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Worker's Compensation - Dispute Resolution

1. What steps should be taken to resolve a dispute?
   
   The employer and insurance company must make a reasonable attempt to resolve the issue(s) in dispute. Both parties should keep a record of any correspondence about the dispute. This information will be necessary in the event that the parties are unable to resolve the dispute.
   
   
2. What if the employer and insurance company are unable to resolve the dispute?
   
   If the employer and insurance company are unable to resolve the dispute after a reasonable effort to do so, and the dispute concerns NCCI manual rules, then the employer may contact NCCI's Customer Service Center for assistance with resolving the dispute. Below are some examples of issues that involve NCCI rules:
   • Application of correct class code(s) to a business’s payroll
   • Application of business payroll among class codes
   • Application of an experience rating modification factor
   • Combination of the experience of one business with that of another
     
   
   If the dispute remains unresolved after assistance from NCCI's Customer Service Center, the dispute may be eligible for NCCI's Dispute Resolution Process. Questions about NCCI's Dispute Resolution Process should be directed to:
   National Council on Compensation Insurance, Inc.
   Regulatory Assurance Department—Dispute Resolution Services
   901 Peninsula Corporate Circle
   Boca Raton, FL 33487-1362
   regulatoryassurance@ncci.com
   Fax Number: 561-893-5043
3. What happens after NCCI receives a request for dispute resolution services?
   NCCI will assign a Regulatory Services Manager (RSM) to the dispute.
   The RSM will contact the workers compensation employer and insurance company to discuss the dispute. Once the RSM has obtained all the necessary information, the RSM will attempt to help the employer and insurance company to reach a resolution of the dispute. Most disputes are resolved by the employer and insurance company without the need for a hearing through NCCI’s dispute resolution services. If a resolution is reached, the RSM will send a letter to the employer and insurance company outlining the agreed upon resolution.
   If the employer and insurance company are unable to reach a resolution, the RSM will ask the employer if a hearing is wanted. If so, the RSM will send both employer and insurance company written notice of the date, time, and place of the hearing before the Connecticut Appeals Board.
   
4. What Type of Appeals are heard by the Connecticut Appeals Board?
   
   The Connecticut Appeals Board generally hears appeals relating to:
   • Experience modification factors
   • Classification assignments
   • Application of rules contained in NCCI manuals
     
     
5. Describe the Connecticut Appeals Board.
   
   • The Board consists of five (5) voting members but no more than seven (7) voting members, one (1) non-voting advisor from NCCI and one (1) non-voting member from the staff of the Connecticut Insurance Commissioner.     
   • Each member will is knowledgeable concerning workers compensation insurance and is familiar with the business environment and business community of the state of Connecticut.
   • At least one member will be a private sector employer or from a private sector employer.
   • At least one member will be affiliated with a local chamber of commerce, small business federation or similar business association.
   • At the meeting of the Board, less than 50% of the voting members will be affiliated with the insurance industry. 
     
     
6. What Happens at the Hearing?
   
   NCCI will notify the employer, producer (if applicable), and insurance company of the date, time and place of the hearing. Hearings are informal. Attorneys are not required because the purpose of the hearing is to present the facts about the business, not to argue legal or procedural points. The employer and the insurance company must be prepared to make brief presentations to Board members. Board members will probably ask questions to clarify issues. Parties to the dispute are excused while the Board meets in executive session to discuss the appeal and reach a decision. A representative of the Board will send a written notice of decision to all parties within 30 days of the hearing.
   
   
7. What if the employer or the insurance company is not satisfied with the decision of the Board?
   
   If the employer or the insurance company is not satisfied with the decision made by the Board, they have the right to appeal the decision to the Connecticut Insurance Department. They have 30 days after the date of the Board's decision letter in which to file such an appeal. Information on how to appeal the Board's decision will be included in the Board's decision letter.