reglab/statecodes huggingface dataset:
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 317.13 - Notice regarding addition of new member to group self-insurer

Current through Register Vol. 46, No. 28, July 10, 2024
A group self-insurer shall, within 30 days of the execution
					 of a new group member's prescribed participation agreement, notify the chair on
					 a prescribed form of such new group member and filed an individual group member
					 application and a copy of the properly executed prescribed participation
					 agreement. Coverage within the group will become effective upon execution of
					 the group member application and participation agreement, except in the case of
					 a withdrawal from policy coverage governed by subdivision (a) of section 94  of
					 the Workers' Compensation Law. In the event the board subsequently rejects the
					 application, the group must file a notice of termination, in accordance with
					 section
					 317.14(a) 
					 of this Part, within 30 days after the notice of rejection.
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 317.14 - Notice regarding termination or withdrawal of member from group self-insurer

Current through Register Vol. 46, No. 28, July 10, 2024
(a) A
				  group self-insurer's termination of a member shall not be effective until at
				  least 10 days after notice of such termination, on a prescribed form, has
				  either been filed in the office of the chair or sent by certified or registered
				  letter, return receipt requested, and also served in like manner upon the
				  employer.
(b) A group member shall
				  not be eligible to withdraw from the group self-insurer and fulfill its future
				  workers' compensation obligations through alternative coverage until it shall
				  have provided the current group self-insurer with at least 30 days notice of
				  its intent to terminate participation. Notice of termination shall also be
				  provided to the chair by the group in accordance with subdivision (a) of this
				  section.
(c) If the termination or
				  withdrawal of a member causes the group self-insurer to fail to satisfy the
				  qualification requirements set forth in section
				  317.3 
				  of this Part, related to net worth of group self-insurer and combined payroll,
				  the group's board of trustees and/or group administrator shall, within 30 days
				  of the notice of withdrawal or decision to terminate, advise the chair of its
				  plan to bring the group self-insurer into compliance with the financial and
				  other requirements in a timely and appropriate manner. If the group
				  self-insurer fails to devise a plan which will bring it into compliance with
				  the financial and other requirements in a timely and appropriate manner, the
				  chair may revoke its group self insurance status.
(d) The group self-insurer shall make a good
				  faith effort to maintain records on the whereabouts of group members which have
				  been terminated or which have withdrawn from participation in the
				  group.
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 317.15 - Changes in legal status of group members

Current through Register Vol. 46, No. 28, July 10, 2024
Any group member which undergoes any changes in its legal
					 status which results in the issuance of a new taxpayer identification number or
					 unemployment insurance number shall be required to complete a new participation
					 application and shall execute a new participation agreement. A group
					 self-insurer shall, within 10 days, notify the chair in writing of any such
					 change and shall, at that time, file the new application and
					 agreement.
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 317.16 - Merger

Current through Register Vol. 46, No. 28, July 10, 2024
With the approval of the chair, two or more group
					 self-insurers may merge into one of the constituent groups. The group
					 self-insurer resulting from the merger of two or more group self-insurers shall
					 assume, in full, all liabilities and obligations of the constituent
					 groups.
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 317.17 - Solicitation of new members

Current through Register Vol. 46, No. 28, July 10, 2024
Group administrators, trustees of the group, and insurance
					 brokers and consultants shall make a good faith effort to fully disclose to
					 prospective group members both the rights and responsibilities of participating
					 in the group. No party shall make a material misrepresentation or omission of a
					 material fact in connection with the solicitation of a prospective group
					 member, or engage in any practices prohibited by section 2403  of the Insurance Law. No group shall
					 pay commissions to or otherwise engage in marketing or sales relationships with
					 insurance brokers who have had their licenses suspended or revoked by the
					 Insurance Department. The trustees of a group shall require all brokers to
					 comply with section 2120  of the Insurance
					 Law.
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 317.18 - Marketing materials

