Risk-Sharing Pools

Liability Protection

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The California JPIA provides liability coverage that offers members two program options: the primary liability program and the excess liability program. Coverage in both programs includes bodily injury, personal injury, or property damage to a third party resulting from a member activity, including automobile liability. Employment practices liability is also a covered exposure. Claims for these programs are managed through a collaborative process with member communication and consultation. The California JPIA uses a third-party administrator to investigate and respond to all claims.

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The California JPIA provides liability coverage that offers members two program options: the primary liability program and the excess liability program. Coverage in both programs includes bodily injury, personal injury, or property damage to a third party resulting from a member activity, including automobile liability. Employment practices liability is also a covered exposure. Claims for these programs are managed through a collaborative process with member communication and consultation. The California JPIA uses a third-party administrator to investigate and respond to all claims.

Report a Third-Party Liability Claim

Primary Liability Program

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CJPIA-Primary-Liability-Program-Graphs-2018-Q3v1

Excess Liability Program

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CJPIA-Excess-Liability-Program-Graphs-2018-Q3v1-D1v1

 

Primary Liability Program

The primary liability program provides first-dollar coverage with no deductibles or member-retained limits. The program offers $50 million of coverage per occurrence and is funded at the 70% – 80% confidence level. Although claims are managed through a collaborative process, the Authority retains ultimate settlement authority. The program is funded by annual contributions that represent an “all-inclusive” charge that covers the pool’s retained layer, excess and reinsurance premiums, claims administration fees, operating expenses, and most training and risk management program expenses.

 

Excess Liability Program

The excess liability program provides for optional member-retained limits of $150k, $250k, $500k, $750k, or $1 million. This program has a coverage limit of $50 million per occurrence, and is funded at the 70% – 80% confidence level. Members retain settlement authority over claims within their layer, except for certain defined claim types that have catastrophic potential. Members use the Authority’s designated claims administrator and their own trust account for claim payments. In the excess liability program, members retain the right to select defense counsel from the Authority’s pre-approved panel. The program is funded by annual contributions from members that cover the pooled layer of losses, operating expenses, and most training and risk management program expenses. Member-retained losses and claims administration costs are paid directly by the members.

For both programs, the California JPIA handles claims from inception to closing through a partnership with Carl Warren & Company. Members need not worry about the details of handling claims, thereby allowing agency staff and resources to instead focus on risk management and preventing the occurrence of claims in the first place.

Claim Delegation

There are two options for the handling of liability claims filed against members. These options, explained below, allow a member to either delegate the claims handling responsibility to a staff member, or delegate the entire process to the Authority, which eliminates the need for the agency’s legislative body to take action or send letters to claimants.

Typical Claim Delegation Procedure

Under a non-delegated claims process, claims are presented to the clerk of the member agency. Carl Warren & Company then reviews each claim for its merits and contacts the member with a requested action based upon the review’s findings. When the determination is made that the claim should be rejected, there are two courses of action, depending upon the claim and prior actions of the legislative body:

  1. The legislative body of the member agency can take no action. The claim will then be deemed rejected by course of law 45 days after it was first presented to the clerk. Under this scenario, the time period in which a lawsuit may be filed is two years from the date of the occurrence; or
  2. The legislative body may choose to reject the claim at a public meeting and then send written notice of the rejection. Under this scenario, the time period in which a claimant may file a lawsuit is reduced to six months following the rejection.

Option 1: Staff Member Claims Delegation

As an alternative to the above non-delegated claims procedure, the legislative body may, by resolution, delegate the claims handling responsibility to a member of staff. That staff member then rejects the claim, shortening the time period in which to file a lawsuit to six months.

Option 2: Full Claims Delegation

A second option allows further streamlining of the process, whereby the legislative body may, by resolution, delegate the claims handling responsibility, in its entirety, to the Authority. This action allows the Authority, through Carl Warren & Company, to send notice of the rejection and shortens the time period in which to file a lawsuit to six months.

If your agency would like to utilize either of these two options, please see the information in the documents section of this page. The response form and certified copy of the adopted resolution must be mailed or emailed to the attention of Edith Aviña at the California JPIA.

Reporting a Claim

Any third-party wishing to make a claim against a member must complete a claim. Never express opinions regarding, cause, fault or liability. Once a claim form has been filed, your agency needs to submit the information.

Report a Claim

If you would like to send your claim directly to Carl Warren, please submit to: publicentityclaims@carlwarren.com

Carl Warren & Company
P.O. Box 25180
Santa Ana, CA 92799-5180

Workers’ Compensation

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The California JPIA provides workers’ compensation coverage that offers members two options: the primary workers’ compensation program and the excess workers’ compensation program. Coverage in both programs includes benefits to employees who are injured or become ill as a result of work-related activities. Benefits include medical treatment, indemnity payments, and other statutory requirements. All employers must provide workers’ compensation protection for their employees.

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The California JPIA provides workers’ compensation coverage that offers members two options: the primary workers’ compensation program and the excess workers’ compensation program. Coverage in both programs includes benefits to employees who are injured or become ill as a result of work-related activities. Benefits include medical treatment, indemnity payments, and other statutory requirements. All employers must provide workers’ compensation protection for their employees.

Claims for these programs are managed through a collaborative process with member communication and consultation.

Primary Workers’ Compensation Program

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Program details

Primary Workers' Compensation Program Graphs

Excess Workers’ Compensation Program

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Program details

Excess Workers' Compensation Program Graphs

 

Primary Workers’ Compensation Program

The primary workers’ compensation program provides first-dollar coverage with no deductibles or member-retained limits. The program offers coverage up to statutory limits and is funded at a confidence level of 70%-80%. Several cost containment programs are in place to reduce the severity of claims and expedite the return of employees to work. These include nurse triage of injuries, a medical provider network, pharmacy management, and a return-to-work program customized for each member and injured worker. The program is funded by annual contributions that represent all costs for the pool’s retained layer, excess and reinsurance premiums, claims administration fees, operating expenses, and most training and risk management program expenses. The day-to-day handling of claims is managed by a third-party administrator with Authority oversight, thereby allowing member staff to focus more on loss control, risk management, and prevention of claims.

Excess Workers’ Compensation Program

The excess workers’ compensation allows members to choose from retained limits of $150k, $250k, $500k, $750k, or $1 million with a pooled retention of $2 million. The program has statutory coverage limits and is funded at a confidence level of 75%-85%. Members of the excess workers’ compensation program have full access to the Authority’s innovative risk management and training programs, have a dedicated claims management team, and utilize defense counsel from the Authority’s pre-approved panel of attorneys. The program is funded by members’ annual contributions that cover the pooled layer of losses, operating expenses, and most training and risk management program expenses. Members are responsible for self-owned trust accounts for member-retained claim payments and California state assessments.

Reporting a Claim

All claims must be reported online at www.sedgwick.com. For username and password assistance, contact Jeff Rush, Workers’ Compensation Program Manager. All written correspondence, including doctor’s reports or disability slips, wage statements, witness statements, and other correspondence must be sent to:

Sedgwick
1612 W. Olive Avenue
Burbank, CA 91506
www.sedgwick.com