STATE COMPENSATION INSURANCE FUND CLAIMS - 8492

(Renumbered: 04/2021)

(Revised and renumbered from 8780 and 8780.1)

 

The State Compensation Insurance Fund (State Fund) is a self-supporting, non-profit enterprise that provides workers’ compensation insurance to California employers.  It will pay all claims for medical expenses and compensation benefits in the first instance. Legally uninsured agencies/departments (all agencies/departments not covered by workers' compensation insurance policies) will be billed for the benefits paid plus a charge for administrative services of State Fund. The latter charges are allowed under a master agreement for all legally uninsured agencies/departments negotiated by the California Department of Human Resources (CalHR) and State Fund.  These bills are payable by legally uninsured agencies/departments from the fund or funds from which the injured or deceased employee's salary or wages were payable at the time of injury or death. In case of agencies/departments operating under plans of financial adjustment, "fund or funds" above means the fund or funds from which the employee's salary or wages were ultimately payable, as adjusted through the plan of financial adjustment.

The master agreement mentioned above also provides that each legally uninsured agency/department place a deposit with State Fund. The service fees for agencies/departments will be billed in twelve (12) equal monthly installments for its percentage of the total service fee. A deposit into the working capital account for agencies/departments, except the California Department of Corrections and Rehabilitation (CDCR) and Department of Developmental Services (DDS), will be a contribution amount equal to 9.6 percent of the annual benefit cost during the preceding July through June 30th. The contribution for CDCR and DDS will be equal to 16.7 percent. Deposits of an agencies/department's estimated annual cost, will be used by State Fund to pay claims as they arise. It is important these deposits, as well as the normal semi-monthly billings, be paid immediately.

If an agency/s/department’s contribution to the working capital account is not enough to cover the actual monthly benefit billing charges in June, State Fund will provide the State Controller’s Office (SCO) the file to debit each agency’s/department’s appropriation for the additional expenditures and to credit State Fund’s operating revenue. If the agency’s/department’s contribution is in excess of the actual charges for June, the remaining balance will be used to offset any other benefit billing charges incurred during the same fiscal year. If the agency’s/department’s contribution is in excess of the actual charges during the same fiscal year. If the agency’s/department’s contributions is in excess of the actual charges during the same fiscal year, the SCO will return the excess contribution.

PAYMENT AND AUDIT

 

The State Fund will bill agencies/departments twice a month (on the 15^th and 30^th or 31^st). Agencies/departments must use the correct agency payroll code on the State Fund Form e3067. The invoices submitted to agencies/departments will also include the agency payroll code. This code will assist in distributing the Workers' Compensation charges among the agency’s/department’s subunits as needed.

It is imperative that Workers' Compensation invoices be paid immediately. Any amount outstanding after 35 calendar days from the date of State Fund’s transmission to the State Controller’s Office (SCO) is subject to an interest charge. All invoices for reimbursement of expenditures on claims will be billed and paid electronically through the SCO. At the same time, State Fund will provide each agency/department with an itemized invoice which shows the expenditures for which reimbursement is claimed. Discrepancies will be reported promptly to State Fund, and they will make the necessary adjustments on subsequent invoices. State Fund will notify the CalHR monthly of any payments that remain unpaid.