A Sweet Win at the Illinois Department of Insurance

 We just learned today we prevailed at a legal hearing at the Illinois Department of Insurance, on behalf of one of our consulting clients. This small biz client had been overcharged by Sentry Insurance, by way of using a wrong classification code (and thus wrong manual rate.) At the hearing, Sentry argued that, because this insured had accepted a proposal that used the wrong classification code, this meant that the clear policy provision that stated that Sentry would ultimately use the correct class for premiums, even if different from what was originally used, was null and void.

The hearing officer found this argument unpersuasive, it seems.
Kudos to my son and biz partner Scott Priz who ably handled this legal hearing. (It's nice to have a brilliant lawyer as part of our firm, one who also has twenty years' experience with the fine details of the classification system used for Workers Comp insurance. This wasn't a huge case in terms of our fee--but it was a huge win nonetheless, against an insurer who seemed determined to avoid returning significant premium overcharges to a small company.

The Florida Nightmare for Employers and Workers Comp Premium Disputes

 A while ago, I wrote about how, in Florida, there apparently is case law that establishes that a Florida employer that has been sued by an insurer over unpaid Workers Compensation insurance premiums cannot, at trial, raise the issue that the insurer calculated those insurance premiums incorrectly, unless the employer disputed those premium charges, before litigation, through the administrative process in Florida.

I've had the dubious pleasure of trying to raise such an administrative complaint on behalf of a Florida employer and have found it to be an administrative nightmare right out of Kafka.

NCCI, the non-governmental insurance industry outfit that writes manuals of rules used by insurers, has said they cannot accept this particular dispute. So I turned to the Office of Insurance Regulation. They in turn said I had to go to the division of Consumer Services, who in turn referred this to the Florida Department of Financial Services, Division of Workers Compensation--who in turn said they can't handle this, and said I should call OIR--the Office of Insurance Regulation--the people I had first filed this administrative complaint with, back in June.

So, Florida courts say that employers must go through the administrative process if they want to be able to later raise the issue of their insurance company screwing up the premium calculations, when that insurance company sues them. But that administrative process is not particularly well designed to actually let employers file such administrative complaints!

I'm recommending my Florida client reach out to his state representative to see if perhaps that can cut through this bureaucratic game of hot potato, but it's enough to make one suspect that perhaps the state of Florida just doesn't want employers to be able to dispute premium overcharges with insurance companies. 

Stay tuned for further developments.