RECIPROCAL OF AMERICA AND
THE RECIPROCAL GROUP
  In Receivership for Liquidation  

 

     

CLAIM COVERAGE QUESTIONS: WORKERS’ COMPENSATION BENEFITS; PRE-RECEIVERSHIP JUDGMENTS; SETTLEMENTS; AND DEFENSE COSTS

 
Question: I have a new claim. How do I go about getting medical treatment and/or getting my benefits started?
   
Answer: All claims must have been filed by the Final Bar Date, September 30, 2004, set by the State Corporation Commission of the Commonwealth of Virginia (the "Commission") in its Order Setting Final Bar Date and Granting Deputy Receiver Continuing Authority to Liquidate Companies. You may file a new claim, but the timely filed claims of all other creditors will have priority over claims received after the Final Bar Date. For further information on the Final Bar Date, see the FILING A CLAIM AND THE PROOF OF CLAIM PROCESS section of the Frequently Asked Questions.
   
Question: I have an old claim, but now require additional medical treatment or am experiencing additional disability. How do I go about getting medical treatment and/or getting my benefits started again?
   
Answer: If you have a claim that was properly reported to ROA prior to the Final Bar Date, you should notify the claims department at ROA of your desire to reopen the claim and send in any documentation you have. The ROA claims department will review your claim and determine what can be done to assist you. In many cases, the claim will be assigned to a state insurance guaranty association ("GA") for review and payment subject to applicable restrictions and conditions.
   
Question: I am receiving my workers’ compensation benefits now, but will I continue to receive them in the future?
   
Answer: If you are receiving benefits from a GA, those benefits should continue as provided for by the GA and workers’ compensation statutes of your state. If you are receiving benefits from your employer, there are several cases in litigation that could impact your future benefits. If your benefits change, you should be notified of those changes by the party taking over your claim. If you have any questions or if you have any bills that are not paid, you should contact the entity currently handling your claim for additional information.
   
Question: Prior to receivership, a judgment was entered against me regarding a claim for which ROA had accepted coverage, will ROA pay this judgment?
   
Answer: The judgment will be approved if it was properly rendered against, or agreed upon by, ROA before receivership. The payment of claims asserted by ROA's direct insureds had been discontinued until such time as such payments were made by the GAs or in accordance with the Commission's orders.  Effective January 13, 2006, the Deputy Receiver, acting under the authority granted in the Commission’s December 13, 2005, Final Order, issued his Eighth Directive Regarding Claim Payments (the "Eighth Directive"). The Eighth Directive directed ROA to make 17% partial payments to claims of ROA’s direct insureds, among others.
   
Question: If a settlement was made in a case prior to receipt of the instruction to cease payments, is that settlement to be honored and payment made?
   
Answer: If ROA agreed to a settlement, ROA is bound to the payment amount and the insured will have a claim for that amount. Payment can be made at the 17% payment percentage as directed in the Eight Directive.
   
Question: If an insured took over the defense of a claim covered by an ROA insurance policy after ROA was placed in receivership and has paid, or is paying, his or her own legal costs, will the insured be reimbursed for those costs from the receivership estate?
   
Answer: Generally, the legal costs incurred in defending a claim covered by an ROA insurance policy that provides for such defense are a benefit under the policy. You should have submitted a claim for the defense costs in accordance with the Proof of Claim process by the Final Bar Date for filing claims of September 30, 2004. (See the FILING A CLAIM AND THE PROOF OF CLAIM PROCESS section of the Frequently Asked Questions.) ROA may have forwarded your claim to a GA (and you would have been notified of that). ROA cannot provide guidance on whether or not the GA will cover your claim. If your claim for defense costs is covered by the policy but not covered by a GA, ROA will pay your claim, if approved, at the 17% payment percentage as directed in the Eighth Directive.  For further information, see the CLAIM PAYMENTS FROM THE RECEIVERSHIP ESTATE section of the Frequently Asked Questions.