Insurance: securing liability for compensation
| Author | David L. Pollak/Roger A. Tolman, Jr./Monika R. Reyes |
| Pages | 721-792 |
INSURANCE
13-1
CHAPTER 13
INSURANCE:
Securing Liability for Compensation
I. GENERAL DISCUSSION
§13:01 Constitutional Basis
§13:02 Compulsory Requirements for Securing Liability
§13:03 Private Employer Options
§13:04 Public Employers
§13:05 Determining Coverage; Internet Resources;
Special Requirements for Building Contractors and Common Carriers
§13:06 Reinsurance and Excess Coverage
II. STATE COMPENSATION INSURANCE FUND
§13:20 Origins and Purpose
§13:21 Self-Sufficient Operation
§13:22 Public Insurance Carrier
§13:23 Competitive With the Private Sector
§13:24 Manager; Broad Authority of Board of Directors
§13:25 Fund Retains Public Character
§13:26 Proposed Sale of SCIF Assets
III. SELFINSURANCE
§13:30 Introduction: Office of Self-Insurance Plans (OSIP)
§13:31 Mandatory Self-Insurance Plans
§13:32 Uninsured Employer Applications
§13:33 Revocation of Certificate
§13:34 Self-Insured User Funding
§13:35 Audits
§13:36 Annual Report
§13:37 Third-Party Administrators
§13:38 Self-Insurers’ Security Fund (SISF)
§13:39 Payment and Reimbursement of Self-Insurer’s Obligations by SISF
§13:40 Employer’s Right to Cease Self-Insurance
§13:41 Employee Leasing Companies Excluded From Self-Insurance
IV. INSURANCE “RIGHTS AND PRIVILEGES”
§13:50 Employee Contribution to Premium Prohibited
§13:51 Credit for Pension, Sick Pay
§13:52 Effect of Collateral Recovery
§13:53 Insurer as Party Defendant
§13:54 Employer’s First Report of Injury
INSURANCE
California Workers’ Compensation 13-2
V. SANCTIONS FOR NONCOMPLIANCE
§13:60 Stop Orders
§13:61 Investigation of Employer Status
§13:62 Penalty Assessments
§13:63 Appeal, Contest and/or Protest Procedures
§13:64 Injunctive Relief
VI. OTHER SANCTIONS FOR NONCOMPLIANCE: CRIMES, PENALTIES & CIVIL SUITS
§13:70 Criminal Liability; Loss of Contractor’s License
§13:71 Increased Compensation: 10% “Penalty”
§13:72 Attorney’s Fee Award
§13:73 Initiation of Civil Suit
§13:74 Attachment to Secure Compensation Recovery
VII. UNINSURED EMPLOYERS BENEFITS TRUST FUND (FORMERLY UNINSURED EMPLOYERS FUND)
A. General Points
§13:80 Background
§13:81 Proceedings; Special Conference Calendar for Uninsured Applicants
§13:82 Joinder of UEBTF; When Required; Representation
§13:83 Effect of Bankruptcy of Uninsured Employer
§13:84 Reimbursement of UEBTF by Statutory Legal Proceedings Against Uninsured Employers
§13:85 Obligation to Repay UEBTF May Be Discharged in Bankruptcy
§13:86 Checklist for UEBTF Joinder Petitions
B. Joinder of UEBTF
§13:89 Introduction
§13:90 Identifying Employers
§13:91 Tools to Assist in Identifying the Correct Name of an Employer
C. Evidence of No Workers’ Compensation Coverage
§13:92 Determining Coverage
§13:93 Job-Site Injuries — Further Joinder
D. Service of Process on Uninsured Employers
1. General Points
§13:100 No Ser vice — No F&A
§13:101 Ser vice of Board Process
2. Board “Summons”
§13:110 Necessity for Summons-Type Notice
§13:111 “Special Notice of Lawsuit”
§13:112 Summons/OSC Precursor to “Special Notice”
3. Manner and Proof of Service
§13:120 Manner and Proof of Service
§13:121 Personal Service — Individual
§13:122 Corporations; Claims Against Defunct Corporations
§13:123 Substituted Service on Person in Charge at Place of Business
