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).

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. These rules apply to reporting 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. Please see the Special Regulatory Filing Decision.

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 to be excluded from the experience rating calculations of individual employers. Since the occurrence or non-occurrence of COVID-19 workers’ compensation claims incurred by an employer are unlikely to be a strong predictor of that employer’s future workers’ compensation claim costs, the inclusion of such claims in an experience modification calculation would not meet the intended goal of experience rating. Please see the Special Regulatory Filing Decision.

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 California Insurance Commissioner has 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 would include pay to employees who are on paid sick or family leave. Excluding this payroll recognizes 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.

Please see the Special Regulatory Filing Decision.

Yes, the California Insurance Commissioner approved in its Special Regulatory Filing Decision that the dollar amounts that are excluded from an employer’s reportable payroll 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.

TThe California Insurance Commissioner has approved in its 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. This provision applies while California’s stay-at-home order is in place and for up to 60 days thereafter.

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

California Gov. Gavin Newsom issued a statewide stay-at-home order effective Thursday, March 19, 2020 (Executive Order N-33-20).

Also see the California Coronavirus (COVID-19) Response page.

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.

Generally, there are two reasons a business is selected for an inspection: (1) it is subject to experience rating or (2) the insurer 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 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 Customer Service Department.

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%.

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% 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.

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.

While the WCIRB cannot provide premium information, since each insurer sets its own rates. The California Department of Insurance website has a Workers’ Compensation Rate Comparison section that includes lists of insurer rates by classification code. To learn more and to view the lists, go to http://www.insurance.ca.gov/01-consumers/105-type/9-compare-prem/wc-rate/. You may also contact your agent, broker, or insurer for more information.