reglab/statecodes huggingface dataset:
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 1 - Regulations Under Disability Benefits Law › Part 357 - Wages › Section 357.2 - Wages paid

Current through Register Vol. 46, No. 28, July 10, 2024
Employee and employer contributions shall be computed and
						determination of employee benefit rights shall be established on the basis of
						wages paid to employees. The term wages paid includes amounts actually paid.
						Amounts not actually paid shall be deemed paid:
(a) as of the day when the amount thereof
					 both has been calculated and has become due, as determined by the established
					 and customary payroll practices of the employer;
(b) wages paid pursuant to an order of a
					 competent tribunal, or an agreement between an employer and his employees or
					 their respective representatives following negotiations or a dispute or
					 disagreement with respect to the amount or the liability for wages shall be
					 deemed paid, as of the date the amount thereof both has been calculated and has
					 become due.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 1 - Regulations Under Disability Benefits Law › Part 358 - Plans › Subpart 358-1 - Existing Plans › Section 358-1.1 - Plans which were in existence april 13, 1949

Current through Register Vol. 46, No. 28, July 10, 2024
A plan which was in existence on April 13, 1949, and
						  which continues in existence on July 1, 1950, is an existing plan and may be
						  accepted by the chairman as complying with the obligation of the employer to
						  provide disability benefits for the employees, or for the class or classes of
						  employees entitled to benefits under the plan, provided:
(a) the employer was on April 13, 1949,
						obligated not to discontinue the provisions of the plan or his contribution
						toward its cost, during some period of time after July 1, 1950; the period for
						which the plan may be accepted shall be limited to the period during which the
						employer is so obligated; or
(b) if
						the plan is one under which the employer is not obligated, as of April 13,
						1949, to continue the provisions of the plan or his contribution towards its
						cost during some period after July 1, 1950, the plan either:
(1) has been found by the chairman to meet
						the requirements of section
						358-3.1 
						of this Part and the employer has, prior to July 1, 1950, entered into the
						required agreements and otherwise complied with section
						358-3.4;
						the period for which such a plan may be accepted shall be limited to the period
						provided in subdivision (c) of section
						358-3.4;
						or
(2) has been agreed to by an
						association of employees or through collective bargaining and the employer has,
						prior to July 1, 1950, entered into the required agreements and otherwise
						complied with section
						358-3.4;
						the period for which such a plan may be accepted shall be the term of the plan
						as so agreed.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 1 - Regulations Under Disability Benefits Law › Part 358 - Plans › Subpart 358-1 - Existing Plans › Section 358-1.2 - Existing plans which are extended or modified

Current through Register Vol. 46, No. 28, July 10, 2024
(a) By agreement with an association of
						employees or by collective bargaining. An existing plan may, after April 13,
						1949, be extended with or without modification, or modified with or without
						extension, by agreement with an association of employees or through collective
						bargaining and as so extended or modified the plan, during the period of such
						extension or modification, may continue to be accepted as complying with the
						obligation of the employer under section 211  of the Workers' Compensation Law.
						If such extension or modification is not effective prior to the expiration of
						the period during which the employer is obligated not to discontinue the plan
						or his contribution to its cost, the employer shall be required to make
						provision of benefits between the expiration of such period and the day when
						the agreement of extension or modification is made and becomes effective; but
						when so extended or modified, the plan may continue to be accepted as complying
						with the obligation of the employer under section 211  during the period of such
						extension or modification.
(b)
						Other than by agreement with an association of employees or by collective
						bargaining. An existing plan that, after April 13, 1949, is extended by an
						employer with or without modification, or modified with or without extension,
						other than by agreement with an association of employees or through collective
						bargaining, may be continued as an existing plan and may be accepted as
						complying with the obligation of the employer under section 211  of the Workers'
						Compensation Law during the period of such extension or modification only if
						the plan, as so extended or modified, is found by the chairman to meet the
						requirements of section
						358-3.1 
						of this Part.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 1 - Regulations Under Disability Benefits Law › Part 358 - Plans › Subpart 358-1 - Existing Plans › Section 358-1.3 - Successor employers