Current through Register Vol. 46, No. 28, July 10, 2024
(a) All
				  marketing materials disseminated or communicated by or on behalf of a group
				  self-insurer, group administrator or trustee of a group shall be strictly
				  factual in nature and shall be truthful and accurate in all respects, and shall
				  not contain any statements which cannot be measured or verified, or which are
				  in any way deceptive, misleading or coercive.
(b) If the chair has reasonable cause to
				  believe that any marketing materials disseminated or communicated by or on
				  behalf of a group self-insurer, group administrator or trustee of a group do
				  not conform to the requirements set forth in subdivision (a) of this section,
				  then he or she may require that all marketing materials disseminated or
				  communicated by or on behalf of such group self-insurer, group administrator or
				  trustee of the group be submitted to the chair within 30 days. The chair may
				  also direct the submission of additional information supporting such marketing
				  materials.
(c) If the chair
				  determines that submitted marketing materials do not conform to subdivision (a)
				  of this section, the chair may direct the group self-insurer, group
				  administrator or trustee of a group to:
(1)
				  immediately cease dissemination or communication of such materials;
(2) provide the chair with the names and
				  addresses of all entities to whom those materials were disseminated or
				  communicated;
(3) disseminate
				  additional information clarifying or explaining such disapproved materials;
				  or
(4) file, until otherwise
				  directed, all future marketing materials with the chair 30 days prior to their
				  dissemination or communication.
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 317.19 - Periodic reports to be submitted by group self-insurers

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Group
				  self-insurers, with the exception of groups consisting exclusively of municipal
				  corporations, shall file the following reports, evidencing proper
				  capitalization and integrity of trust funds, with the Workers' Compensation
				  Board no later than 120 days after the close of the fiscal year of the group:
(1) a financial summary report in a form
				  prescribed by the chair;
(2)
				  audited financial statements prepared in accordance with GAAP, for the
				  preceding fiscal year, certified by an independent certified public
				  accountant;
(3) an actuarial report
				  certified by an independent qualified actuary verifying claims as defined in
				  section
				  317.2(c) 
				  of this Part, and the method of calculating such claims, based upon accepted
				  actuarial standards of practice; and
(4) a payroll report filed by classification
				  code for each group member and in aggregate for the preceding 12 month period
				  and including the current total number of employers participating in the group
				  as well as the current total number of employees for each employer; such
				  payroll report should be accompanied by the final payroll audit of the group,
				  as submitted to the group's excess insurance carrier.
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 317.20 - Insolvent; assessments; termination and dissolution of the group

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Insolvent, in
				  the context of a determinati on by the Chair, or his or her designee, to levy
				  an assessment pursuant to the provi- sions of Workers' Compensation Law section
				  50(5)(g), shall mean the inability of a private group self-insurer, to pay its
				  outstanding lawful obligations under the Workers' Compensation Law as they
				  mature in the regular course of business, as may be shown by:
(1) the self-insurer being under-funded as
				  defined in Worker s' Compensation Law, section 50 (3-a); and
(2) the sum of the self-insurer's assets, as
				  defined by section
				  317.2(n) 
				  of this Part, plus the available security deposit held by the Chair pursuant to
				  Workers' Compensation Law, section 50(3-a) and section 317.5  of this Part,
				  being less than the total cost of all of the self-insure rs anticipated
				  workers' compensation liabilities, as defined by section 31 7.2(o) of this
				  Part, that will accrue within the succeeding six months.
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 317.21 - Revocation of group self-insurer status

Current through Register Vol. 46, No. 28, July 10, 2024
A group which persistently or repeatedly or in any case
					 willfully violates any provision or multiple provisions of this Part, or
					 persistently or willfully fails to comply with any requirement set forth in
					 this Part, may be subject, upon notice and an opportunity to be heard, to
					 revocation of its authorization. In the alternative, the chair may direct the
					 issuance of penalties pursuant to section
					 317.22  of
					 this Part.
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 317.22 - Penalties

Current through Register Vol. 46, No. 28, July 10, 2024
(a) A group which
				  violates any provision of this Part, or fails to comply with any requirement
				  set forth in this Part, except failure to timely submit any report required by
				  section
				  317.19 
				  of this Part, may be subject, upon notice and an opportunity to be heard, to a
				  civil penalty of up to $2,500 for each violation or instance of noncompliance,
				  payable by the group into the fund created by section 151  of the Workers'
				  Compensation Law.
(b) A group which
				  fails to timely submit any report required by section
				  317.19 
				  of this Part may be subject, upon notice and an opportunity to be heard, to a
				  civil penalty of $500 per day for each day during which it refuses or neglects
				  to submit such report, payable by the group into the fund created by section 151  of the Workers' Compensation Law.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter B - Self-insurers › Part 318 - Finance Regulations › Section 318.1 - Purpose

