The Road to Recovery: Commissioner Lara's Plan to Rescue Property Insurance in California

Author, Jeremy Hoolihan, Account Executive, Rancho Mesa Insurance Services, Inc.

California Governor Gavin Newsom recently declared property insurance a State of Emergency in CA based on a mass exodus of property insurance companies. This has allowed CA Insurance Commissioner Ricardo Lara to strike a deal with insurance companies to encourage new coverage in the State. The changes are slated to go into effect by the end of 2024. However, the hope is that insurers will begin to write homeowner’s policies sooner.

The agreement between Lara and the insurance industry will have insurers return to high-risk zones in the State, in exchange for relief in current regulations. This would allow insurers to get higher rate increases through the state regulator much faster.

Key regulatory elements of Lara’s plan, per his press conference on September 21, 2023, include:

1. Executive action by the Commissioner to transition homeowners and businesses from the FAIR Plan back into the normal insurance market with commitments from insurance companies to cover all parts of California by writing no less than 85% of their statewide market share in high wildfire risk communities. For example, if a company writes 20 out of 100 homes statewide, it must write 17 out of 100 homes in a distressed area.

2. Allowing FAIR Plan policyholders who comply with new safer wildfire regulations the first priority to transition to the normal market.

3. Expediting the Department’s introduction of new rules for the review of climate catastrophe models that recognize the benefits of wildfire safety and mitigation actions at the state, local, and parcel levels.

4. Directing the FAIR Plan to further expand commercial coverage to $20 million per building to close insurance gaps for homeowner’s associations and condo developments to help meet the State’s housing goals and to provide required coverage to other large businesses in the state.

5. Holding public meetings to explore incorporating California-only reinsurance costs into rate filings.

6. Improving rate filing procedures and timelines by enforcing the requirement for insurance companies to submit a complete rate filing, hiring additional Department staff to review rate applications and inform regulatory changes, and enacting intervener reform to increase transparency and public participation in the process.

7. Increasing data reporting by the FAIR Plan to the Department, Legislature, and Governor to monitor progress toward reducing its policyholders.

8. Ordering changes to the FAIR Plan to prevent it from going bankrupt in the case of an extraordinary catastrophic event, including building its reserves and financial safeguards.

Lara’s plan is hopefully going to deter more insurance companies from leaving California by loosening certain elements of insurance regulations. Under the existing system, insurers need to apply with the Department of Insurance to raise their rates and provide supporting documentation to justify the rate hike. The process would allow consumer advocates to intervene along the way, acting as watchdogs in the process.

With property owners desperately searching for affordable comprehensive coverage, Lara’s plan cannot come sooner. While this will take time to implement, it is an important step in restoring the property marketplace in California. If you have any questions relating to this article please feel free to reach out to me at jhoolihan@ranchomesa.com or 619-937-0174.

California Workers' Comp Carriers React to Commissioner's COVID-19 Amendment Approval

Author, Alyssa Burley, Media Communications and Client Services Manager, Rancho Mesa Insurance Services, Inc.

With California Insurance Commissioner Lara’s recent approval of a special regulatory filing introduced to alleviate the burden COVID-19 workers’ compensation (WC) claims threaten to have on California employers, we reached out to several prominent carrier executives to share their thoughts.

The amendments address accounting for employees whose job duties have changed to clerical work, which is typically a less expensive workers’ compensation insurance classification than the jobs they were performing prior to Governor Newsom’s March 19, 2020 Stay-at-Home Executive Order. It also excludes payroll for furloughed employees who are not working, but collecting a paycheck. It creates a way to identify COVID-19 cases within the California workers’ compensation system and excludes the cases from the Experience Modification Rate (XMOD) calculation.

When asked about the amendments scheduled to take effect July 1, 2020, Margaret Hartmann, Senior Vice President and Chief Marketing Officer at Berkshire Hathaway Homestate Companies, California’s second largest workers’ compensation insurance carrier, said “Lara’s approval of the WCIRB [Workers’ Compensation Insurance Rating Bureau] proposal was not surprising. These are not unreasonable, at least from the perspective of ratemaking and predicting future experience of employers once COVID passes.”

Bryan Anderson, Senior Vice President at The Zenith explained the WCIRB’s amendments to the California Unit Statistical Reporting Plan and XMOD calculation were “not likely to change under any normal circumstances but the Bureau made these recommendations to address the unique pandemic situation that California (and the world’s) businesses find themselves in."

Another industry leader Paul Zamora, ICW Group’s Senior Vice President for Workers’ Compensation Underwriting said, “We support Commissioner Lara’s decision to approve the recommended changes by the WCIRB.  We believe the rule modifications accurately reflect changes in exposures created by COVID-19 and will provide the appropriate relief needed by California businesses.”

The changes were expected by California’s workers’ compensation insurance carriers as a mechanism to adjust employers’ insurance rates, since COVID-19 claims aren’t necessarily an indicator of a company’s safety record. 

“Under normal situations,” Anderson explained, “workers’ compensation covers only those occupational illnesses that are created from the work environment. In this instance, that understanding changed with the Governor’s Executive Order requiring employers to accept compensability for Covid-19 claims unless they can prove they are not work-related.”

Hartmann added, “This is clear cost-shifting to the industry, which we expected. The combination of a broad WC presumption, possible additional legislation extending these presumptions past July 5th, excluding COVID from ratemaking and XMODs, means that the insurance industry will absorb the lion’s share of COVID costs that can be assigned to WC.”

Zamora points out “it’s imperative that business owners understand the rule changes and adopt new practices, particularly with respect to the record keeping criteria associated with two of the changes. By adopting new record keeping procedures to apply to the new rules, policyholders will have the necessary audit documentation to realize the full value of Commissioner Lara’s decision.”