Current through Register Vol. 46, No. 28, July 10, 2024
An existing plan shall be deemed continued and may be
						  accepted as the plan of an employer who, after April 13, 1949, has acquired all
						  or substantially all. or an identifiable portion, of the assets or employment,
						  and assumed liabilities, including liabilities under the plan, of an employer
						  who immediately preceding such acquisition had an acceptable existing
						  plan.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 1 - Regulations Under Disability Benefits Law › Part 358 - Plans › Subpart 358-2 - New Plans › Section 358-2.1 - Plans which were not in existence april 13, 1949

Current through Register Vol. 46, No. 28, July 10, 2024
Any plan which was not in existence on April 13, 1949,
						  but which is in existence on or after July 1, 1950, is a new plan and, if the
						  benefits provided meet the requirements of section
						  358-3.1 
						  of this Part, may be accepted by the chairman under section 211  of the Workers'
						  Compensation Law provided:
(a) the
						benefits are to be provided under the plan for a fixed term; the acceptable
						period of such a plan shall be such term; or
(b) the employer has filed with the chairman
						the required agreements and otherwise complied with section
						358-3.4 
						of this Part; the acceptable period of such a plan shall be limited to the
						period provided in section
						358-3.4(c) 
						of this Part.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 1 - Regulations Under Disability Benefits Law › Part 358 - Plans › Subpart 358-3 - Regulations Applying Both To Existing And New Plans › Section 358-3.1 - Benefits "at least as favorable" construed

Current through Register Vol. 46, No. 28, July 10, 2024
(a) On or after May 1, 1989 and prior to July
						1, 1989:
(1) Benefits under any plan within
						the provisions of sections
						358-1.1(b)(1),
						358-1.2(b)
						 and
						358-2.1 
						of this Part may, in aggregate, be deemed to be "at least as favorable,"
						provided:
(i) the aggregate benefits for each
						employee, including cash benefits and other benefits directly related to
						disability, are equivalent to or greater than the disability benefits under
						section 204  of the Workers' Compensation Law; and
(ii) the cash disability benefits meet the
						minimum requirements under paragraph (2) of this subdivision.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 1 - Regulations Under Disability Benefits Law › Part 358 - Plans › Subpart 358-3 - Regulations Applying Both To Existing And New Plans › Section 358-3.2 - Employees not covered under a plan

Current through Register Vol. 46, No. 28, July 10, 2024
If an employee who is eligible for benefits under
						  section 204  of the Workers' Compensation Law is not eligible for benefits under
						  the plan for any of the following reasons:
(a) the eligibility or probationary period
						under the plan is no longer than that provided by law;
(b) there is an eligibility or probationary
						period under the plan for employees who are entitled by law to immediate
						coverage;
(c) the plan does not
						provide for payment of benefits for disability occurring after termination of
						employment, to the extent provided by law; or
(d) the employee is not of the class or any
						of the classes of employees entitled to benefits under the plan; then, and in
						any one or more of the foregoing circumstances, the employer shall be required
						to provide for the payment of benefits to such employee in one or more of the
						ways set forth in section 211  of the Workers' Compensation Law. The employer
						may, however, modify the plan so as to extend the plan benefits for the
						statutory periods referred to in subdivisions (a), (b) and (c) of this section,
						and such extension shall not be deemed a material modification.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 1 - Regulations Under Disability Benefits Law › Part 358 - Plans › Subpart 358-3 - Regulations Applying Both To Existing And New Plans › Section 358-3.3 - Benefits less favorable with respect to certain employees eligible under a plan

Current through Register Vol. 46, No. 28, July 10, 2024
If the benefits under a plan, other than a plan under
						  subdivision (a) or paragraph (2) of subdivision (b) of section
						  358-1.1 
						  of this Part, do not meet the requirements of section
						  358-3.1 
						  of this Subpart as to any class of employees eligible for such benefits, but do
						  meet such requirements as to another class or other classes of employees, the
						  plan may be accepted under section 211  of the Workers' Compensation Law with
						  respect to the class or classes of employees as to whom the benefits provided
						  do meet the requirements of section
						  358-3.1 
						  of this Subpart. The employer may provide statutory benefits for the class or
						  classes of employees for whom the plan benefits do not meet the requirements of
						  section
						  358-3.1 
						  of this Subpart, or may supplement the plan benefits by another plan, in order
						  that the benefits provided for all employees entitled to benefits under the
						  plan shall meet the requirements of section 358- 3.1 of this
						  Subpart.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 1 - Regulations Under Disability Benefits Law › Part 358 - Plans › Subpart 358-3 - Regulations Applying Both To Existing And New Plans › Section 358-3.4 - Procedure for obtaining acceptance of plans under subdivisions 4 and 5 of section 211 of the workers' compensation law