Current through Register Vol. 46, No. 28, July 10, 2024
The regulations contained herein are intended to support
					 the Board in fulfilling its legislative mandate to fund administrative costs
					 and special fund payments that are imposed upon and collected from all affected
					 employers provided for in the Workers' Compensation Law (WCL). In addition,
					 Chapter 57 of the Laws of 2013 authorized the Board to streamline the manner in
					 which it collects its administrative and special fund assessments to one that
					 is consistent among the various categories of remitters and is based upon
					 active coverage. The regulations contained herein support that
					 streamlining.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter B - Self-insurers › Part 318 - Finance Regulations › Section 318.2 - Assessment rate

Current through Register Vol. 46, No. 28, July 10, 2024
(a) On the
				  first day of November, 2013 and annually thereafter, the chair shall establish
				  an annual assessment rate. Such rate shall be applicable to policies effective
				  on or after January 1st of the next succeeding calendar year, unless otherwise
				  directed pursuant to section
				  318.6 
				  of this Part, and shall be applied to a base of standard premium as defined at
				  section
				  318.4 
				  of this Part. The amounts collected and remitted to the board for assessments
				  will not be considered premium.
(b)
				  The annual rate shall be available upon request and published on the board's
				  website on or before November 1st of every calendar year.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter B - Self-insurers › Part 318 - Finance Regulations › Section 318.3 - Expenses covered by rate

Current through Register Vol. 46, No. 28, July 10, 2024
The assessment rate when applied to the base of standard
					 premium as defined at section
					 318.4 
					 of this Part shall produce assessment receipts at least sufficient to:
(a) fund all expenses necessary for the board
				  to administer:
(1) the WCL;
(2) the Disability Benefits Law;
(3) the Volunteer Ambulance Workers' Benefit
				  Law;
(4) the Volunteer
				  Firefighters' Benefit Law;
(5) the
				  Workers' Compensation Act for Civil Defense Volunteers; and
(6) inter-departmental programs at the
				  Departments of Health and Labor; and
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter B - Self-insurers › Part 318 - Finance Regulations › Section 318.4 - Assessment base

Current through Register Vol. 46, No. 28, July 10, 2024
The assessment rate established by November 1st of each
					 year for the succeeding calendar year shall be applied to a base of standard
					 premium as defined below.
(a) Standard
				  premium is defined as follows:
(1) Carriers
				  and State Insurance Fund - For employers securing workers' compensation
				  coverage via a policy issued either by an authorized carrier or the State
				  Insurance Fund, standard premium shall mean the full annual value of premiums
				  for each policy written or renewed during a specific reporting period as
				  determined on forms prescribed by the chair.
(2) Private and public self-insured employers
				  - Standard written premium for self-insured employers shall be determined by
				  applying payroll by classification codes to applicable loss cost rates. Loss
				  cost rates for self-insured employers shall be furnished by the chair based, in
				  whole or in part at the discretion of the chair, upon comparable rates
				  applicable to carrier policies which may be adjusted for administrative
				  expenses. To the extent there are no corresponding class codes for one or more
				  classifications of payroll, the chair shall establish an equivalent
				  rate.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter B - Self-insurers › Part 318 - Finance Regulations › Section 318.5 - Calculation of rate

Current through Register Vol. 46, No. 28, July 10, 2024
The assessment rate shall be a percentage of standard
					 premiums and calculated as follows: Total estimated annual expenses as defined
					 in section
					 318.3  of
					 this Part divided by total estimated statewide premiums as defined in 318.4(b)
					 of this Part.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter B - Self-insurers › Part 318 - Finance Regulations › Section 318.6 - Assessment rate adjustments

Current through Register Vol. 46, No. 28, July 10, 2024
(a) If the
				  rate established for any given year results in the collection of assessments
				  which exceed the amounts described herein, the assessment rate for the next
				  calendar year shall be reduced accordingly. However, the assessment rate for
				  each calendar year shall ensure that the clearing account described in section
				  318.7 
				  of this Part maintains a balance of at least 10 percent of the annual projected
				  assessments.
(b) If it appears that
				  the rate established for any given year will not produce assessment revenue
				  sufficient to meet all estimated annual expenses as described herein, the board
				  may make adjustments to the existing published rate prior to the beginning of
				  the next calendar year. Any such mid-year rate adjustments must be published at
				  least 45 days prior to becoming effective and will apply to policies with
				  effective dates between the effective date of the adjusted rate through
				  December 31st of that calendar year or until the board issues a new rate,
				  whichever is later.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter B - Self-insurers › Part 318 - Finance Regulations › Section 318.7 - Clearing Account for Receipt of Assessments

