New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter B - Self-insurers › Part 317 - Group Self-insurance › Section 317.4 - Application requirements for authorization of new employer groups

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Any group of
				  employers seeking initial authorization to operate as a group self-insurer in
				  accordance with subdivision (3-a) of section 50  of the Workers' Compensation
				  Law shall satisfy the qualifications set forth in section
				  317.3 
				  of this Part and shall submit an application to the chair as prescribed below.
				  This application shall contain:
(1) a current
				  payroll report filed by classification code for each participating employer of
				  the employer group for the preceding annual fiscal period. Such payroll shall
				  only include amounts paid to workers in New York State who are covered by the
				  self-insured group;
(2) a
				  description of the safety program, if any, proposed for the employer
				  group;
(3) applications for
				  participation duly executed by each employer participating in the group in a
				  form prescribed by the chair;
(4)
				  copies of the following items, certified by the group's board of trustees and
				  group administrator:
(i) the bylaws of the
				  group self-insurer which shall provide for all of the prescribed terms as set
				  forth in section
				  317.12  of this
				  Part;
(ii) a list of the names and
				  addresses of all trustees, specifically identifying voting trustees. At least
				  two-thirds of the voting trustees shall be officers, partners, members or
				  employees of group members;
(iii) a
				  list of the names and addresses of each of the officers, directors and general
				  managers of the group administrator;
(iv) a description of the group's
				  organization for the administration of claims as well as the duly executed
				  contract between the board of trustees, the group administrator and the claims
				  administrator; and
(v) any duly
				  executed contract between the board of trustees and either an attorney-at-law
				  licensed to practice in New York State or a representative of self-insured
				  employers licensed by the Workers' Compensation Board pursuant to subdivision
				  (3-b) or (3-c) of section 50  of the Workers' Compensation Law, pertaining to
				  the representation of group members before the Workers' Compensation
				  Board;
(5) with the
				  exception of groups consisting exclusively of municipal corporations:
(i) the trust agreement, with language
				  prescribed by the chair and in a form approved by the chair, which must be
				  shared with all prospective members of the group and which must be signed by
				  each of the trustees of the group;
(ii) the participation agreement, with
				  language prescribed by the chair and in a form approved by the chair, which
				  must be shared with all prospective members of the group and which must be
				  individually executed by each member of the group, and which shall include an
				  acknowledgment that the prospective member has been provided a copy of the
				  trust agreement and has reviewed that agreement, specifically the provisions
				  related to joint and several liability, the methodology utilized to determine
				  member contributions, the annual adjustment to contributions, and to membership
				  terms;
(6) documentation
				  from the group administrator consisting of:
(i) evidence of experience in the
				  administration of group insurance or group self-insurance programs or other
				  relevant experience such as that of an attorney-at-law, a certified public
				  accountant, or a qualified actuary who has experience in providing professional
				  services to such groups;
(ii) two
				  professional references associated with recent group administration services or
				  other relevant experience; and
(iii) if incorporated in New York, a
				  certificate of incorporation or, if not incorporated or incorporated in a state
				  other than New York, proof of an actual place of business in New York, within
				  the meaning of section 308  of the Civil Practice Law and Rules;
(7) a properly executed
				  application from as prescribed by the chair, whereby the group self-insurer
				  acknowledges its commitment:
(i) to pay to or
				  on behalf of injured employees and to the dependents of deceased employees all
				  compensation and medical benefits as required by the provisions of the Workers'
				  Compensation Law;
(ii) to pay
				  annually its proportionate share of the expense of administration or other
				  expenses or assessments as provided by the Workers' Compensation Law;
(iii) to pay any awards commuted pursuant to
				  section 27  of the Workers' Compensation Law into the aggregate trust fund, if
				  required by the chair;
(iv) to
				  permit the chair's authorized representatives access to the premises and to
				  audit relevant records of the group administrator, the trustees of the employer
				  group, and/or any individual member of the employer group for the purpose of
				  examining operations and records;
(v) to notify the chair, in writing, within
				  10 days of the election, resignation or removal of any member of the board of
				  trustees;
(vi) to notify the chair,
				  in writing, within 10 days of the hiring of any new independent law firm, or
				  third party administrator licensed by the Workers' Compensation Board pursuant
				  to subdivision (3-b) or (3-d) of section 50  of the Workers' Compensation Law,
				  to represent the group before the board, and to file with the chair a properly
				  executed and certified copy of the contract or service agreement;
(vii) to notify the chair, in writing, within
				  10 days of the appointment of any new group administrator and to file with the
				  chair a properly executed and certified copy of the contract or the service
				  agreement, as well as documentation from the new group administrator as
				  required by subdivision (a) of this section;
(viii) to produce full, truthful and timely
				  reports as required by the chair in section
				  317.19 
				  of this Part; and
(ix) to notify
				  the chair and all group members, in writing, within 10 days of any alteration,
				  modification or amendment to terms of the group's trust document, participation
				  agreement or bylaws;
(8)
				  with the exception of groups consisting exclusively of municipal corporations,
				  groups shall:
(i) deposit with the chair and
				  maintain securities, cash, surety bond or irrevocable letters of credit, in a
				  form and an amount as determined by the chair in accordance with section
				  317.5  of this
				  Part;
(ii) maintain excess
				  insurance as defined in section
				  317.2(f) 
				  of this Part; and
(iii) have each
				  group member execute a participation agreement as prescribed by this
				  section.