A Win For The Books in Georgia

 We just received notification of a win for a client down in Georgia over proper Workers Comp classification of their business. And this one is one for the books.

I had made a presentation on behalf of this client down at the Workers Compensation Appeal Board about a month ago. I thought we had a rock-solid case. I advocated to reverse a recent NCCI inspection that had assigned a much more expensive classification to this client. I made a strong case that the newly-assigned classification was wrong and that the Appeal Board should assign the less expensive class that this client had for years and years, before the inspection.

In spite of what I thought was a very persuasive case, we lost. The Appeal Board instead ruled that the much more expensive class should stand.

I was honestly surprised. And we were assisting this client with the further appeal of that decision when this notification arrived today. From the Georgia Department of Insurance.

The Georgia Department of Insurance overruled the Appeal Board and reinstituted the cheaper class I had been advocating for. Without the necessity of our even filing an appeal.

In all my years of doing this kind of work, I have never seen something like this. I have never seen a Department of Insurance overturn a decision by a Workers Comp Appeal Board without our having to even make an appeal of that decision.

I'm delighted by this turn of events, of course. And I'm intensely curious regarding what the heck happened, behind the scenes. I mean, the Department of Insurance had a representative at the hearing, a voting member of this Appeal Board. So someone at the department knew the arguments I had made and had heard the testimony of the business owner.

So now, on to my next case. Cases, actually, as in the plural. We keep getting phone calls and emails just about every day from small and medium-sized businesses, across the country, who need help disputing Workers Compensation insurance classifications and premium audits. Got two this morning, from different parts of the country. So I'm going to be a busy little insurance consultant, it seems, without too much time for resting on my laurels after this unexpected notification. But that's fine by me.

The Kind of Thing That Makes Me Angry

 I'm currently working on behalf of a small construction company. On their last Workers Comp audit, the insurance company couldn't be bothered to send out an auditor. So they instructed the policyholder to fill out a self-audit form. And the construction guy, trying to do the work of a trained premium auditor, made some mistakes. He caught them after he sent in the form, but the insurer wouldn't revise the audit. So he hired us.

As a first step, we went to the Dispute Resolution process offered by NCCI. I explained the problems--a guy who belongs in the clerical code got assigned to the carpentry class. Plus, I found that this company didn't even belong in the carpentry class--they are a painting company, and properly belong in the cheaper painting classification.

Insurance company just gave their official reply to NCCI. They told us to pound sand. 

Now, this galls me, because I know from experience that insurance companies routinely change these audits when it benefits them, sometimes years later. But when the policyholder wants to fix things, because construction guys aren't so well trained as premium auditors, the insurance company says "No takebacks."

My own initial first response is something less polite and more of an Anglo-Saxon type of exclamation. But that won't get us anywhere.

So now I have to roll up my sleeves, put on my thinking cap, and figure out how best to fight this. Because NCCI has kind of just shrugged at this non-response by Pekin Insurance and asked us if we can prove our assertions. And we're certainly looking into this.

But the thought occurs to me that is a classic example of how the system is not a level playing field. and how the insurance oversight system is not exactly a consumer-friendly system, in spite of places like NCCI having some very dedicated and helpful people. The system just is designed to put the burden of proof on the policyholder, Instead of insisting that insurance companies actually have to bear the expense and effort of getting these audits right, the system tends to push that off onto policyholders. Kind of like a mandatory self-checkout lane at Wal-Mart. Where the scanner sometimes reads a bag of apples as a vacuum cleaner.

Well, the game is afoot, I suppose. Time to see if I can make Pekin Insurance do the right thing. Stay tuned.