Current through Register Vol. 46, No. 28, July 10, 2024
On an annual basis, all assessment monies received shall
					 first be deposited into a clearing account established for the purpose of
					 receiving assessments. Assessment revenue will be applied pursuant to WCL
					 §151-8 in accordance with each then applicable financing agreement prior to
					 application for any other purpose. Once any and all amounts required by
					 applicable financing agreements have been met for the year, assessments will
					 then be applied from the clearing account, at the discretion of the Chair, to
					 the administrative and special fund expenses described herein.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter B - Self-insurers › Part 318 - Finance Regulations › Section 318.8 - Remittance of assessment payments

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The assessment rate established by the
				  board shall apply to all employers required to secure compensation for their
				  employees.
(b) Until such time as
				  the board can establish a direct employer payment process, the remittance to
				  the board of all required assessments that are imposed upon and collected from
				  all affected employers shall be as follows:
(1) for those employers obtaining coverage:
(i) through a policy with the State Insurance
				  Fund;
(ii) through a policy with an
				  authorized carrier;
(iii) through a
				  county self-insurance plan under article V of the WCL; or
(iv) through a private or public group
				  self-insurer; such assessment amounts shall be collected from the employer and
				  remitted to the board by the State Insurance Fund, carrier, county plan, or
				  self-insured group. The State Insurance Fund, carrier, county plan, or
				  self-insured group shall complete the reports identified in section
				  318.9 
				  of this Part, apply the applicable assessment rate as established by the board
				  and timely remit both the report and the corresponding payment to the board on
				  the schedule set forth in subdivision (c) of this section.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter B - Self-insurers › Part 318 - Finance Regulations › Section 318.9 - Premium reports

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The
				  assessment payment remitted quarterly shall be accompanied by reports
				  prescribed by the chair. Depending upon whether the remitter is a carrier, the
				  State Insurance Fund, private or public self-insured employer, or private or
				  public group self-insured employer, these reports may contain but not be
				  limited to: written premium; total payroll; payroll by classification;
				  adjustments from prior periods; etc. Annual reports prescribed by the chair may
				  also be required.
(b) All such
				  prescribed reports will require an attestation by an authorized representative
				  that all information is true, correct and complete. A remitter that knowingly
				  makes a material misrepresentation of information related to assessments shall
				  be guilty of a Class E felony.
(c)
				  To the extent that a remitter is also required to report the information
				  requested by this section, or substantially similar values, to other
				  governmental entities including but not limited to State and Federal agencies,
				  then the information reported by the remitter to the board shall be consistent
				  with the payer's reporting to other entities. To the extent that the remitter's
				  reporting to the board is materially inconsistent with the remitter's reports
				  to other governmental entities, then the remitter shall disclose such
				  inconsistency in the reports submitted to the board and supply an explanation
				  for such inconsistency.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter B - Self-insurers › Part 318 - Finance Regulations › Section 318.10 - Failure to remit

Current through Register Vol. 46, No. 28, July 10, 2024
In the event of a carrier, the State Insurance Fund, a
					 private or public self-insured employer, or a private or public group
					 self-insured employer's failure to remit assessment payments and reports in
					 accordance with the requirements contained herein the board may undertake any
					 or all of the following collection activities with respect to the
					 assessments:
(a) refer the matter to
				  the Office of the Attorney General for commencement of a collection
				  action;
(b) withhold any and all
				  payments to the carrier, the State Insurance Fund, private or public
				  self-insured employer or private or public group self-insured employer
				  including but not limited to special fund reimbursements, until such time as
				  all assessments have been paid in full;
(c) the failure of a private or public
				  self-insured employer or private or public group self-insured employer to
				  timely remit assessments and required reports shall constitute good cause for
				  the board to revoke said self-insurers self-insured status.
In the event that a carrier, the State Insurance Fund, a
					 private or public self-insured employer, or a private or public group
					 self-insured employer has underpaid an assessment as the result of inaccurate
					 reporting, such remitter shall pay all overdue assessments in full within 30
					 days of notification by the board and may be subject to interest at a rate of
					 nine percent annually on the unpaid amount. Further, in the event that it is
					 determined that the remitter knew or should have known that the reported
					 information was inaccurate an additional penalty of up to 20 percent of the
					 unpaid amount may be imposed by the board against such carrier, the State
					 Insurance Fund, private or public self-insured employers.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter B - Self-insurers › Part 318 - Finance Regulations › Section 318.11 - Rate Modification Report

