California Insurance Code 11751.8 – An insurer shall report to its rating organization as corrections or …
An insurer shall report to its rating organization as corrections or revisions of losses, pursuant to the unit statistical plan and uniform experience rating plans approved by the commissioner, if any of the following is applicable:
(a) A loss record detail was incorrectly reported through mistake other than error of judgment.
Terms Used In California Insurance Code 11751.8
- Commissioner: means the Insurance Commissioner of this State. See California Insurance Code 20
- Insurer: means every insurer authorized to transact workers' compensation insurance and employer's liability insurance incidental thereto and written in connection therewith in this state, including the State Compensation Insurance Fund. See California Insurance Code 11750.1
- Prosecute: To charge someone with a crime. A prosecutor tries a criminal case on behalf of the government.
- Rating organization: means any organization which has as its primary object or purpose the collecting of loss and expense statistics and other statistical information and data, the making of pure premium rates and those rating plans authorized by Section 11734 for workers' compensation insurance and employer's liability insurance incidental thereto and written in connection therewith and presenting them to the commissioner for approval. See California Insurance Code 11750.1
- State: means the State of California, unless applied to the different parts of the United States. See California Insurance Code 28
(b) One or more claims are declared noncompensable. A claim is declared noncompensable if any of the following applies:
(1) There is an official ruling specifically holding that a claimant is not entitled to benefits under the workers’ compensation laws of the state, even though the claimant may have been awarded reimbursement for expenses incurred by the claimant in presenting the case.
(2) No claim was filed during the period of limitation provided by the workers’ compensation laws for the filing of the claim, and the carrier, therefore, closes the claim.
(3) Where the carrier contends, prior to the valuation date, that a claimant is not entitled to benefits under the workers’ compensation laws and the claim is officially closed because of the claimant’s failure to prosecute the claim.
(c) The carrier has recovered in an action against a third party.
(d) A death claim has been compromised over the sole issue of the applicability of the workers’ compensation laws of the state.
(e) The exposure has been reassigned to another classification through the revision of an audit, in which case the insurer shall file with the revision of exposure a revision of losses that will reassign all claims to the appropriate classification.
(f) A clerical error in either the classification assignment or the type of injury assignment of a given claim, or a group of claims, has been discovered by the insurer.
(g) A clerical error in either the classification assignment or the type of injury assignment of a given claim has been discovered by the rating organization. The insurer shall, when notified by the rating organization, file a revision of losses or make satisfactory explanation.
(h) A correction is made in a classification assignment of a given claim, or a group of claims, as a result of the organization test audit of an insured for which the experience has been submitted.
(i) The claim has been determined to be a joint coverage claim in accordance with the unit statistical plan approved by the commissioner.
(Amended by Stats. 1997, Ch. 748, Sec. 3. Effective January 1, 1998.)