Any person or entity (business, organization, corporation, etc.) who is harmed by an order, decision, action or proposed action of the insurance commissioner can challenge the order, decision, action or proposed action by filing a demand for hearing.
Administrative hearings include both contested case hearings (including appeals from disciplinary actions taken by the commissioner) and other types of hearings, such as approval of proposed mergers, which are required by law.
Hearings of the Office of Insurance Commissioner (OIC) are governed by:
Hearings are conducted according to:
- RCW 34.05.410 through 34.05.598 (leg.wa.gov) (Administrative Procedure Act)
- Chapter 10-08 WAC (leg.wa.gov) (Model Rules)
For further information see statutes and rules governing OIC hearings.
What happens after I file a demand for hearing?
The Administrative Hearings unit will mail an acknowledgment that your demand has been received and filed and schedule a telephonic prehearing conference. However, if the case impacts the status of a license, your demand will be referred to the Office of Administrative Hearings (OAH) (www.oah.wa.gov) for a hearing.
If the demand is filed prior to the effective date of the commissioner's order or action, the order or action will be automatically stayed; that is, it will not go into effect pending the final outcome of the case.
Who will hear and decide my case?
A presiding officer hears and decides: (1) challenges to the commissioner's actions and (2) applications that require a hearing by statute. The presiding officer is an attorney experienced in the applicable laws, has no prior knowledge of the case and conducts the proceedings according to stringent rules to ensure fairness to all parties.
For cases referred to OAH, an OAH administrative law judge schedules a prehearing conference, presides over an evidentiary hearing and then issues an initial order. The initial order and the hearing file are then returned to the Administrative Hearings unit. The OIC presiding officer reviews the entire hearing file and initial order and enters a final order.
What happens at the prehearing conference?
The prehearing conference is normally held by telephone and lasts between 15 to 30 minutes.
Participants in the conference include: (1) you and/or your representative, (2) a person appearing on behalf of the insurance commissioner, and (3) the presiding officer.
Topics for discussion include: (1) procedures to be followed before, during and after the hearing, (2) issues or concerns that may arise while preparing for the hearing, (3) setting deadlines for filing any motions and lists of witnesses and evidence to be presented at the hearing, and (4) scheduling the hearing date, with an effort to accommodate the needs of all parties. No final decisions will be made during the prehearing conference.
Additional prehearing conferences may be requested as issues or concerns arise in preparation for the hearing.
What can I expect at the hearing?
An administrative hearing is similar to a court trial, although less formal. The goal is for the presiding officer to be presented with all pertinent information in order to make the best decision. The presiding officer will answer any questions you may have.
Each party presents an opening statement summarizing the nature of the case and what they intend to prove.
Each party presents evidence, which normally includes documents and testimony. Witnesses give their testimony under oath and are subject to cross-examination by the other party. You may be a witness for yourself, and sometimes you may be the only witness.
The hearing concludes with each party presenting their closing arguments summarizing what they believe the evidence has shown. Sometimes the presiding officer will ask the parties to present additional written arguments or evidence following a hearing.
When will I get a decision?
The presiding officer issues a written decision within 90 days of receiving all the evidence and closing the hearing. The decision includes findings of fact, conclusions of law and a final order.
The decision may: (1) uphold the original action of the commissioner; (2) modify the action of the commissioner; or (3) set aside the original action of the commissioner. In the case of an application that requires a hearing, the decision will approve or disapprove the application.
The decision of the presiding officer may be reviewed by a superior court if a party files a petition for review within 30 days of the final decision being mailed.
- Read (RCW 34.05.542 (leg.wa.gov) for more information on filing a petition for review.
Can you check the status of my unemployment insurance claim or workers' compensation claim?
The OIC doesn’t handle unemployment insurance or industrial insurance claims (also known as workers’ compensation). We are unable to check the status of these claims for you.
In Washington state, the Employment Security Department (esd.wa.gov) handles unemployment benefits, and the Washington State Department of Labor & Industries (lni.wa.gov) handles workers’ compensation claims. You can contact these respective agencies to check the status of these types of claims.