CHAPTER 3. Regulation of Business of Workers’ Compensation Insurance [11690. - 11761.]
Heading of Chapter 3 amended by Stats. 1979, Ch. 373.
§§ 11690–11761 · 87 sections
ARTICLE 1. Deposits by Workers’ Compensation Insurers §§ 11690–11703 · 26 sections
- § 11690 For purposes of this article: (a) “Compensable workers’ compensation claim” means a claim where the claimant is entitled to benefits under the workers’…
- § 11691 (a) (1) In order to provide protection to the workers of this state in the event that the insurers issuing workers’ compensation insurance to employers fail to…
- § 11691.1 The fees for filing a schedule of securities with the Treasurer, and making a deposit of the same, and for each withdrawal, substitution, or any other change…
- § 11691.2 The deposit required pursuant to Section 11691 shall be security for the payment of the insurer’s obligations on worker’s compensation insurance transacted in…
- § 11691.3 The commissioner shall establish a list of all insurers or reinsurers authorized to reinsure the injury, disablement, or death portions of policies of workers’…
- § 11692 A certificate of authority to transact workers’ compensation insurance in this state shall not be issued nor renewed to any insurer until the deposit required…
- § 11692.5 On and after the effective date of this article, the commissioner shall collect a late filing fee from any admitted insurer or reinsurer that fails to deposit…
- § 11693 The deposit required pursuant to Section 11691 shall be adjusted on or prior to March 31 of each year in an amount as follows: (a) Not less than the sum of the…
- § 11694 After the first annual statement to the commissioner covering business of the insurer for a full year in this state, the deposit required pursuant to Section…
- § 11694.5 On or before March 1 and May 15 of each year, the insurers or reinsurers subject to Section 11694 shall file a report in the form and manner prescribed by the…
- § 11695 Where an admitted insurer has voluntarily ceased to do in this state the business for which a deposit is required pursuant to Section 11691, the deposit shall…
- § 11696 In the event an insurer not in a delinquency proceeding fails to pay any compensable workers’ compensation claim against it, or fails to pay, to the extent of…
- § 11697 The payment of a workers’ compensation claim by the commissioner shall constitute a satisfaction of the claim to the extent of the payment made. In the event…
- § 11698 (a) In the event any one of the eventualities described in paragraph (1), (2), (3), or (4), transpires, the commissioner shall immediately take control or…
- § 11698.01 When the commissioner is authorized to proceed under Section 11698 he or she may do either of the following: (a) Subject to Sections 11698.2, 11698.21, and…
- § 11698.02 The proceeds of the deposit required pursuant to Section 11691 shall be used solely to pay compensable workers’ compensation claims under the insured or…
- § 11698.1 From time to time and in any event at or prior to the time of the filing of his or her petition for discharge as receiver, the commissioner shall do the…
- § 11698.2 If the commissioner enters into a reinsurance and assumption agreement as provided in subdivision (a) of Section 11698.01, that agreement shall provide for all…
- § 11698.21 (a) The reimbursement provision referred to in subdivision (c) of Section 11698.2 shall provide for the transfer of the securities in the deposit to the…
- § 11698.22 The commissioner shall not enter into an agreement with an insurer if its reinsurance and assumption of liability will impair its solvency or render its…
- § 11698.3 (a) If the insurer is a member insurer of the California Insurance Guarantee Association (the association) and has been the subject of an order of liquidation…
- § 11699 Unless the deposit required pursuant to Section 11691 is withdrawn by the commissioner pursuant to the authority granted him or her by this article, it, or any…
- § 11700 The deposit required pursuant to Section 11691, unless withdrawn by the commissioner, shall be used only for the payment of compensable workers’ compensation…
- § 11701 The commissioner may revoke the certificate of authority to transact workers’ compensation insurance or to reinsure the injury, disablement, or death portions…
- § 11702 The provisions of this article shall not apply to workers’ compensation insurance covering those persons defined as employees by subdivision (d) of Section…
- § 11703 An insurer desiring to write workers’ compensation insurance shall maintain or provide occupational safety and health loss control consultation services…
ARTICLE 2. State Rate Supervision §§ 11730–11742 · 14 sections
- § 11730 The following definitions govern the construction and meaning of the terms used in this article: (a) “Classification system” or “classification” means a plan,…
- § 11731 This article applies to workers’ compensation insurance and employers’ liability insurance written in connection therewith.