Current through Register Vol. 46, No. 28, July 10, 2024
On an annual basis in conjunction with the publication of
					 the assessment rate on or before November 1st, the Board will prepare a report
					 which supports the assessment rate established for policies effective in the
					 succeeding calendar year. Such report shall also be prepared in the event an
					 assessment rate modification is required pursuant to Section
					 318.6.
					 Such report will include a summary of the projections or estimates made in the
					 development of the assessment rate including the expenses covered by the rate
					 and underlying assessment base.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter B - Self-insurers › Part 318 - Finance Regulations › Section 318.12 - Audit

Current through Register Vol. 46, No. 28, July 10, 2024
The Chair may conduct periodic audits on employers,
					 self-insurers, carriers and the State Insurance Fund concerning any information
					 or payment related to assessments.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter B - Self-insurers › Part 319 - Transportation Network Companies › Section 319.1 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The terms
				  "transportation network company" or "TNC", "TNC driver", "TNC vehicle", "TNC
				  passenger", and "TNC prearranged trip" shall have the same meaning as set forth
				  in section 1691 of article forty-four-B of the vehicle and traffic
				  law.
(b) "Board" means the New York
				  State Workers' Compensation Board.
(c) "Permitted" shall mean that the TNC
				  driver is the holder of a valid TNC driver's permit, which has been issued
				  pursuant to article 44-B of the vehicle and traffic law.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter B - Self-insurers › Part 319 - Transportation Network Companies › Section 319.2 - Exclusivity of TNC Services

Current through Register Vol. 46, No. 28, July 10, 2024
For the purposes of the administration of article 6-F of
					 the executive law, a TNC driver shall mean a TNC driver who is engaged in a TNC
					 prearranged trip, or who otherwise meets the definition of a TNC driver as set
					 forth in article 44-B and Part 319.3(a)(2) of this title, and who at the time
					 of injury was not also acting as :
(a)
				  a black car operator, as defined in paragraph 1 of section 160-cc  of the
				  executive law, who (1) may operate anywhere in the state of New York and (2)
				  accepts passengers through means other than a TNC digital network;
(b) an independent livery operator, who
				  satisfies the eligibility criteria set forth in paragraphc of section
				  309.2 of
				  title 12 of the New York codes, rules, and regulations, and (1) accepts
				  passengers from a central dispatch facility other than one that is a member of
				  the New York Black Car Operators' Injury Compensation Fund, Inc., as defined in
				  article 6-F of the executive law, and (2) operates in the five boroughs of the
				  city of New York or Westchester or Nassau counties;
(c) a medallion cab or a borough taxi
				  operator, regulated pursuant to section 148-a  of the vehicle and traffic law and
				  section 19-50 2 of the administrative code of the city of New York;
(d) a livery driver, who (1) is not a member
				  of the Independent Livery Drivers Benefit Fund, the New York Black Car
				  Operators' Injury Compensation Fund, Inc., or a medallion cab or borough taxi
				  operator, and (2) accepts passengers through means other than a TNC digital
				  network; or
(e) a for-hire vehicle
				  operator, as defined in section 19-502 of the administrative code of the city
				  of New York and regulated by the New York city taxi and limousine commission,
				  who accepts passengers within the city of New York (New York, Kings, Queens,
				  Bronx and Richmond counties).
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter B - Self-insurers › Part 319 - Transportation Network Companies › Section 319.3 - Scope of Coverage

Current through Register Vol. 46, No. 28, July 10, 2024
(a) For
				  purposes of the administration of article 6-F of the Executive Law, a "Black
				  car operator" shall include:
(1) any TNC
				  driver that is engaged in a TNC prearranged trip and
(2) any TNC driver that is logged onto a TNC
				  digital network and is not engaged in a TNC prearranged trip, provided:
(i) the TNC driver was permitted by the TNC
				  on or before 11:59 PM of June 29, 2018, in accordance with criteria set forth
				  in section 1696 of article forty-four-B of the vehicle and traffic law;
				  and
(ii) at the time of the event
				  giving rise to a claim for benefits from the New York Black Car Operators'
				  Injury Compensation Fund, the TNC driver was engaged in an activity reasonably
				  related to driving as a TNC driver taking into consideration the time, place
				  and manner of such activity.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter B - Self-insurers › Part 320 - New York Jockey Injury Compensation Fund, Inc › Section 320.1 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
(a) "Fund" means
				  the New York Jockey Injury Compensation Fund, Inc.
(b) "Board" means the New York State Workers'
				  Compensation Board.
(c) "Chair"
				  means the chairperson of the New York State Workers' Compensation
				  Board.
(d) "Self-insure" and
				  "self-insurance" shall have the same meaning as set forth under section 50  of
				  the workers' compensation law.
(e)
				  "Employees of licensed trainers or owners" shall have the same meaning as
				  subdivision twenty-four of section 2  of the workers' compensation
				  law.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter B - Self-insurers › Part 320 - New York Jockey Injury Compensation Fund, Inc › Section 320.2 - Application to Self-Insure