§13:124 Substituted Service on Person in Charge — Member of Household, at Office, Business or Dwelling
§13:125 By Acknowledgment
§13:126 Out-of-State Defendant
§13:127 As Directed by Court
§13:128 By Publication
E. Proceedings After Service
§13:140 Appearing Defendants
§13:141 Defaulting Defendants
F. Payment by Fund
§13:150 Demand on Fund; Award Must Name Employer Only and not UEBTF
§13:151 No Penalties
§13:152 Enforcement Against UEBTF by Writ of Mandate
§13:153 Cf. Collection of Penalties by UEBTF
§13:154 Emergency Advances
INSURANCE
13-3 Insurance: Securing Liability for Compensation
§13:155 C&R and Stipulations; Employer Objections
§13:156 UEBTF Repor t of Job Classification Data to Legislature
§13:157 Immigration Status Not a Bar to UEBTF Benefits
G. Certificates of Lien Against Uninsured Employers — Property Liens
§13:170 Judgment Lien of Record With County Recorder
§13:171 Prima Facie Insurance
§13:172 Notice to Employer
§13:173 Appeal by Employer to WCAB
§13:174 “ Wrong Name” Petition
H. Liens, Suits Against Substantial Shareholders or Corporate “Parents”
§13:180 Corporate Veil Pierced
§13:181 Substantial Shareholder = 15% Ownership
§13:182 Lien Upon DIR Finding
§13:183 Claims Unit Chief ’s Finding and Protest Thereof
§13:184 Appeal to Director
§13:185 Judicial Review: Superior Court Writ of Mandate
§13:186 Cancellation of UEBTF Liens
I. DIR Civil Actions Against Uninsured Employer
§13:200 F&A = Liquidated Damages, Civil Judgment
§13:201 Execution by Non-Judicial Foreclosure
J. Subrogation Rights of UEBTF
§13:210 Direct Actions vs. Third Parties
§13:211 Right to Credit for Employee Third-Party Recovery
§13:212 UEBTF Notice and Lien Rights in Employee Third-Party Actions
VIII. INSURANCE COVERAGE; CIGA; JOINDER OF SOLVENT CARRIERS
A. Coverage by Solvent Carriers
§13:220 Background: Mandatory Arbitration
§13:221 Civil Declaratory Relief
§13:222 Proof of Coverage/Non-Coverage
§13:223 Oral Binders
§13:224 Designation of Principal
§13:225 Estoppel to Deny Coverage
§13:226 No Retroactive Coverage
B. CIGA Coverage; Issues Affecting CIGA Liability
§13:227 CIGA — Benefit Payments on Behalf of Insolvent Carriers
§13:228 CIGA’s Limited Liability — Liens; Temp Agency Cases; Assignees
§13:229 CIGA Liabilit y and CIGA Dismissal in Cumulative Trauma Cases
§13:230 Self-Insurance, Bonds and Excess Coverage in CIGA Cases
§13:231 CIGA Not Liable Where There Is Shared Liability for Benefits
§13:232 Credit for Third-Party Recoveries in CIGA Cases
§13:233 CIGA’s Liability for Penalties, Sanctions, Interest, and Costs
§13:234 Contribution and Reimbursement Proceedings in CIGA Cases
§13:235 Administration of Award by CIGA; Are Solvent Carrier’s Administration Agreements Binding on CIGA?
C. Joinder and Dismissal of Carriers Based on Coverage
§13:236 Petitions for Joinder and Dismissal
IX. TERMS OF COVERAGE
§13:240 Required Clauses: Choice of Law; Special Requirements for Homeowners’ Policies
§13:241 Limitations on Coverage
§13:242 Exclusions of Family Members — Ins. Com. Opinion
§13:243 Limiting Employees and Other Limiting Endorsements
§13:244 Limiting Location and Operations Covered
§13:245 Other Limitations: Officers/Owners; Disputed Occupations or Activities;
Payroll Service and Employee Leasing Companies
§13:246 Ambiguities
§13:247 Reformation and Estoppel
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