While reasonable efforts have been made to ensure that this information is accurate, it is general in nature and may not apply to your specific situation. You are urged to contact your agent, broker, company or the Division with your specific situation.

 




ANSWERS

WHAT IS THE ROLE OF THE DIVISION OF INSURANCE REGARDING WORKERS' COMPENSATION?

The Division of Insurance (DOI) has broad authority to regulate companies who write workers' compensation insurance. The DOI has several responsibilities including the authority to approve or disapprove workers' compensation rates, industrial classifications, rating plans and many sorts of policy forms. We also run the assigned risk pool, although we have appointed the WCRB (Worker's CompensationRating and Inspection Bureau, 101 Arch Street, Boston, MA 02109, (617)439-9030) to perform most of the day-to-day operations, such as assigning employers to particular servicing carriers. The Division also regulates self insurance groups, (but not self-insured employers) and workers' compensation preferred provider organizations. In certain instances we hold hearings on rates, classifications, premiums or other matters involving workers' compensation, including loss reserves.

The Division does not oversee the relationship between insurance companies and injured workers. Disputes over claims for benefits by employees, health care providers or others, are most appropriately handled by the Department of Industrial Accidents located at 600 Washington Street, Boston, Massachusetts 02111. Their telephone number is (617) 727-4900.

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WHO HAS TO HAVE WORKERS' COMPENSATION INSURANCE?

Any person or business that employs workers must purchase workers' compensation insurance except (i) individuals employing people to do work on their own homes, (ii) non-profit corporations with no paid staff, and (iii) corporations in which each employee is an officer/director who owns at least 25% of the corporation and each has given up his/her right to workers' compensation benefits in the state.

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I AM SELF-EMPLOYED AND WAS TOLD BY AN INSURANCE AGENT THAT I CANNOT GET COVERAGE FOR MYSELF BUT MANY PEOPLE WON'T HIRE ME UNLESS I HAVE COVERAGE. WHAT AM I SUPPOSED TO DO?

As of October 23, 2002, sole proprietors and partners in partnerships will be able to buy workers' compensation coverage for themselves as well as for their workers. It remains an option for sole proprietors to purchase (less expensive) workers' compensation policies that will cover only their employees. As of the same date, those choosing to incorporate now have the option to waive all their rights to coverage under the workers' compensation laws if they own 25% of the corporation. The forms needed to make this election are available at the Department of Industrial Accidents.

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MY ACCOUNT WAS AUDITED AND I DISAGREE WITH MY INSURER OVER THE CORRECT PREMIUM. HOW CAN I DISPUTE THEIR RESULTS?

If you believe that you are being charged an incorrect amount, you can submit a written request to the WCRB asking that it review your case as to the correct application of the rating system. If you disagree with the WCRB's finding, you have 30 (thirty) days to appeal in writing to us. The WCRB is located at 101 Arch Street, Boston, Massachusetts 02210. The telephone number is (617) 439-9030 and the fax number is (617) 439-6055.

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CAN AN INSURER CANCEL MY POLICY IN MID-TERM?

An insurer can cancel a policy mid-term for only three reasons: (i) non-payment of premium, (ii) fraud or material misrepresentation or (iii) a substantial increase in the hazard being insured.

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HOW CAN I GET THE INSURANCE NECESSARY TO STAY IN BUSINESS IF MY INSURER HAS CANCELED MY COVERAGE EITHER MID-TERM OR AT THE END OF THE POLICY?

Your agent can apply to the Massachusetts Assigned Risk Pool for coverage if two carriers turn you down. The WCRB, who manages the pool, will then assign you to one of a number of carriers which will handle your business just as if it were covering your losses itself and you will be charged at the same rate. However, certain premium discounts might not be available to you. It's important to remember, though, that if your cancellation was the result of non-payment of premium, the Pool will not issue a policy until you have made all payments that are due to your former carrier.

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I HAVE AN ASSIGNED RISK POLICY AND I AM ENGAGED IN A CLASSIFICATION DISPUTE WITH MY CARRIER. CAN THEY CANCEL ME IF I REFUSE TO PAY THEM WHAT THEY BELIEVE I OWE?

Employers in the Pool that are threatened with a cancellation that they believe is unjustified have the right to appeal these within ten days of receiving the notice. The appeal should be directed to the Office of Insurance at the Department of Industrial Accidents , 600 Washington Street, Boston, Massachusetts 02111. That office has the authority to prevent cancellation until the dispute is resolved.

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WHOM CAN I CALL IF I WANT TO VERIFY THAT THE RATE MY INSURER IS CHARGING FOR MY CLASSIFICATION IS CORRECT FOR THE UPCOMING YEAR?

You can call the WCRB at (617) 439-9030 or send us a postcard.

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MY WORKERS' COMPENSATION PREMIUMS CONTINUE TO RISE. IS THERE ANYTHING THAT CAN BE DONE TO CONTROL THE COST?

If you are paying more than $500.00 in annual premiums, then your costs, at least to some extent, will be a function of your losses. If you can get your losses down, your premiums will come down. It is very important for you to take an active interest in matters such as safety, the medical management of claims and early return to work for any injured workers. If you are in the assigned risk pool, and are paying over $5,000.00 a year in premium, the odds are that your agent or broker may be able to find voluntary coverage for you. If he or she is successful, you may then be eligible to receive a stock or non-stock premium discount. Ultimately, employers pay the costs of losses to carriers plus the costs of the carriers operating. The more employers do to control or prevent losses, the less expensive workers' compensation will be for all employers. Finally, employers in the Pool can get up to 15% premium credits for hiring a Qualified Loss Management firm, to help them contain costs. Your agent can provide you with a list of such firms.

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I BELIEVE THAT MY EXPERIENCE MODIFICATION HAS GOTTEN WORSE AND MY ARAP (ALL RISK ADJUSTMENT PROGRAM) CHARGE HAS GOTTEN HIGHER BECAUSE OF ONE OR MORE CLAIMS THAT I CAN PROVE WERE FRAUDULENT. IS THERE ANYTHING I CAN DO ABOUT THIS?

Yes. Allegations of fraud should be reported to the Insurance Fraud Bureau ("IFB") (617) 439-0439 which has the power to investigate these allegations. Experience modifications may be recalculated when paid workers' compensation claims are later determined to be "noncompensable". Administrative Judges at the DIA have the power to make such determinations. Third party claim forms may be obtained from any DIA office.

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The Workers Compensation Insurance Questions & Answers were compiled to help consumers answer some of the most frequently asked questions about the workers' compensation program. Additional questions or comments should be made to:

The Commonwealth of Massachusetts
Division of Insurance
Consumer Service Unit
1000 Washington St, Suite 810
Boston, MA 02118-6200

Consumer Service Line Boston: (617) 521-7777