Current through Register Vol. 46, No. 28, July 10, 2024
(a) In
				  order for the Fund to self-insure pursuant to subdivision three of section 50 
				  of the workers' compensation law and paragraph b of subdivision six of section
				  221 of the racing, pari-mutuel wagering and breeding law, the Fund shall
				  furnish satisfactory proof to the chair of its financial ability to pay
				  workers' compensation. Such proof shall consist of a notice of intent to
				  self-insure and satisfactory proof of the financial ability to
				  self-insure.
(b) Satisfactory proof
				  of the financial ability to self-insure shall consist of the following:
(1) the posting of a security deposit with
				  the Board, as determined and calculated by the Board using full annual payroll
				  by class code; and (2) proof of excess insurance coverage in an amount
				  determined by the Board.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter B - Self-insurers › Part 320 - New York Jockey Injury Compensation Fund, Inc › Section 320.3 - Annual Coverage and Assessments

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Upon
				  approval to self-insure by both the chair of the Board and the gaming
				  commission, on the date established pursuant to paragraph f of Part 320.2 of
				  this Subchapter, the Fund shall remit to the Board the assessment established
				  by the chair pursuant to section 151  of the workers' compensation law, in the
				  manner consistent with subdivision five of section 151  of the workers'
				  compensation law, and the assessment established by the chair and the
				  department of audit and control pursuant to paragraph (c) of subdivision five
				  of section 50  of the workers' compensation law, in the manner set forth in
				  paragraph (e) of subdivision five of section 50  of the workers' compensation
				  law.
(b) Annually, no later than
				  April first of each fiscal year, and for the duration that the Fund elects to
				  self-insure, the Fund shall submit to the board all financial statements,
				  payroll information, and workers' compensation claims to continue its status as
				  a self-insurer pursuant to subdivision 3 of section 50  of the workers'
				  compensation law.
(c) Annually,
				  based upon the financial information submitted, the Chair shall reassess the
				  Fund's proof of the financial ability to self-insure. Upon completion of such
				  review, the Chair may adjust the required security. If additional security is
				  required to be posted, the Fund shall submit such amounts within 90 days of
				  notification. In the event that such additional security is not posted, the
				  chair may determine that the proof of financial ability to pay workers
				  compensation is insufficient for good cause shown, and the Fund 's
				  self-insurance status may be terminated.
(d) Any owner or trainer that is licensed
				  under article two or four of the racing, pari-mutuel wagering and breeding law
				  and that is a member of the Fund shall not charge any jockey, apprentice
				  jockey, or exercise person for any portion of the cost of joining and/or being
				  a member of the Fund. In the event the Fund elects, with the approval of the
				  gaming commission, to secure workers' compensation insurance for employees of
				  licensed trainers or owners, owners and licensed trainers that are members of
				  the Fund shall not charge said employees for any portion of the cost of joining
				  and/or being a member of the Fund.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter B - Self-insurers › Part 320 - New York Jockey Injury Compensation Fund, Inc › Section 320.4 - Reserve

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Following
				  approval to self-insure by the chair and the gaming commission, the Fund shall
				  establish a self-insurance reserve to provide coverage in the event that the
				  Fund is deficient. The board of directors of the Fund shall establish an annual
				  fee to be paid by owners and licensed trainers that are members of the Fund for
				  the purposes of contributing to the reserve. The reserve shall be established
				  no later than 60 days following the approval to self-insure by both the chair
				  and the gaming commission, on that date set forth pursuant to paragraph f of
				  Part 320.2 of this Subchapter. At the time of establishment and annually
				  thereafter, the Fund shall provide the Board with detailed information
				  concerning the reserve. Such information shall include the financial
				  institution holding the reserve as well as account information, the account
				  balance, and any deposits to and debits from such reserve in the preceding
				  year.
(b) The Fund may at any time
				  in its discretion expend moneys in such reserve to pay any liability of the
				  plan.
(c) In the event the Fund no
				  longer self-insures, all moneys remaining in such reserve in excess of an
				  amount sufficient to satisfy all accrued and contingent liabilities, shall be
				  refunded to the owners and licensed trainers that are members of the Fund in
				  such manner as may be established by the board of directors of the
				  Fund.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 323 - Medical Provider Authorization › Section 323.2 - Designating contacts for the portal

