knowledgeable company representative who is authorized to discuss company information, such as the number of employees, estimated payroll and a description of the business operations, must be available.

After an inspection is conducted, a report is prepared and a copy is sent to the employer and the employer's insurer. The employer should contact its insurer for additional copies; however, a copy may be obtained for a nominal charge by contacting the WCIRB Contact Center.

Your employer is required to post the name of the current insurer and instructions on how injuries should be reported. If you have asked but cannot get this information from your employer, you may go to the Coverage Inquiry Website. For more information on coverage research services provided by the WCIRB, visit the Coverage Research page on this website.

Your employer remains liable for paying workers' compensation benefits. Contact the Department of Industrial Relations, Division of Workers' Compensation district office, for information about benefits to which you may be entitled.

It is a percentage that compares the payroll and loss history of a company to those of similar-sized companies in the same industry. For example, if a company has a better than average loss record, their experience modification would be less than 100 percent.

Normally, an experience modification is calculated based on the actual audited payroll and losses reported by the insurer for three consecutive policy years.

A business qualifies for an experience modification if the amount produced by applying the approved expected loss rates (shown in Table I of the California Workers' Compensation Experience Rating Plan—1995)  to the total remuneration that would be used in the experience rating calculation is greater than or equal to the experience rating eligibility threshold. The experience rating eligibility threshold is adjusted each year to reflect wage inflation and changes in the average expected loss rate. The experience rating eligibility threshold is specified each year in Section III, Rule 1 of the California Workers' Compensation Experience Rating Plan—1995. Both the current experience rating eligibility threshold and the approved expected loss rates can be viewed in the Filings and Plans section of this website. 

If two or more businesses are owned by the same person, or share more than 50 percent common ownership, then they will be combined for experience rating purposes. The payrolls and losses of all commonly owned businesses will be combined to compute a single experience modification, which will then be applied to all the commonly owned businesses. For experience rating purposes, commonly owned businesses may be insured on a single policy or on separate policies.

Yes, if the insurer submits a correction (as specified in the California Workers' Compensation Uniform Statistical Reporting Plan—1995), such as for a non-compensable claim, or if you have ownership changes, then the WCIRB may revise your experience modification. Also, if the insurer or the WCIRB reassigns the classification applicable to the business after a WCIRB inspection or test audit, then the WCIRB may revise the experience modification.

If a claim is declared "non-compensable" (because it is fraudulent or otherwise), the insurer will submit a correction to the WCIRB. The correction could trigger a revision to one or more experience modifications.

The fastest way to search for an X-Mod is with the Bureau Number. Once you have logged into WCIRB Connect, enter the Bureau Number into the search field at the top of the screen and click GO. This will bring you straight to the Policyholder Details page and the policyholder's X-Mod history, if they have one.
 

By selecting the magnifying glass icon located on the tool bar, you can access the Policyholder Search screen. There you can search through the WCIRB's policy records by entering one of the following:

Bureau Number, or
FEIN, or
Policyholder Name and Policy Effective Date range.

Note: The Policyholder Effective Date range does not need to match the actual policy period as it is a search for policies that incept within that date range on our system. We recommend that you include prior years in your search in case there is no current coverage on file for a policyholder.

On the Policyholder Results page, click on the Bureau Number hyperlink to access the Policyholder Details page and the policyholder's X-Mod history. If a policyholder does not qualify for an X-Mod, that ARD year will be marked as "DNQ."

It is one component in determining the price an employer will pay for workers' compensation insurance. Classifications are established for an industry and typically include all occupations or operations within a business. There are approximately 500 classifications in California.

Initially, the classification is determined by the insurer using information provided on the application or information received from the WCIRB. The WCIRB may inspect your business to verify the class assignment for data reporting purposes.

Typically, an industry or trade organization contacts the WCIRB to explore the possibility of setting up a new classification. Also, the WCIRB routinely reviews existing classes and industry trends to ascertain whether the existing classifications are appropriate in today's business environment.

The employer should seek an explanation from its insurer. If necessary, the insurer should be asked to request a WCIRB inspection. There may be a charge for the inspection. If the class assigned by the WCIRB is still disputed, contact the WCIRB for reconsideration. The Policyholder Ombudsman is available to assist policyholders through the process.

Debit experience modifications that exclude unaudited payroll are permitted to be issued even if they do not meet the eligibility threshold, provided the policyholder was experience rated in the immediately preceding year.

Yes. When the insurer submits a unit statistical report (USR) correction with the audited payroll to the WCIRB, the current and two immediately preceding experience modifications are subject to revision in accordance with the Experience Modification Corrections–Effective Dates rule in the Experience Rating Plan.

It is a financial incentive for the policyholder to cooperate with the audit. The WCIRB’s ability to produce accurate experience modifications, expected loss rates and advisory pure premium rates is dependent upon accurate audited payroll reporting. 

On the experience rating worksheet, an “E” designation next to the experience modification indicates that the rating excludes unaudited payroll. The policyholder also receives a notification from the WCIRB that their experience modification excludes estimated payroll but includes any losses.

After a workers’ compensation policy expires, the insurer is required to complete an audit of the employer’s payroll records to validate the correct premium amount is charged. The audited payroll information is also reported to the WCIRB and used to calculate an employer’s experience modification. If an insurer notifies the WCIRB that an employer has not complied with the insurer’s request for payroll records, the WCIRB will send a letter to the employer with the subject, “Payroll Records – Not Available.” For more information about the importance of audited payroll records, watch the “Payroll Records – Not Available” video (run time: 10:21).

The WCIRB will attempt to publish an experience modification excluding the unaudited payroll, but using all of the reported losses. The Experience Rating Plan does not allow the use of estimated or unaudited payroll in the experience modification calculation. When an insurer reports estimated payroll to the WCIRB due to the failure of an employer to cooperate with the audit, the WCIRB sends a letter to the policyholder to inform it of the potential impact and encourages it to cooperate with the audit. If the WCIRB does not receive the audited payroll within 60 days, we will attempt to publish an experience modification excluding the unaudited payroll, but using all of the reported losses.