The Legislature has given the Insurance Commissioner authority under Insurance Code sections 11737 (f), 11752.6(c) and 11753.1 to review and decide certain types of disputes between insurers, the Workers' Compensation Insurance Rating Bureau (WCIRB) and policyholders. The Commissioner has set up a process for your disputes to be initially reviewed by your insurance carrier or the WCIRB. If after following this process your dispute is not settled, you may appeal to the Insurance Commissioner. This review and appeal process is described in California Code of Regulations, title 10, beginning at section 2509.40.
If you are seeking information about your workers' compensation insurance policy, or if you have a dispute with your insurance carrier about how their rating plan was applied to your policy (e.g. a dispute about a classification assignment or experience modification applied to your policy), you must first submit a written Complaint and Request for Action (CRA) to your workers' compensation insurance company. The insurance company must provide you with a written decision on your CRA.
All workers' compensation companies doing business in California are required to designate an office for receipt of Complaints and Requests for Action. These companies are also required to include a notice in all policies containing: (i) the name and contact information of the designated office and officer, (ii) the insured's right to contest the insurer's action, and; (iii) the insured's right to appeal the insurer's final decision on a Complaint and Request for Action to the Insurance Commissioner. California Code of Regulations, title 10, sections 2509.43(c) and 2509.77.
You also can obtain your workers' compensation insurance company's specific contact information for Receipt of Complaints and Request for Action by accessing our list of Workers' Compensation Companies. Look through the alphabetical list to locate your company. Once found, select the "(Info)" link after the company name. Once selected, the company profile will appear. Please refer to the "Workers' Compensation Complaint and Request for Action/Appeals Contact Information" link in the left column navigation panel to view your company's contact information.
If you believe that your workers' compensation insurance coverage as written or experience as reported is contrary to the rules of the Workers' Compensation Insurance Unit Statistical Reporting Plan or the Workers' Compensation Insurance Experience Rating Plan, or any other regulations of the Insurance Commissioner governing workers' compensation insurance; you may request a review of the WCIRB's decision, action or omission to act by sending a written Complaint and Request for Action to the WCIRB at the following address:
525 Market Street
San Francisco, CA 94105-2767
Attention: Complaints and Request for Action
Refer to the Workers' Compensation Insurance Unit Statistical Reporting Plan or the Workers' Compensation Insurance Experience Rating Plan for important time limits and procedural requirements for the submission of Inquiries, Complaints and Requests for Action to the WCIRB.
Appeals to the Commissioner:
Details on how and when to submit an appeal to the Insurance Commissioner can be found in California Code of Regulations, title 10, section 2509.46. Appeals must be sent to the following address at the California Department of Insurance:
Administrative Hearing Bureau
California Department of Insurance
45 Fremont Street, 22nd Floor
San Francisco, CA 94105