Current through Register Vol. 46, No. 28, July 10, 2024
An employer who has an existing plan or a new plan, and
						  who desires to be permitted to provide benefits thereunder in lieu of the
						  statutory benefits for a class or classes of employees, may apply in writing to
						  the chairman to have the plan accepted. The employer shall, as a part of such
						  application, and in form prescribed by the chairman, file with the
						  chairman:
(a) a statement setting
						forth the provisions of the plan and, if required by the chairman, a copy of
						the plan;
(b) a written agreement
						with the chairman, providing that the employer, or in his behalf the carrier,
						will pay all assessments to the special fund under section 214  of the Workers'
						Compensation Law and all assessments for expenses of administration under
						section 228;
(c) a written
						agreement, satisfactory to the chairman, if the plan is one that under
						subdivision (b) of section
						358-1.1,
						subdivision (b) of section
						358-1.2 
						or section
						358-2.1 
						requires such agreement, that the benefits under the plan will be continued
						with respect to all employees included under the plan for disabilities
						occurring prior to the date the employer files with the chairman written notice
						of termination of the plan;
(d)
						evidence satisfactory to the chairman that the obligation to pay benefits under
						the plan has been insured and is kept insured, either with a stock or mutual
						corporation or reciprocal insurer duly authorized to transact the business of
						accident and health insurance in this State, or with the State Fund, or proof
						satisfactory to the chairman of financial ability to pay such benefits and
						otherwise complying with subdivision 3 of section 211.
Such application shall be duly verified before a notary
						  public.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 1 - Regulations Under Disability Benefits Law › Part 358 - Plans › Subpart 358-3 - Regulations Applying Both To Existing And New Plans › Section 358-3.5 - Substitution of new carrier under a plan

Current through Register Vol. 46, No. 28, July 10, 2024
If the agreement filed with the chairman under
						  subdivision (b) of section 358- 3.4 of this Subpart is the agreement of a
						  carrier and not of the employer, acceptance of the plan shall terminate
						  forthwith whenever the carrier's obligation to pay benefits shall terminate,
						  unless prior thereto an acceptable new carrier, assuming fully the obligations
						  of the employer under the plan, has duly filed with the chairman notice thereof
						  and has filed also the agreements with the chairman required under section
						  358-3.4.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 1 - Regulations Under Disability Benefits Law › Part 358 - Plans › Subpart 358-3 - Regulations Applying Both To Existing And New Plans › Section 358-3.6 - Default in payment of assessments

Current through Register Vol. 46, No. 28, July 10, 2024
If the agreement filed with the chairman under
						  subdivision (b) of section 358- 3.4 of this Subpart is the agreement of an
						  employer, or of an association of employers or an association of employees
						  authorized to pay benefits, or a trustee or trustees under a plan paying
						  benefits, the acceptance of the plan shall terminate forthwith on default,
						  after notice, in any payment required to be made to the chairman in accordance
						  with section 213, 214 or 228  of the Workers' Compensation
						  Law.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 1 - Regulations Under Disability Benefits Law › Part 358 - Plans › Subpart 358-3 - Regulations Applying Both To Existing And New Plans › Section 358-3.7 - Notices and reports required with respect to plans

