Dispute Resolution Process

Posted Date: Current
    

NCCI provides dispute resolution services in all NCCI states. A policyholder who believes that an NCCI rule or classification code has not been properly applied by their carrier to their workers compensation insurance policy can request NCCI's assistance. If a carrier is unable to resolve a dispute with a policyholder, that carrier has a duty to inform the policyholder about NCCI's dispute resolution services, which are designed to provide an opportunity for policyholders and carriers to resolve disputes without the need for litigation.

The following information provides a generic overview of typical state dispute resolution procedures. The procedure, if applicable, for any given state's "Dispute Resolution Process" can be found in that state's Miscellaneous Rules section of NCCI's Basic Manual for Workers Compensation and Employer's Liability Insurance (Basic Manual). Different rules may apply regarding the resolution of disputes involving policies written in the residual market.

Click on the questions below for details


Q1: What steps should be taken to resolve a policyholder dispute?

Q2: What if the carrier and policyholder are unable to resolve the dispute?

Q3: What happens after NCCI receives a request for dispute resolution services?

Q4: What is the difference between an Appeals Board, Internal Review Panel, or Workers Compensation Committee?

Q5: Do the policyholder and carrier have to appear in person before the Board, Panel, or Committee?

Q6: Does a policyholder have to pay its disputed premium before utilizing NCCI's dispute resolution process?

Q7: Will NCCI inspect the policyholder's business?

Q8: How long does the dispute resolution process take?




 

Q1: What steps should be taken to resolve a policyholder dispute?


A: The carrier and policyholder must make a reasonable attempt to resolve the issue(s) in dispute. Both parties should keep a record of any correspondence about the dispute. This information will be necessary in the event that the parties are unable to resolve the dispute.

Q2: What if the carrier and policyholder are unable to resolve the dispute?


A: If the carrier and policyholder are unable to resolve the dispute after a reasonable effort to do so, and the dispute concerns NCCI manual rules, then the policyholder may contact NCCI's Customer Service Center for assistance with resolving the dispute. Below are some examples of issues that involve NCCI rules:

  • Application of correct class code(s) to a business's payroll
  • Application of business payroll among class codes
  • Application of an experience rating modification factor
  • Combination of the experience of one business with that of another

If the dispute remains unresolved after assistance from NCCI's Customer Service Center, the dispute may be eligible for NCCI's Dispute Resolution Process. Questions about NCCI's Dispute Resolution Process should be directed to:

National Council on Compensation Insurance, Inc.
Regulatory Assurance Department—Dispute Resolution Services
901 Peninsula Corporate Circle
Boca Raton, FL 33487-1362
regulatoryassurance@ncci.com
Fax Number: 561-893-5043

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Q3: What happens after NCCI receives a request for dispute resolution services?


A: NCCI will assign a Regulatory Services Manager (RSM) to the dispute.

The RSM will contact the workers compensation insurance carrier and the policyholder to discuss the dispute.

Once the RSM has obtained all the necessary information, the RSM will attempt to help the carrier and policyholder to reach a resolution of the dispute. Most disputes are resolved by the policyholder and carrier without the need for a hearing through NCCI's dispute resolution services. If a resolution is reached, the RSM will send a letter to the carrier and the policyholder outlining the agreed upon resolution.

If the carrier and policyholder are unable to reach a resolution, the RSM will ask the policyholder if they want a hearing. If so, the RSM will send both carrier and policyholder written notice of the date, time, and place of the hearing before the state's Board, Panel, or Committee.

Q4: What is the difference between an Appeals Board, Internal Review Panel, or Workers Compensation Committee?


A: Some states appoint Appeals Boards to hear disputes over workers compensation insurance policies. Boards are typically composed of 5 to 10 members appointed by the state's Department of Insurance. NCCI may be a voting member on the Board or may just facilitate the Board meetings. Where NCCI is not a voting member, NCCI may still be called upon by the policyholder, the carrier, or the Board to provide an expert opinion on how NCCI's rules should be applied or interpreted regarding the issue in dispute. The Board's decision will be provided in writing to both the policyholder and the carrier involved in each dispute.

Other states require NCCI to appoint an Internal Review Panel to hear disputes. In those states, NCCI convenes a Panel of 3 to 5 persons employed by NCCI who have particular expertise in the subject matter of the dispute. The Panel's written decision is provided by NCCI to both the policyholder and the carrier involved in the dispute.

Lastly, a few states have established a Committee to review workers compensation business for the state, including disputes over workers compensation insurance policies. In Committee states, NCCI facilitates the meetings of the Committee and may be asked by the policyholder, the carrier, or the Committee to provide an expert opinion on how NCCI's rules should be applied to or interpreted regarding the issue in dispute. The Committee will hear both sides of the dispute, and may ask NCCI or other experts for their opinion. Then, the Committee will vote and issue a written decision, which will be provided to the policyholder and the carrier.

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Q5: Do the policyholder and carrier have to appear in person before the Board, Panel, or Committee?


A: Each state has its own rules regarding procedures for dispute resolution hearings. In some states, policyholders and carriers have the option to appear in person, by telephone, or by mail.

In those states that require or allow a policyholder to appear in person or by phone before the Board, Panel, or Committee, both the carrier and policyholder must be prepared to make a brief presentation (10–20 minutes) explaining the dispute and the relief being sought. Members of the Board, Panel, or Committee may ask questions. In most states, after the Board, Panel, or Committee has heard from everyone, the parties and witnesses are excused while the Board, Panel, or Committee meets to discuss the dispute and make a decision. This is called an executive session.

In those states that do not allow a policyholder or carrier to appear in person before the Board, Panel, or Committee, or if the policyholder has elected not to appear in person, then the Board, Panel, or Committee will consider only the written documentation submitted by the carrier and policyholder before the hearing. In any case, the Board, Panel, or Committee's final decision will be issued in writing to both the policyholder and the carrier within 30 days after the dispute has been heard.

Q6: Does a policyholder have to pay its disputed premium before utilizing NCCI's dispute resolution process?


A: A policyholder may be eligible to defer payment of premium (put premium in abeyance) that is the subject of a dispute until the end of the dispute resolution process. Each state has its own rules regarding whether a policyholder can put premium into abeyance.

Q7: Will NCCI inspect the policyholder's business?


A: Many disputes that involve the assignment of classification codes or the allocation of payroll among class codes can be resolved through an inspection of the business by NCCI. Either the policyholder or the carrier can request that NCCI inspect the business.

Q8: How long does the dispute resolution process take?

A: A state may have time requirements in which the dispute must be heard. The RSM will explain the rules and requirements in a state.

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