Calif. Commissioner Identifies Steps for State Fund to Reduce Workers’ Comp Rates

Insurance Commissioner John Garamendi released a statutorily mandated report on the State Compensation Insurance Fund’s (SCIF’s) potential to reduce workers’ comp rates based on his review of its financial condition, underwriting practices and rate structure.

The report, prepared by the California Department of Insurance (CDI), found that SCIF could realize additional rate reductions of 5.9 percent for all policyholders by implementing recommendations made by IBM Business Consulting Services (IBM), redirecting its investment portfolio, and reducing maximum commission rates. Any potential rate decreases would be in addition to the 9.7 percent in reductions SCIF filed during 2004.

SCIF Workers Comp Report

Download the Garamendi SCIF Workers Comp Report.

Available in PDF Format.

“Our exam of SCIF, to the extent it was possible, shows much room for operational improvement as we balance the twin goals of lowering rates and preserving the fund’s solvency,” said Insurance Commissioner John Garamendi. “I am firmly committed to working with the new board of directors to meet those goals and insure savings are passed through to California’s business community.”

CDI determined that SCIF’s underwriting practices, in at least two significant areas, hinder its ability to ensure that each eligible employer is paying the lowest premium possible or that there is not disparate treatment of policyholders in terms of the premiums and deposits paid.

Additional findings from CDI’s review include:
SCIF’s current underwriting procedures do not allow the Company to maximize employer participation in the Kaiser Alliance and Preferred Provider Network (PPN) programs and safety group programs. State Fund’s failure to communicate the availability of these programs to all policyholders and its failure to collect information to determine who is eligible for participation result in the application of rates that are unfairly discriminatory.

SCIF has not adhered to the implementation timeline IBM identified for realizing savings from the recommended reforms and, therefore, will not realize the $294 million of annual savings IBM estimated by 2005. This potential savings translates to a potential rate reduction of approximately 4 percent.

SCIF has adopted different procedures for handling direct written accounts with less than $25,000 in annual premiums. This has resulted in small accounts not receiving the same level of disclosure regarding the future costs of their workers’ compensation coverage and having these future charges calculated on the basis of less accurate information than is used for all other, larger accounts.

In reviewing SCIF’s rate structure, CDI found that SCIF should, among other things, adhere to its filed rating plan by providing credit to directly written accounts.

“As important as underwriting practices and rate structures are, true rate relief is impacted more significantly by loss reserves and claims handling,” added Garamendi. “That is why my department will supplement this report within the next 45 days with its findings on the adequacy of SCIF’s current loss reserves. I also recommend the Legislature and Governor order an operational review of SCIF that includes claims handling.”

Reserves, an insurer’s largest liability, are the dollars that an insurer expects to pay over time for claims that have already occurred. Determining the financial condition of SCIF, and therefore the extent of its ability to pass through the reform savings, is a highly complex process because workers’ compensation benefits are often paid out over many years and reserves must be adequate to pay those claims. Projections of needed reserves are difficult even in a static system, but the unprecedented scope and impact of the 2003 and 2004 reforms – and the divergent points of view experts have taken with respect to the impacts – have made the task very difficult. Further study of SCIF’s loss reserves is integral to carefully, prudently and thoroughly evaluating this issue.

In addition, IBM concluded even prior to workers’ compensation reforms that SCIF used an operating model which impaired its ability to address high cost claims in a timely manner.

SCIF has evolved from an insurer primarily for small employers to the largest provider of workers’ compensation in the United States, as measured by premiums written. Its premiums went from approximately $1 billion in 1995, the first year of open rating, to $7.8 billion for 2003 – a five-year increase of 550 percent.