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Whenever a plan accepted by the chairman
						shall thereafter be modified or extended, written notice of such modification
						or extension, in form approved by the chairman, shall be filed forthwith with
						the chairman; and except as to modifications which are not material
						modifications, and except for the extension of a new plan without material
						modification for a fixed period of time specified in the agreement or
						extension, no such modification shall be effective until it has been accepted
						by the chairman and no such extension shall be effective until notice of
						extension has been filed with the chairman.
(b) A material modification of a plan shall
						be effective on acceptance by the chairman; and, without limitation, any
						modification which reduces the class or classes of employees to which the plan
						is applicable or the rate of weekly benefits or the period during which
						benefits are payable, or which increases the waiting period of the contribution
						of employees to the cost of benefits, shall be deemed a material
						modification.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 1 - Regulations Under Disability Benefits Law › Part 358 - Plans › Subpart 358-3 - Regulations Applying Both To Existing And New Plans › Section 358-3.8 - Accepted plans

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The
						chairman shall give to the carrier, and if the carrier is not the employer or
						association of employers or association of employees by whom the application
						for acceptance was filed, then also to the applicant, written notice that the
						plan is accepted as satisfying the obligation of the employer or employers to
						provide for the payment of benefits, or that it is not accepted. From and after
						the effective date of notice of acceptance, the provision for benefits and
						employee contributions under such plan shall be effective for the employees, or
						the class or classes of employees, entitled to benefits under the plan, in lieu
						of the provision for benefits under section 204  of the Workers' Compensation
						Law and for employee contributions under section 209.
(b) In the event a self-insured employer,
						association of employers, or association of employees subject to an accepted
						plan fail to pay benefits after being found liable under section 221  of the
						Workers' Compensation Law, the board shall draw on the security deposit
						required by section
						361.3 
						of this Title to pay benefits at the rate provided for in section 204  of the
						Workers' Compensation Law.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 1 - Regulations Under Disability Benefits Law › Part 358 - Plans › Subpart 358-3 - Regulations Applying Both To Existing And New Plans › Section 358-3.9 - Review of denial of application for plan acceptance

Current through Register Vol. 46, No. 28, July 10, 2024
(a) When an application for acceptance of a
						plan has been denied on the ground that the benefits under the plan do not meet
						the requirements of section 358- 3.1 of this Subpart, the applicant, within 15
						days after notice of such denial has been given, may apply in writing to the
						chairman for review. In support of his application for review, and as a part of
						such application, the applicant shall submit a memorandum of the facts on the
						basis of which he contends that the benefits provided under the plan are,
						notwithstanding the requirements of section
						358-3.1,
						at least as favorable as the disability benefits under section 204  of the
						Workers' Compensation Law.
(b) The
						chairman, or an officer or employee of the board designated by the chairman for
						that purpose, shall review the application and plan, and the chairman may
						direct that a hearing be held for the taking of evidence and for such other
						consideration as the proofs warrant.
(c) Upon such review, the chairman, or the
						officer or employee designated by the chairman, may make a variation from the
						provisions of section
						358-3.1 
						of this Subpart, provided such variation reflects the general intent and
						purpose of section 211 and is in the interest of justice.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 1 - Regulations Under Disability Benefits Law › Part 359 - Employees Who Are Eligible For Benefits Provided By Their Employers › Section 359.1 - Disabilities on or after july 1, 1950

Current through Register Vol. 46, No. 28, July 10, 2024
Employees are entitled to benefits under the law only for
						disabilities that occur on and after July 1, 1950.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 1 - Regulations Under Disability Benefits Law › Part 359 - Employees Who Are Eligible For Benefits Provided By Their Employers › Section 359.2 - Employees who acquire eligibility during employment

Current through Register Vol. 46, No. 28, July 10, 2024
(a) An employee of a covered employer is
					 eligible for disability benefits to be provided by his employer for
					 disabilities that occur during his employment with such employer and during the
					 first four weeks after his employment with the covered employer terminates,
					 provided the employee has been either:
(1) in
					 employment, as defined in section
					 355.3  of
					 this Title, of one or more covered employers for at least four consecutive
					 workweeks immediately preceding disability or such termination of employment;
					 or
(2) in employment during the
					 work period usual to and available during such four consecutive weeks in any
					 trade or business in which he is regularly employed and in which hiring from
					 day to day of such employees is the usual employment practice; or
(3) in regular employment of a single
					 employer on a work schedule less than the employer's normal workweek; such a
					 part-time employee shall acquire eligibility on the 25th day of such regular
					 employment.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 1 - Regulations Under Disability Benefits Law › Part 359 - Employees Who Are Eligible For Benefits Provided By Their Employers › Section 359.3 - Employees who acquire eligibility on return to work after unemployment

