The Fourth District Court of Appeal says the California Department of Insurance’s administrative law judges and Insurance Commissioner Ricardo Lara do not have the authority to decide breach of contract disputes through the administrative hearing process. The decision came in a 12-year-old premium audit case, but observers say the findings apply broadly to the common contractual disputes that arise between employers and insurance companies.
Drew Pomerance, a partner in Roxborough, Pomerance, Nye & Adreani (RPNA), successfully argued the instant case for ReadyLink Healthcare, a nurse staffing firm. ReadyLink is fighting State Compensation Insurance Fund over the amount of premium owed on the per diem payments the employer made to nurses. It will now get a new trial on that issue.
Read more about the case in the full Workers’ Comp Exec article.