Current through Register Vol. 46, No. 28, July 10, 2024
As more fully set forth in section
					 324.3,
					 section
					 324.4,
					 section
					 325-1.4 
					 and section 442.4 of Title 12 NYCRR, insurance carriers, self-insured
					 employers, or third-party administrators must provide the Chair or his or her
					 designee in the manner prescribed by the Chair with the name and contact
					 information for the point(s) of contact for a prior authorization request (PAR)
					 on or before May 1, 2021.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 323 - Medical Provider Authorization › Section 323.3 - Effective dates and notice for the Formulary

Current through Register Vol. 46, No. 28, July 10, 2024
For purposes of section
					 441.3(f)
					 of Title 12 NYCRR, the insurance carrier, self-insured employer or third-party
					 administrator shall identify all claimants with current prescriptions for
					 Non-Formulary drugs and provide written notification in the format prescribed
					 by the Chair to the claimant and to the prescribing medical provider after the
					 effective date of this regulation and on or before May 1,
					 2021.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 324 - Medical Treatment Guidelines › Section 324.1 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
For purposes of this Subchapter:
(a) The definitions of the terms in section
				  300.1(a) 
				  of this Title are applicable to this Subchapter.
(b)
Calendar day
means the time
				  period from midnight to midnight. For the purposes of calculating calendar
				  days, the day of submission is day zero and the first calendar day begins at
				  midnight following the submission.
(c)
Carrier's Physician
means a
				  physician or physicians, licensed by New York State, or the appropriate state
				  where the professional practices, who is:
1.
				  employed or contracted by the insurance carrier, self-insured employer, or
				  third-party administrator; or
2.
				  employed by a URAC accredited company retained by the insurance carrier,
				  self-insured employer, or third-party administrator through a contract to
				  review prior authorization requests and advise the insurance carrier,
				  self-insured employer, or third-party administrator; and
3. is not employed or contracted by the
				  carrier, self-insured employer, or third-party administrator's recommendation
				  of care network.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 324 - Medical Treatment Guidelines › Section 324.4 - PARs confirming consistency with MTG or medical necessity when no MTG

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Every insurance
				  carrier, self-insured employer and third-party administrator shall designate a
				  qualified employee or employees as a point of contact for the Board and
				  Treating Medical Providers regarding PARs to confirm consistency with the
				  Medical Treatment Guidelines or medical necessity. Insurance carriers,
				  self-insured employers and third-party administrators shall provide the Chair
				  or his or her designee in the manner prescribed by the Chair with the name and
				  contact information for the point(s) of contact for PARs to confirm consistency
				  with the Medical Treatment Guidelines (PAR: MTG Confirmation) or review for
				  medical necessity (PAR: Non-MTG $1,000 or Under).
Such contact information may include the contacts' direct
					 telephone number(s) and email address(es).
1. If the designated point(s) of contact
				  changes at any time for any reason, the insurance carrier, self-insured
				  employer or third-party administrator shall notify the Chair or his or her
				  designee of such change in the manner prescribed by the Chair.
2. The list of designated points of contact
				  for each insurance carrier, self-insured employer and third-party administrator
				  shall be maintained by the Board electronically. When a treating medical
				  provider submits a PAR electronically, it shall be directed to the appropriate
				  contact person. Any change in the designated contact shall not be effective
				  until the designated contact information has been updated in the Board's
				  electronic records.
3. In the event
				  that an insurance carrier, self-insured employer or third-party administrator
				  fails to so provide the Chair or his or her designee with such name and contact
				  information (in the manner prescribed), or provides incorrect or incomplete
				  contact information during initial registration or when updating pursuant to
				  subparagraph (1) of this subdivision, such insurance carrier, self-insured
				  employer or third-party administrator may be subject to:
i. Orders of the Chair granting any PAR
				  submitted during such time when the name and contact information is missing,
				  incomplete or incorrect; and
ii.
				  Penalties issued pursuant to section 114-a (3)  of the Workers' Compensation Law
				  for every case, where a PAR was requested.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 324 - Medical Treatment Guidelines › Section 324.5 - Conditions, treatments, or diagnostic tests not addressed by medical treatment guidelines