- § 11732 Rates shall be adequate to cover an insurer’s losses and expenses. Rates shall not tend to create a monopoly in the market. For the purpose of this section,…
- § 11732.5 Rates shall not be unfairly discriminatory. Rates are unfairly discriminatory if, after allowing for practical limitations, price differentials fail to reflect…
- § 11733 In determining whether rates comply with Section 11732, the following criteria shall apply: (a) Due consideration may be given to past and prospective loss and…
- § 11734 (a) Every workers’ compensation insurer shall adhere to a uniform experience rating plan filed with the commissioner by a rating organization designated by the…
- § 11735 (a) Every insurer shall file with the commissioner all rates and supplementary rate information that are to be used in this state. The rates and supplementary…
- § 11736 An experience rating plan shall contain reasonable eligibility standards, provide adequate incentives for loss prevention, and shall provide for sufficient…
- § 11736.5 (a) The commissioner shall establish, by regulation, those forms of collateral or security that an insurer may designate to secure the deductible amount of any…
- § 11737 (a) The commissioner may disapprove a rate if the insurer fails to comply with the filing requirements under Section 11735. (b) The commissioner may disapprove…
- § 11738 A classification shall take no account of any physical impairment of employees or the extent to which employees may have persons dependent upon them for…
- § 11739 (a) An insurer shall not use any plan for the payment of dividends to policyholders by reason of a participating provision in a workers’ compensation insurance…
- § 11740 Rates and supplementary rate information filed for use in this state pursuant to this article and Article 3 (commencing with Section 11750), as added and…
- § 11742 (a) The Legislature finds and declares that the insolvencies of more than a dozen workers’ compensation insurance carriers have seriously constricted the…
ARTICLE 3. Rating and Other Organizations §§ 11750–11759.2 · 44 sections
- § 11750 (a) The purpose of this article is to promote the public welfare by regulating concert of action between insurers in collecting and tabulating rating…
- § 11750.1 As used in this article, unless a different meaning is manifest, the term: (a) “Insurer” means every insurer authorized to transact workers’ compensation…
- § 11750.2 The provisions of this article shall apply to all workers’ compensation insurance and employer’s liability insurance incidental thereto and written in…
- § 11750.3 A rating organization may be organized pursuant to this article and maintained in this state for the following purposes: (a) To provide reliable statistics and…
- § 11751 On and after January 1, 1952, a rating organization shall not conduct its operations in this state without first having filed with the commissioner a written…
- § 11751.1 To obtain and retain a license, a rating organization shall provide satisfactory evidence to the commissioner that it shall do all of the following: (a) Permit…
- § 11751.2 The commissioner shall examine each application for license to act as a rating organization and the documents filed therewith and may make any further…
- § 11751.25 Notwithstanding Section 11751, each rating organization possessing a license of indefinite term pursuant to this article shall owe and pay to the commissioner…
- § 11751.3 (a) Subject to the approval of the commissioner, a rating organization licensed under this article may adopt any reasonable constitution, articles of…
- § 11751.35 (a) Four members of the public, two representing organized labor and two representing insured employers, appointed pursuant to subdivision (b) of Section…
- § 11751.4 From and after the taking effect of this act, it shall be the duty of every insurer to be a member of a rating organization. No insurer may at the same time…
- § 11751.5 The commissioner, after notice and hearing, may promulgate reasonable rules and statistical plans, which may be modified from time to time and which shall be…
- § 11751.55 If an insurer, the State Compensation Insurance Fund, a rating organization, or an advisory organization requests an official action by the commissioner under…
- § 11751.7 (a) The rating organization designated the statistical agent pursuant to Section 11751.5 shall provide to the Director of Industrial Relations, upon request,…
- § 11751.8 An insurer shall report to its rating organization as corrections or revisions of losses, pursuant to the unit statistical plan and uniform experience rating…
- § 11751.82 (a) An insurer under a wrap-up insurance policy shall report workers’ compensation losses and payroll information for each contractor and subcontractor to its…
- § 11751.9 Whenever a claim or claims used in an experience rating are closed and reported pursuant to the unit statistical plan approved by the commissioner and are…
- § 11752 The commissioner may, as often as reasonable and necessary, make or cause to be made an examination of each rating or advisory organization to ascertain…
- § 11752.1 The officers, managers, agents and employees of any such organization may be examined by the commissioner at any time under oath and shall exhibit all books,…
- § 11752.2 The reasonable cost of any examination authorized by this article of any rating or advisory organization shall be paid by the organization examined.
