General claims related questions when an insolvency occurs.

Nothing in the following frequently asked questions (FAQs) and answers alters the statutory and case law definitions of covered claims for which CIGA is responsible. The actual terms of the applicable statutes, other controlling laws, and legal opinions prevail over the information provided on this web site. These FAQs and answers are not intended to provide legal advice.

When does CIGA become responsible for handling the claim of an insolvent insurance company?
CIGA is triggered when a Member Insurer admitted to transact business in California is found by a court of competent jurisdiction to be insolvent and ordered into liquidation.
I have legal expenses incurred prior to the insolvency, what should I do?
Legal expenses incurred prior to the insolvency date should be directed to the liquidator of the insolvent Member Insurer. CIGA can only consider legal expenses if incurred after the insolvency.
If I receive notice of a new claim or I am served with a lawsuit, what should I do?
If you have insurance coverage for the new claim or lawsuit with an insolvent insurer, you should immediately contact CIGA and send a copy of the claim and/or lawsuit to our office. In addition, most liquidators require that they also be notified of any new claim or lawsuit.
Do I have to file my claim again with CIGA if it is already filed with my insurance company?
If your claim appears in the insurer's records, CIGA will have notice of your claim and there is no need to file it again.

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Will someone from CIGA contact me about my claim?
CIGA will endeavor to contact each person who had an open claim on file with the insolvent insurer. Additionally, most liquidators attempt to contact all known claimants and policyholders notifying them of the process for filing a claim in the liquidation proceeding.
As soon as possible after receiving the claim files from the company receiver (referred to as a liquidator in some states), CIGA will mail out letters detailing a person's rights under the Guarantee Act and let that person know who will be handling his or her claim. If you do not hear from CIGA within a month from the date the company was declared insolvent, please contact CIGA at your convenience. However, bear in mind that CIGA will be unable to provide specific information about your claim or to make payments until CIGA has received your claim from the insurer.
Will my benefits be delayed?
Some delays may occur since CIGA must obtain the claim files from the insolvent insurer and then have time to review those claims. CIGA makes every effort to quickly identify and expedite the handling of all claims.
Is there a deadline to file a claim?
Claims for statutory workers' compensation benefits do not have a deadline for filing a claim with CIGA. However, the claim must have been timely filed in accordance with the procedures of the California Workers' Compensation Act.
For all other types of claims, the deadline is the last date fixed for filing a Proof of Claim with the receiver/liquidator. Even if you have an open claim, you should file a claim with the liquidator prior to that date. If you have already filed a claim with the insurer prior to its insolvency, CIGA considers your claim to have been filed prior to the deadline.
Who is handling my claim or what should I do if my Third Party Administrator can't help me?
Contact CIGA at 818-844-4300.
My insurance company is bankrupt but I paid an insurance policy premium for future coverage. Can I receive a refund?
To determine if you are eligble for an "unearned premium refund", please have the following information available when you contact CIGA Premium Research at 818-844-4300 Ext. 166; the name of your insolvent insurance company, your policy number, and your dates of insurance coverage.

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For web links to other sites related to insurance guarantee association business, click this link CIGA Links.

Specific information related to liability, auto, and property claims.

The California Insurance Guarantee Association (also known as "CIGA" ) was created under California law to provide a limited fund for the payment of some, but not all, Liability, Auto, and Property claims made by or against a California resident, or property permanently located within California, which are within the coverage of policies issued by California admitted insurers that have been declared insolvent and ordered into liquidation by a California court or court in the state in which the insurer is domiciled. CIGA is authorized to pay and discharge only certain "covered claims" as that term is defined under California Insurance Code Sections §1063.1 and §1063.2 subject to additional statutory and case law limitations. The "covered claims" that CIGA is authorized may be more limited and/or restricted than the coverage that would have been afforded under the policy issued by the insolvent and liquidated insurer. To qualify as a "covered claim" for CIGA, the claim must satisfy all the requirements set forth in California Insurance Code Sections §1063.1 and §1063.2, including the requirement that the claim must be presented to the Liquidator in this state, if any, or CIGA on or before the last date fixed for the filing of claims in the domiciliary liquidation proceeding.