Current through Register Vol. 46, No. 28, July 10, 2024
An employee who, during any period of eligibility to
						benefits under subdivision 2 of section 207  of the Workers' Compensation Law
						has returned to employment with a covered employer, and any employee who, while
						currently receiving unemployment insurance benefits or immediately following
						entitlement to disability benefits has returned to employment with a covered
						employer, shall be eligible for benefits, to be provided by the employer,
						immediately on such employment.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 1 - Regulations Under Disability Benefits Law › Part 359 - Employees Who Are Eligible For Benefits Provided By Their Employers › Section 359.4 - Effect of disability on eligibility for benefits to be provided by employer

Current through Register Vol. 46, No. 28, July 10, 2024
An employee who becomes disabled while he is eligible for
						benefits to be provided by a covered employer shall not have his employment
						terminated, for purposes of determining his right to disability benefits,
						during any period in which he would otherwise continue to be eligible for the
						benefits to be provided by his employer.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 1 - Regulations Under Disability Benefits Law › Part 359 - Employees Who Are Eligible For Benefits Provided By Their Employers › Section 359.5 - Waiver under section 235 of the workers' compensation law

Current through Register Vol. 46, No. 28, July 10, 2024
(a) An employee of a covered employer who is
					 receiving or is entitled to receive old-age insurance benefits under title two
					 of the Social Security Act, may file with his employer and with the chairman a
					 statement of facts supporting the employee's waiver of benefits and claimed
					 exemption of the employee and employer from their obligations to pay
					 contributions.
(b) If such
					 statement, filed with the chairman, evidences the fact that like notice has
					 been filed with the covered employer and the date of such filing, and execution
					 of the statement has been duly acknowledged before a notary public, then on
					 filing such statement with the chairman, the employee shall be exempt,
					 effective at the beginning of the next payroll period following such filing,
					 from liability to make contribution to the cost of benefits. The employer shall
					 likewise be relieved of responsibility for providing thereafter for the payment
					 of benefits to such employee, and the employee shall be deemed to have waived
					 his rights to receive benefits.
(c)
					 A like statement shall be filed with each new covered employer of such
					 employee, and with the chairman.
(d) The chairman may, by rule, prescribe the
					 form of statement.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 1 - Regulations Under Disability Benefits Law › Part 360 - The Insurance Contract › Section 360.1 - The insurance contract

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Every
					 contract of insurance, including any amendment, endorsement, or rider thereto,
					 which provides for employee benefits under the Disability Benefits Law,
					 Workers' Compensation Law, art. 9, whether such benefits are statutory benefits
					 or benefits under a plan, shall meet the requirements of the Superintendent of
					 Insurance.
(b) To make effective a
					 contract of insurance to provide benefits pursuant to section 211  of the
					 Workers' Compensation Law and other obligations under the Disability Benefits
					 Law, each insurance carrier shall either:
(1)
					 apply for acceptance by the chairman of one or more forms of insurance
					 contract, on acceptance of each such form the chairman will assign to it an
					 identifying number. The carrier may thereafter, and until acceptance of such
					 contract form has been revoked by the chairman or its approval rescinded by the
					 Superintendent of Insurance, file with the chairman a satisfactory certificate
					 that it has issued an insurance contract in the accepted form, giving the
					 required information with regard thereto; or
(2) apply promptly to the chairman for
					 acceptance of an insurance contract as written and issued.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 1 - Regulations Under Disability Benefits Law › Part 361 - Self-insurance Regulations › Section 361.2 - Agreement