Current through Register Vol. 46, No. 28, July 10, 2024
If the medical treatment guidelines do not address a
					 condition, treatment or diagnostic test for a part of the body covered by the
					 medical treatment guidelines, then the factors in section
					 324.3(a)(3) 
					 of this Part and relevant medical literature as described in section
					 324.3(a)(4) 
					 of this Part shall be used to determine whether the insurance carrier or
					 special fund shall be obligated or not obligated to pay for the medical care at
					 issue.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 324 - Medical Treatment Guidelines › Section 324.6 - Incorporation into policies, procedures and practices

Current through Register Vol. 46, No. 28, July 10, 2024
Insurance carriers and special funds shall incorporate the
					 medical treatment guidelines set forth in section
					 324.2(a)
					 and (b)  and the provisions in sections
					 324.3(b),
					 324.4(a),
					 and
					 324.5 
					 of this Part, and section
					 325-1.25 
					 of this Title into their policies, procedures, and practices so that their
					 utilization review and management criteria are consistent with the medical
					 treatment guidelines. Insurance carriers and special funds shall have certified
					 to the chair within 120 days of the effective date of this Part that they have
					 done so and shall re-certify to the incorporation of the medical treatment
					 guidelines and the regulatory provisions cited in the previous sentence within
					 60 days of any changes to their policies, procedures, and practices. The chair
					 and Insurance Department will conduct audits of insurance carriers and special
					 funds with respect to the accuracy of the certifications. Each insurance
					 carrier shall submit the policies and procedures incorporating the medical
					 treatment guidelines incorporated by reference in section
					 324.2(a)
					 and (b)  of this Part and the provisions in
					 sections
					 324.3(b),
					 324.4(a),
					 and
					 324.5 
					 of this Part, and section
					 325-1.25 
					 of this Title to the chair or Insurance Department in connection with such
					 audit.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 325 - Medical And Surgical Care And Treatment › Subpart 325-1 - General › Section 325-1.1 - Application for compensation medical bureau license required

Current through Register Vol. 46, No. 28, July 10, 2024
When a physician, in association or in copartnership with
						another physician or physicians, or through another physician or physicians as
						employees or agents, maintains and operates one or more offices principally for
						the treatment of injured claimants under the Workers' Compensation Law, he or
						she shall apply for a compensation medical bureau license.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 325 - Medical And Surgical Care And Treatment › Subpart 325-1 - General › Section 325-1.2 - Reports of specialists

Current through Register Vol. 46, No. 28, July 10, 2024
All specialists and consultants, except independent
						medical examiners, shall file the reports prescribed for attending physicians
						under section
						325-1.3 
						of this Subpart with the board, claimant, the claimant's attending physician,
						the claimant's legal representative, if any, and the employer or insurance
						carrier.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 325 - Medical And Surgical Care And Treatment › Subpart 325-1 - General › Section 325-1.3 - Reports of treating providers

Current through Register Vol. 46, No. 28, July 10, 2024
In order to expedite the processing of claims and to
						avoid, so far as possible, the appearance of providers in contested bill
						proceedings, the rules with respect to filing of medical reports by treating
						providers are here stated:
(a) All
					 medical reports filed by treating providers and specialists must be submitted
					 to the insurance carrier, self-insured employer, or third-party administrator
					 and the Board in the format prescribed by the Chair, which may be
					 electronic.
(b) Every provider
					 shall file all medical reports with the Chair, and also with the employer or
					 the employer's carrier, if known, in the format prescribed by the Chair, which
					 may be electronic, in the following intervals:
(1) within 48 hours following first
					 treatment;
(2) within 15 days after
					 filing the medical report filed within 48 hours after the first
					 treatment;
(3) thereafter during
					 continuing treatment and without further request, a progress report for each
					 follow-up visit to be scheduled when medically necessary except the intervals
					 between follow-up visits shall be no more than 90 days;
(4) when a claimant reaches the maximum
					 medical improvement, which must include an opinion whether there is any
					 permanent impairment, if any;
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 325 - Medical And Surgical Care And Treatment › Subpart 325-1 - General › Section 325-1.5 - Choice of specialist

Current through Register Vol. 46, No. 28, July 10, 2024
The authority of an employer or carrier to authorize the
						services of a specialist in excess of a fee of $1,000 applies only to the
						necessity for such services, but the choice of such specialist is entirely the
						choice of the injured worker, unless the employer or carrier has a contract
						with a diagnostic testing network or networks, requires an injured worker to
						utilize a provider or facility affiliated with such diagnostic testing network
						or networks and has furnished the notification required by section
						325-7.5(d) 
						of this Part.