Employers in the State of California are required to maintain insurance for workers’ compensation and often do so by self-insuring for these liabilities as part of a self-insurance group or SIG. These members of SIGs must apply first for inclusion in the group and, once they are accepted and receive a certificate to self-insure from the Department of Industrial Relations – Office of Self-Insurance Plans (“OSIP”), they must provide funds to the SIG that are used to ensure payment for the workers’ compensation claims and administrative expenses. If these SIGs do not have sufficient funds to pay for the liabilities arising from workers’ injuries, the certificates to self-insure are revoked and the employers, who were once members of this SIG, are jointly and severally liable for the liabilities accrued during their respective periods of membership. The claims themselves are taken over by the California Self-Insurer’s Security Fund or SISF, who often seek reimbursement of the funds expended in administration and payment of the claims. In this instance, employers can be vulnerable to being exploited and require expert counsel to protect them from allegations of purportedly owed (and exponentially increased) claim costs and reserves.
RPNA fights for the rights of employers in exactly this scenario, protecting our clients from claims mishandling and improper reserve setting, which could cost them millions of dollars above and beyond the actual costs of workers’ compensation claims. In the face of SISF and their selected third party administrator (“TPA”) usually providing as little information as possible, while demanding millions of dollars for claims, RPNA battles to obtain the claim files in their fullest form and any actuarial information related to case and financial reserves. RPNA then conducts careful analyses of these documents and related discovery, with the assistance of tried and true experts in the areas of claims handling and actuarial studies (as well as in the area of sampling in cases where thousands of claims are at issue), in order to ensure that the claims are handled according to industry standards. A similar approach is used when employers are faced with workers compensation premium audit disputes. This game plan is vitally important because poor claims handling unnecessarily increases the costs of claims and unwarranted reserve setting multiplies the anticipated cost of claims, all to the disadvantage of our employer clients. Essentially, RPNA holds these organizations financially and legally accountable for their conduct.