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Dispute Resolution

The ICRB has a process for addressing disputes through its Dispute Resolution Committee ("DRC") and assigned risk rules.

Dispute Resolution Committee ("DRC")
Ind. Code § 27-7-2-20.3 permits any person aggrieved by the application of a filing of the ICRB to request, in writing, a review of the manner in which such rating system has been applied in connection with the insurance afforded or offered. The ICRB's statutory review is conducted by the ICRB's Dispute Resolution Committee ("DRC").
 

ICRB Bylaws, Article XI “to provide an informal mechanism whereby any person aggrieved by the application of the Bureau’s filings may be heard on written request to review the manner in which such rating system has been applied in connection with the insurance afforded or offered.”

 
The DRC is comprised of five voting members. Two (2) DRC members are appointed by the ICRB Governing Board from among its membership. Three (3) DRC members are appointed by the Insurance Commissioner of the State of Indiana from among the public. One public member represents a private sector employer. The second public member represents an Indiana statewide business association. The third public member is knowledgeable concerning worker's compensation insurance and familiar with the business environment in Indiana.

The DRC hears disputes between the insured and insurer. Any person may appeal the DRC decision within thirty (30) days to the Insurance Commissioner who may, after a hearing, affirm, modify or reverse the DRC. Appeals from the decision of the Insurance Commissioner must be made within thirty (30) days to the Marion County Superior Court. The court may affirm or set aside the decision of the Insurance Commissioner. An appeal from the decision of the Marion County Superior Court must be taken to the Indiana Supreme Court.
 
Rules and Manuals

The Basic Manual, Experience Rating Plan Manual, and The Forms Manual of Workers Compensation & Employers Liability Insurance contain rules and guidelines for the issuance of workers compensation policies. The ICRB has filed these manuals and other rules with the Indiana Department of Insurance. The rules authorize the ICRB to determine classifications, experience ratings for insureds in Indiana, and decide if the rules are properly applied. On the occasion when an insured or insurance company believes that the rules are being applied inappropriately, the DRC is the appeal mechanism.

 

Procedures

The DRC meeting is informal and not an adversarial proceeding. Each party has an opportunity to present its position. The DRC members may ask questions or clarify points of interest. The Committee dismisses the participants and meets in executive session to decide the matter. A vote is taken and the majority vote prevails. The ICRB takes minutes and informs the participants of the decision.

 

  

Assigned Risk Premium in Dispute

The Indiana Workers Compensation Insurance Plan of Operation (WCIP), Article I - Definitions, has a rule 1.15 titled "Premium Dispute." It reads:

 

"A dispute between an Employer and Servicing Carrier concerning a Workers Compensation Insurance premium obligation. A Premium Dispute may be established only if the Employer or its representative has provided:

(i) written notice to the insurer or the Servicing Carrier detailing the specific areas of dispute;

(ii) an estimate of the premium the Employer believes to be correct, with an explanation of the premium calculation;

(iii) payment of the undisputed portion of the premium; and

(iv) a written request that includes all information relevant to the dispute to the Plan Administrator for a hearing before the appropriate administrative or regulatory body having jurisdiction over appeals on Plan matters."

 
 

Related Files

The material in this document has been prepared and shared for informational purposes only and should not be relied upon as legal advice on any particular situation.