Where your insurer has been declared insolvent and liquidated, and you have a new claim under your own property policy, or a liability claim or suit has been made against you that you believe would be covered under your Auto or Liability policy, you should immediately contact the Liquidator for your insurer utilizing the Liquidated Insurance Companies link so that you may protect your rights in the liquidation proceeding by providing the Liquidator immediate notice of the claim or loss and filing any requisite Liquidator mandated claims form. Please note that the Liquidator's acceptance or allowance of your claim in the liquidation proceeding does not mean that your claim qualifies as a "covered claim" or has been accepted by CIGA. In addition, you should promptly notify CIGA of such claims, loss, or demand, by mailing CIGA notice of such loss, including copies of any and all claim documents, claim records, policy information, or legal papers delivered or served upon you concerning, referring to or mentioning the particular Auto, Liability, or Property claim. Send such notice of claim to CIGA at:

California Insurance Guarantee Association
P.O. Box 29066
Glendale, CA 91209-9066

In the alternative, you may notify CIGA by submitting sufficient information, to include policy and claim related documentation, as email attachments, to the email address: newliabilityloss@caiga.org.

Specific information related to workers' compensation claims.

The California Insurance Guarantee Association (also known as "CIGA") was created under California law to provide a limited fund for the payment of some, but not all, workers' compensation claims of injured workers within the coverage of policies issued by California admitted insurers that have been declared insolvent and ordered into liquidation by a California court or a court in the state in which the insurer is domiciled. CIGA is authorized to pay and discharge only certain "covered claims" as that term is defined under California Insurance Code Sections §1063.1 and §1063.2. The "covered claims" that CIGA is authorized to pay may be more limited and/or restricted than the coverage that would have been afforded under the policy issued by the insolvent and liquidated insurer. To qualify as a "covered claim" for CIGA, the claim must satisfy all the requirements set forth in California Insurance Code Sections §1063.1 and §1063.2, including the requirements that the claim must be presented to the Liquidator in this state, if any, or to CIGA on or before the last date fixed for the filing of claims in the domiciliary liquidation proceeding.

CIGA claim professionals are uniquely trained and qualified in administering workers' compensation benefits in accordance with CIGA's statutory obligations in conjunction with its third party administrators. CIGA is dedicated to providing quality medical care through its Medical Provider Network (MPN) and Pharmacy Program. Understanding the inconvenience and often hardship resulting from an insurer's liquidation, CIGA strives to provide timely and appropriate benefits to injured workers.

Additionally, CIGA's claim staff is trained in identifying suspected workers' compensation fraud and through its Special Investigation Unit (SIU) partner reports cases of suspected fraud to the California Department of Insurance Fraud Division and district attorneys throughout the State of California.

If you are an injured worker and your claim appears in the insurer's records, CIGA will have notice of your claim and there is no need to file it again. Some delays may occur since CIGA must obtain the claims files from the Liquidator of the insolvent insurer and then have time to review those claims. CIGA makes every effort to quickly identify and expedite the handling of all claims. CIGA will endeavor to contact each injured worker with an open claim on file with the insolvent insurer as soon as possible by mailing out letters detailing the injured worker's rights under the Guarantee Act and let that person know who will be handling his or her claim. If you do not hear from CIGA within a month from the date the company was liquidated, please contact CIGA at your convenience. However, CIGA will be unable to provide specific information about your claim or to make any payments until CIGA has received your claim from the Liquidator.

If you are an employer with insurance coverage for the claim or lawsuit with an insolvent insurer, you should immediately contact CIGA and send a copy of the claim and/or lawsuit to our office at the address listed below. In addition, most Liquidators require that they also be notified of any new claim or lawsuit. Please note that the claims for statutory workers' compensation benefits do not have a deadline for filing a claim with CIGA. However, the claim must have been timely filed in accordance with the procedures of the California Workers' Compensation Act.

California Insurance Guarantee Association
P.O. Box 29066
Glendale, CA 91209-9066

In the alternative, you may notifiy CIGA by submitting sufficient information, including policy and claim related documentation as email attachments to:

newworkcompclaim@caiga.org

Specific information related to CIGA's MPN.

The purpose of a California MPN is to provide injured workers with covered claims prompt access to a network of medical providers who understand Workers' Compensation rules and regulations.

1. The CIGA Anthem Medical Provider Network (MPN), #3118, was approved by the California Division of Workers' Compensation pursuant to Title 8, California Code of Regulations, Labor Code Sections §9767 et seq and §4616 et seq, as a new customized MPN effective as of November 1, 2018.