This means employers should start documenting employees’ hours worked under each class code, now, and not wait until a final audit.

“Hopefully, these measures will play a small part in helping California employers as they try to recover from the devastating impacts of this pandemic,” Hartmann concluded.

“I think this solution is a testament to the strength and objectivity of the Bureau, the companies it represents and to the integrity of the Workers’ Compensation Industry in California,” said Anderson.

Gene Simpson, CompWest’s Vice President of Underwriting and Marketing, added, “To confront the challenges presented by the COVID-19 pandemic to California employers, regulatory authorities, insurance carriers and employers must work together on effective solutions.”

While the amendments should reduce workers’ compensation premium costs for California businesses in the short-term, only time will tell how lower revenues and higher costs due to COVID-19 claims will impact California’s workers’ compensation insurance premiums in the future.

For a greater understanding of these changes and how they will impact your company, please contact our team at (619) 937-0164.

Commissioner Lara Approves WCIRB Proposed Amendments Addressing COVID-19

Author, Dave Garcia, President, Rancho Mesa Insurance Services, Inc.

California Insurance Commissioner Lara has approved, as filed, the proposed special regulatory filing submitted by the Workers’ Compensation Insurance Rating Bureau (WCIRB) concerning proposed amendments addressing the Coronavirus Disease (COVID-19). The special regulatory filing is effective July 1, 2020 and will apply retroactively starting March 19, 2020, the day California Governor Newsom issued the Stay-at-Home Executive Order N-33-20. Those amendments are as follows:

New COVID-19 Rule: Clerical Office Employees

Part 3, Section III, General Classification Procedures, was amended to add Rule 7, Coronavirus Disease 2019 (COVID-19), to permit during a statewide California COVID-19 stay-at-home order the following: The division of an employee’s payroll between Classification 8810, Clerical Office Employees, and a non-standard exception classification when the employee’s work is exclusively clerical in nature and the non-standard exception classification does not include Clerical Office Employees. This amendment will conclude 60 days after the Stay-at-Home Executive Order N-33-20 is lifted.

New COVID-19 Rule: Basis of Payroll

Part 4, Section IV, Exposure Information, Rule 1, Classification Code, and Rule 4, Exposure Amount, were amended to report payments excluded from remuneration pursuant to new Rule 7, Coronavirus Disease 2019 (COVID-19). Payments made to an employee while the employee is performing no duties of any kind in service of the employer are to be excluded from payroll when the payments are equal to or less than the employee’s regular rate of pay. This amendment will conclude 30 days after the Stay-at-Home Executive Order N-33-20 is lifted.

New COVID-19 Rules: Claims Reporting

Part 4, Section V, Loss Information, Rule B, Loss Data Elements, Sub rule 4, Catastrophe Number, was amended to add Catastrophe Number 12 for the reporting of COVID-19 claims. Appendix III, Injury Description Codes, Section B, Nature of Injury (Positions 3-4), and Section C, Cause of Injury (Positions 5-6), were amended to add a Nature of Injury code and a Cause of Injury code for COVID-19 claims. This amendment includes claims with an accident date after December 1, 2019, reported on a Unit Statistical Report due on or after August 1, 2020, and reported with a Catastrophe Number 12.

Exclusion of COVID-19 Claims from Experience Modification

Section VI, Rating Procedure, Rule 2, Actual Losses and Actual Primary (Ap) Losses, was amended to specify that all claims directly arising from a diagnosis of Coronavirus Disease 2019 (COVID-19) shall not be reflected in the computation of an experience modification.

For a greater understanding of these changes and how they will impact your company please contact our team at (619) 937-0164.

CA Governor Issues Executive Order Making Workers’ Compensation Benefits More Readily Available to Essential Workers

Author, Sam Brown, Vice President, Human Services Group, Rancho Mesa Insurance Services, Inc.

On Wednesday, May 6 2020, California Governor Gavin Newsom issued an Executive Order making workers’ compensation benefits more readily available to essential workers.

The Executive Order states “any COVID-19-related illness of an employee shall be presumed to arise out of and in the course of employment for purposes of awarding workers’ compensation benefits if all of the following requirements are satisfied:

a.  The employee tested positive for or was diagnosed with COVID-19 within 14 days after a day that the employee performed labor or services at the employee’s place of employment at the employer’s direction;

b.  The day referenced in subparagraph (a) on which the employee performed labor or services at the employee’s place of employment at the employer’s direction was on or after March 19, 2020;

c.  The employee’s place of employment referenced in subparagraphs (a) and (b) was not the employee’s home or residence; and;

d.  Where subparagraph (a) is satisfied through a diagnosis of COVID-19, the diagnosis was done by a physician who holds a physician and surgeon license issued by the California Medical Board and that diagnosis is confirmed by further testing within 30 days of the date of the diagnosis.”

Insurance companies have 30 days from the date of a COVID-19 diagnosis to rebut with evidence.

According to the Executive Order, the presumption pertains only “to dates of injury occurring through 60 days following the date of this Order.”

The order establishes a rebuttable presumption that any essential workers infected with COVID-19 contracted the virus on the job. It is important to understand the order shifts the burden of proof from the injured worker and now requires employers or insurance companies to prove the employee didn’t get sick at the place of work.

Prior to the change, it was difficult to prove workers’ compensation claims related to a COVID-19 infection.

Rancho Mesa’s Response

In response to the Executive Order and other proposed rule changes, Rancho Mesa President David Garcia interviewed Berkshire Hathaway Homestate Companies President Rob Darby on the impact to California businesses and the workers’ compensation market. Berkshire Hathaway is one of the largest workers’ compensation insurance companies in California.

Read Governor Newsom’s Executive Order on Cal/Gov website.

Please contact your Rancho Mesa broker with questions specific to your business.