Dispute Resolution Process

Posted Date: Current
    

NCCI provides a filed and approved Dispute Resolution Process (Process) in most NCCI states. The Process provides policyholders with a means to resolve disputes with their carriers regarding the application of NCCI manual rules to their workers compensation insurance policy. For purposes of this Process, manual rules are defined as rules in NCCI’s manuals that pertain to the application of the workers compensation rating system used as the basis for premium calculation, including but not limited to classifications and experience rating.

If a policyholder is unable to resolve a dispute with its carrier, that carrier should inform the policyholder about NCCI’s Dispute Resolution Process. This Process is designed to provide an opportunity for policyholders and carriers to resolve disputes without the need for litigation.

The following information provides a basic overview of the Process. The Process, if NCCI Manual rules are applicable, is detailed in Appendix G of NCCI’s Basic Manual for Workers Compensation and Employers Liability Insurance (Basic Manual). Different rules may apply regarding the resolution of disputes involving policies issued under the state’s Workers Compensation Insurance Plan (Plan) as administered by NCCI.

Click on the questions below for details


Q1: What steps should a policyholder take to resolve a dispute with a carrier?

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 a Workers Compensation Appeals Board or Committee?

Q5: Do the policyholder and carrier have to appear in person before the Workers Compensation Appeals Board or Committee?

Q6: What requirements does a policyholder have to meet before utilizing NCCI's Dispute Resolution Process?

Q7: Does NCCI inspect the policyholder's business?

Q8: How long does the Dispute Resolution Process take?

Q9: Does the policyholder have to pay the premium dispute before requesting dispute resolution services?

Q10: What if the policyholder is dissatisfied with the decision of the Board or Committee?



 

Q1: What steps should a policyholder take to resolve a dispute with a carrier?


A: A policyholder must:

  • Attempt to resolve the dispute directly with the carrier
  • Calculate and pay the carrier all undisputed premium that is due
  • Provide to the carrier an estimate of the premium in dispute with a written explanation of the premium calculation

Both parties must keep a record of any correspondence about the dispute. This information will be necessary if the parties are unable to reach a resolution.

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 for assistance with resolving the dispute. Below are some examples of issues that involve NCCI manual rules:

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

Questions about NCCI's Dispute Resolution Process or requests for disputes to be reviewed through the Process should be directed to:

NCCI
Regulatory Operations Department—Dispute Resolution Services
901 Peninsula Corporate Circle
Boca Raton, FL 33487-1362
Email: regulatoryoperations@ncci.com
Fax: 561-893-5043

A dispute resolution request sent to NCCI must also be sent simultaneously to all other parties to the dispute.

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Q3: What happens after NCCI receives a request for Dispute Resolution Services?


A: NCCI assigns a dispute consultant (consultant) to the dispute. The consultant contacts the carrier and the policyholder to review the dispute.

After obtaining all the necessary information, the consultant attempts to help the carrier and policyholder reach a resolution. Most disputes are resolved by the policyholder and carrier without the need for further review through NCCI's Process. If a resolution is reached, the consultant will communicate the details to all parties.

If the policyholder and carrier are unable to reach a resolution, the dispute consultant asks the policyholder if they want the dispute to be reviewed by a state's Workers Compensation Appeals Board or Committee (as described in Q4 below). If so, the consultant sends all parties written notice of the date, time, location, or teleconference information of the meeting before the state's Workers Compensation Appeals Board or Committee.

Q4: What is a Workers Compensation Appeals Board or Committee?


A: Workers Compensation Appeals Boards or Committees assist in dispute resolution by hearing disputes involving workers compensation insurance policies. Pursuant to the state-approved Process, these Boards or Committees are typically composed of 3 to 10 members chosen by NCCI or appointed by the appropriate state regulatory authority. NCCI facilitates the Board or Committee meetings and serves as a nonvoting technical advisor regarding NCCI's manual rules.

The Board or Committee hears both sides of the dispute, makes a decision, and provides a written decision to all parties involved in each dispute.

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Q5: Do the policyholder and carrier have to appear in person before the Workers Compensation Appeals Board or Committee?


A: Policyholders and carriers participate by teleconference or in person; however, each state has its own rules regarding procedures for dispute resolution meetings. In all states, the policyholder bringing the dispute must participate in the meeting.

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 or Committee may ask questions. This is called the discussion phase.

The policyholder or the carrier may, at its own expense, be represented by legal counsel, or the policyholder may be represented by the policyholder’s agent. Either the policyholder or the carrier may have witnesses participate in the meeting.

In most states, after the Board or Committee has heard all presentations, the parties and witnesses are excused while the Board or Committee meets to discuss the dispute and make a decision. This is called the deliberation phase.

Q6: What requirements does a policyholder have to meet before utilizing NCCI's Dispute Resolution Process?


A: A policyholder must establish a bona fide dispute for the dispute to be reviewed through the Process. A bona fide dispute exists when the policyholder has submitted a written request to NCCI that includes:

  1. A request for dispute resolution services
  2. Premium and payment information:
    1. An estimate of the premium in dispute
    2. Verification of payment of all undisputed premium provided to the carrier
    3. A written explanation of the premium calculation
  3. All documentation relevant to the dispute
  4. A description of the attempts to resolve the dispute with the carrier

Q7: Does NCCI inspect the policyholder's business?


A: The resolution of a dispute that involves the assignment of classification codes or the allocation of payroll among class codes may be facilitated through an inspection of the business by NCCI to determine proper classification code(s). It must be noted that a classification inspection is an on-site review of a policyholder’s current business operations which may not be the same as the business operations during the policy period in dispute. Therefore, an inspection used for this purpose is not binding on the outcome of the pending dispute.

A request can be made for NCCI to inspect the policyholder’s business. NCCI charges for inspection services and bills for on-site and off-site time.

For more information, contact the dispute consultant.

Q8: How long does the Dispute Resolution Process take?

A: The time to complete the dispute resolution process depends upon NCCI’s receipt and review of complete information from the carrier and policyholder, and whether the dispute is scheduled for an Appeals Board or Committee meeting.

Q9: Does the policyholder have to pay the premium in dispute before requesting dispute resolution services?

A: Subject to any state-specific rule, any undisputed portion of the premium that is due to the carrier must be paid before the policyholder is eligible for NCCI’s dispute resolution services.

The 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. The dispute consultant will explain the policyholder’s rights and responsibilities in a state.

Q10: What if the policyholder is dissatisfied with the decision of the Appeals Board or Committee?

A: Under the Process, the policyholder may appeal the decision of the Appeals Board or Committee. How and where a decision may be appealed also depends on a state’s laws. The written decision notice from the Appeals Board or Committee will contain information on how to submit an appeal, including any deadline for submission. The dispute consultant is available to provide assistance regarding the next step in the Process.

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