2. The CIGA Anthem MPN Employee Notification is posted on this website. For English (click here) or in Spanish (click here)

3. How to seek treatment:

• For emergency services, the injured worker may call 911 or go to the nearest emergency room.
• For non-emergency services, the injured worker may contact their MPN Contact or use an MPN Medical Access Assistant as outlined below.

4. To search for a Medical Provider, please go to the CIGA Anthem MPN "Provider Finder" website available 24 hours a day at: www2.viiad.com/CIGA No password is required.

5. To find a MPN Pharmacy, please go to the CIGA Anthem MPN "Optum"website available 24 hours a day at: http://www.helioscomp.com/resources/pharmacy-locator No password is required.

6. MPN Contact: Every Injured Worker with a covered workers' compensation claim has a CIGA MPN Contact, who is their assigned CIGA Claims Adjuster. The MPN Contact will be able to answer questions about the use of the MPN and setting an appointment with a provider and to address MPN complaints. If you do not have MPN Contact information, then call the CIGA toll- free number: (800) 847-9459 between 8:00am to 5:00pm (Pacific Standard Time) and ask the CIGA Operator for assistance to find the WC Claims Adjuster. If needed, CIGA's FAX Number is: (818) 291-1863.

7. MPN Medical Access Assistance is available to help Injured Workers find available MPN physicians and assist with scheduling appointments Monday through Saturday from 7am-8pm (Pacific Standard Time). Assistance is available in English and in Spanish. Other language interpretation services are also available. The contact information for Medical Access Assistance is: Toll Free Telephone Number: 844-699-8803 Fax Number: 855-619-5711 Email Address: CIGAMAA@anthemwc.com


8. Medical Providers: Providers that are interested in joining the CIGA Anthem MPN may download the Provider Nomination Form and submit via email to Anthem as instructed on the form.

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(Note: CIGA's prior MPN was the "CIGA MPN" #0508 in effect from 9/16/2005 and terminated on 10/31/2018.)
(Note: For general information about CIGA's MPN, you may contact CIGA's MPN Manager by email at: MPNManager@caiga.org

For Medical Providers interested in billing electronically

CIGA has partnered with WorkCompEDI as its eBilling Clearing House Service Provider. For Medical Providers interesting in submitting billing electronically, please contact:

Work Comp EDI
info@workcompedi.com
www.workcompedi.com
(800) 297-6909

To determine if an insurance company is licensed by the State of California Department of Insurance

To find information about an insurance company's location, former names of the company, agent for service of process, and reference information such as license status, company type, state of domicile, lines of insurance the company is authorized to transact, and compliant history, click this link Insurance Company Profiles.

To research liquidated insurance companies domiciled in California and nationwide.

To find information about an insurance company's location, former names of the company, agent for service of process, and reference information such as license status, company type, state of domicile, lines of insurance the company was authorized to transact, and compliant history, click one of the following links:

Insurance companies domiciled in the State of California

Insurance companies domiciled outside the State of California

Current Request for Proposals

The California Insurance Guarantee Association (CIGA) has issued its Request for Proposal (RFP) to obtain competitive bids from qualified Workers Compensation Pharmacy Benefit Managers (PBM). For those interested and qualified parties, please note that all final RFP responses must be received by CIGA using the email address of cigarfp@caiga.org. no later 9/6/2019 at 5:00pm, PST.

Attached is a copy of the PBM RFP document in WORD and PDF formats. Direct responses to the questions can be incorporated directly into the word document.

Also attached are 2 supplemental documents to be completed and returned to Susan Feit, CIGA Medical Programs Manager, at cigarfp@caiga.org. no later than 8/16/2019 at 5:00pm, PST:

• 1. The CIGA Indication of Intent to Participate Form, to indicate the appropriate choice.
• 2. The CIGA Nondisclosure Agreement (NDA), which is an unalterable standard form for signature.

Schedule of key due dates:
Indication of Intent to Participate and CIGA Nondisclosure Agreement Due: August 16, 2019
Bidder Clarification Questions Due: August 30, 2019
Bidder Withdrawal of Proposal Due: September 5, 2019
Bidder Proposal Due: September 6, 2019
CIGA evaluation and oral presentations to be completed by October 25, 2019
Award of Contract issued in November 2019
Start of Contract: To be determined

NOTE: All communication must be emailed to a CIGA-designated email address: cigarfp@caiga.org.