The Administrative hearings unit reviews all contested cases, including appeals from disciplinary actions taken by the Commissioner, approval of proposed mergers and acquisitions, and the review of Small Pharmacy Reimbursement Appeals Initial Orders.
Any person or business entity who is harmed by an order, decision, action or proposed action of the Insurance Commissioner can file a demand for a hearing.
The Office of the Insurance Commissioner (OIC) doesn’t handle unemployment insurance or industrial insurance claims (also known as workers’ compensation). We also do not hear cases involving these types of actions.
In Washington state, the Employment Security Department handles unemployment benefits, and the Washington State Department of Labor & Industries handles workers’ compensation claims.
Hearings process
All administrative hearings conducted by OIC are held by Zoom or MS Teams and are recorded. Any requests for in person hearings must be made in writing, agreed to by the other party(s) and approved by the OIC Presiding Officer. The meetings are also open to the public, which means there may be observers in the virtual hearing. Hearings notices are posted at least seven (7) days in advance of the hearing.
A presiding officer hears and decides challenges to the commissioner's actions and 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 the Office of Administrative Hearings (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, along with the initial order and enters a final order. The final order can be appealed to the superior court.
The Unit is governed by the following Statutes and Regulations —
- RCW 48 is the State Insurance Code adopted by the State Legislature
- RCW 48.04 is the portion of the State Insurance Code which governs Hearings and Appeals
- WAC 284 contains additional regulations governing the business of insurance promulgated by the Insurance Commissioner
- RCW 34.05 is the State’s Administrative Procedure Act
- WAC 10-08 contains the model rules of procedures followed for administrative hearings
- RCW 42.56 is the Public Records Act governing disclosure of documents retained by the Hearings Unit and provides for limited exemptions from disclosure.
- RCW 34.05.542 provides more information on filing a petition for review.