Garamendi Challenges Calif. WC Firms

By Daniel Hays

Increased competition and pressure from California's insurance commissioner will probably erode profits in the state's workers' compensation insurance sector, a leading research firm warned last week.

The forecast from Bank of America Securities Equity Research followed Commissioner John Garamendi's remarks that he will investigate carriers' handling of workers' comp claims at a May 19 hearing. In light of that competition and pressure from Mr. Garamendi, “California workers' comp insurance is likely to become less attractive and profitability will likely erode,” the analysts wrote.

Groups representing employees have been complaining that a new disability schedule improperly reduces benefits. (See related story on page 32.)

Mr. Garamendi said he had listened to complaints from across the state that injured workers were losing benefits even as insurers were reaping large profits in the wake of legislative reforms. He said employers large and small told him that they have not seen the reduction in premiums that reform savings would lead one to expect.

Mr. Garamendi said this leads him to ask whether injured workers are receiving the benefits they are entitled to, whether they are being unjustly denied treatment, and why insurers aren't sharing savings from reforms with employers?

The amount of carrier premium that goes to pay for injured worker treatment and benefits, measured by their loss ratio, has dropped to 45 percent of the premium dollar, noted Mr. Garamendi. He promised that if claims are not handled properly under the new laws, “we will take action to ensure that the guidelines are adhered to more closely.”

A representative for the commissioner, Norman D. Williams, said Mr. Garamendi could invoke Insurance Code Section 90.3, which regulates the state's market conduct bureau and covers a range of prohibited acts, such as misrepresenting terms of a policy by “telling people they don't have rights to benefits when they do.”

Mr. Garamendi also promised to look into why workers' comp premium amounts rose 11 percent while the cost of claims fell 15 percent. He said he would also investigate the State Compensation Insurance Fund–the state-owned entity that insures 50 percent of the market–to see if it is passing on savings properly.

Banc of America said that SCIF had a 95.7 combined ratio last year and is a major competitor to the private sector.