How Can the Ombudsman Help Me?
Workers’ compensation insurance is complex. The rules and processes involved are prescribed by law and often contain language that is difficult to understand. The Policyholder Ombudsman is familiar with and can clearly describe the relevant rules and procedures to you, the employer.
The Ombudsman is a resource for employers to 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 can also act as an intermediary between you and your insurance company and/or the WCIRB.
Contact the Ombudsman
Contact Information
Phone: 415.778.7159
Fax: 415.371.5288
Email: [email protected]
Mail: Workers’ Compensation Insurance Rating Bureau of California
1901 Harrison St., 17th Floor
Oakland CA 94612
Attn: Policyholder Ombudsman
Speaking Opportunities
The Policyholder Ombudsman is available to speak to employers and employer associations to help improve understanding of the workers’ compensation insurance system, prevent issues from arising and provide information to facilitate dispute resolution.
Educational Resources for Employers
Learn how to apply rules in the California Workers’ Compensation Uniform Statistical Reporting Plan—1995 (USRP) for recordkeeping, division of payroll and dual wage classifications.
Have you tried to resolve an issue regarding an action or failure to act on an informal basis and would like to pursue the issue as a formal dispute? Learn the steps through either through your insurer’s internal dispute process or the WCIRB’s internal dispute process.
Have you received a letter stating you’ve been selected for an inspection or a test audit? Visit the following page for information.
Ask the Ombudsman your question and read answers to employers’ frequently asked questions.
Learn some of the most common types of compensation that the Policyholder Ombudsman receives questions about.
Video Resources for Employers
The Standard Classification System: Time Card/Recordkeeping Requirements
Learn about the importance of recordkeeping for the division of payroll and dual wage classifications.
Video Runtime: 13 minutes
The Standard Classification System: Standard Exception 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.
Video Runtime: 14 minutes
California's Experience Rating System: Payroll Records – Not Available
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.
Video Runtime: 10 minutes
Understanding the Workers' Compensation Dispute Process
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.
Video Runtime: 12 minutes
Policyholder Ombudsman Position
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.