- § 11752.5 (a) Subject to subdivision (b), a licensed rating organization shall make available any policy information contained in its records to the following: (1) The…
- § 11752.6 (a) A licensed rating organization shall make available, in writing, to an employer insured under a workers’ compensation policy, all policyholder information…
- § 11752.7 (a) A licensed rating organization may make available experience rating information contained in its records to any insurer admitted to transact workers’…
- § 11752.75 (a) (1) Notwithstanding any other provision of law, a licensed rating organization shall, pursuant to regulations adopted by the commissioner after notice and…
- § 11752.8 (a) For all policies of insurance issued, or renewed for the first time on or after January 1, 1995, the insurer shall provide a notice, approved by the…
- § 11752.9 Notwithstanding subdivision (d) of Section 11750.3, a rating organization shall provide a policyholder with written notification if it imposes a change in the…
- § 11753 No advisory organization shall conduct its operations in this State unless and until it has filed with the commissioner: a. A copy of its constitution,…
- § 11753.1 (a) Any person aggrieved by any decision, action, or omission to act of a rating organization may request that the rating organization reconsider the decision,…
- § 11753.2 (a) If a change in a classification assignment on a workers’ compensation insurance policy is due to an erroneous classification and results in a decreased…
- § 11753.3 Notwithstanding Section 1851.1, a workers’ compensation insurance rating organization licensed pursuant to the provisions of this article which does not make…
- § 11754 If the commissioner has good cause to believe that a rating or advisory organization or an insurer does not comply with the requirements of this article…
- § 11754.1 If the commissioner has good cause to believe such noncompliance to be wilful, or if within the period prescribed by the commissioner in the notice required by…
- § 11754.2 If, after a hearing pursuant to Section 11754.1, the commissioner finds: a. That any rating or advisory organization or other organization authorized by this…
- § 11754.3 In addition to other penalties provided in this code the commissioner may suspend or revoke the license of any rating organization or insurer which fails to…
- § 11754.4 Except as otherwise provided in this article, all proceedings in connection with the denial, suspension or revocation of a license of a rating organization or…
- § 11754.5 Any finding, determination, rule, ruling, or order made by the commissioner under this article or Article 2 (commencing with Section 11730) shall be subject to…
- § 11755 No person, insurer, rating or advisory organization shall willfully withhold information from, or knowingly give false or misleading information to, the…
- § 11756 (a) Any person, insurer, or organization, who fails to comply with a final order of the commissioner under this article shall be liable to the state in an…
- § 11757 Nothing in this article shall be construed to prohibit or regulate the payment of dividends, savings or unabsorbed premium deposits allowed or returned by…
- § 11758 No act done, action taken or agreement made pursuant to the authority conferred by this article shall constitute a violation of or grounds for prosecution or…
- § 11758.1 The provisions of this article shall not apply to the workers’ compensation insurance covering those persons defined as employees by subdivision (d) of Section…
- § 11759 The Legislature hereby finds and declares as follows: The Legislature pursuant to its plenary power over workers’ compensation granted by Section 4 of Article…
- § 11759.1 A rating organization shall, no later than June 1 of each year, notify the Governor and the Legislature that a report containing an analysis of all losses and…
- § 11759.2 (a) A licensed rating organization designated as the Insurance Commissioner’s statistical agent shall prepare a report to be submitted to the Insurance…
ARTICLE 4. Penalties for Misrepresentation §§ 11760–11760.1 · 2 sections
- § 11760 (a) It is unlawful to make or cause to be made any knowingly false or fraudulent statement, whether made orally or in writing, of any fact material to the…
- § 11760.1 (a) If an employer fails to provide for access by the insurer or its authorized representative to its records, to enable the insurer to perform an audit to…
ARTICLE 5. Standards Applicable to Claims Adjusters § 11761 · 1 section
- § 11761 (a) The commissioner shall adopt regulations setting forth the minimum standards of training, experience, and skill that workers’ compensation claims adjusters…