Current through Register Vol. 46, No. 28, July 10, 2024
Each applicant for self-insurance and each self-insurer
						active as of the effective date of family leave benefits of section 204  of the
						Workers' Compensation Law, and electing to self-insure for paid family leave
						benefits, shall execute and file with the chair an agreement, in form
						prescribed by the chair:
(a) to pay
					 disability benefits and paid family leave, if applicable benefits and paid
					 family leave, if applicable to employees eligible under section 203  of the
					 Workers' Compensation Law:
(1) as provided
					 under section 204  of the Workers' Compensation Law, if there is no plan
					 applicable to such employees; and
(2) as provided by a plan accepted under
					 subdivision 4 or 5 of section 211  of the Workers' Compensation Law for
					 employees covered by the plan;
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 1 - Regulations Under Disability Benefits Law › Part 361 - Self-insurance Regulations › Section 361.4 - Periodic reports

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Each
					 self-insurer, and each employer, shall file annually verified reports in form
					 prescribed by the chair, which (without limitations) shall report the following
					 information:
(1) number of eligible
					 employees;
(2) amount of covered
					 payrolls;
(3) amount of employee
					 contributions; and
(4) estimate of
					 amount of employee contributions in the ensuing year.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 1 - Regulations Under Disability Benefits Law › Part 361 - Self-insurance Regulations › Section 361.5 - Proof of ability to process claims

Current through Register Vol. 46, No. 28, July 10, 2024
Each applicant shall submit proof satisfactory to the
						chair that adequate provision has been made by the applicant to comply with the
						obligation to pay benefits, and upon request, shall satisfy the Chair that such
						provision is kept effective. The use of third-party administrators is
						restricted to those third-party administrators that are licensed by the
						Workers' Compensation Board.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 1 - Regulations Under Disability Benefits Law › Part 361 - Self-insurance Regulations › Section 361.6 - Obligations

Current through Register Vol. 46, No. 28, July 10, 2024
The obligations of a self-insurer shall include all its
						obligations, and those of each and every employer for whose employees the
						self-insurer provides benefits under section 211  of the Workers' Compensation
						Law.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 1 - Regulations Under Disability Benefits Law › Part 361 - Self-insurance Regulations › Section 361.7 - Termination of self-insurer's status and withdrawal of security deposit

Current through Register Vol. 46, No. 28, July 10, 2024
(a) A self-insurer
					 which has terminated its self-insurer status, or as to which approval for
					 self-insurance has been withdrawn pursuant to section
					 361.8 
					 of this Part, may apply to the chair for termination of its status as a
					 self-insurer and for the return of its security deposit or cash, letter of
					 credit, or cancellation of the surety bond.
(b) After the lapse of 24 months and proof
					 satisfactory to the chair that all claims have been finally adjudicated and
					 paid; that all fines, penalties, expenses and assessments have been paid; that
					 the balance of employee contributions have been disposed of satisfactorily; and
					 that the self-insurer has otherwise complied with the applicable provisions of
					 law, regulations and rules, and provisions of the self-insurer's agreement, the
					 chair may release the securities or cash, letter of credit deposited, or permit
					 cancellation of the surety bond.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 1 - Regulations Under Disability Benefits Law › Part 361 - Self-insurance Regulations › Section 361.8 - Revocation of self-insurance status; self-insurance deposit credit

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The chair may
					 revoke consent to self-insurance at any time for good cause. Failure to comply
					 with these regulations and rules, or with any award, order or direction of the
					 chair, or the board, either by the self-insurer or an employer or employers for
					 whose employees benefits are provided by the self-insurer, is cause for
					 revocation.
(b) If an approved
					 self-insurer has deposited securities, irrevocable letters of credit or cash
					 under subdivision 3 of section 50  of the Workers' Compensation Law, the chair
					 in his or her discretion may reduce the amount of deposit or of the penal sum
					 of the bond required under article 9 of the Workers' Compensation Law, provided
					 the self-insurer has, by agreement satisfactory to the chair, made all such
					 deposited securities, irrevocable letters of credit or cash available for the
					 payment of unpaid benefits under article 9 of the Workers' Compensation Law
					 with respect to obligations incurred for disabilities commencing prior to the
					 effective date of the chair's revocation of his or her approval of an
					 applicant's self-insurer status under article 9 of the Workers' Compensation
					 Law.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 1 - Regulations Under Disability Benefits Law › Part 362 - Permanent Contributions › Section 362.1 - Amount and collection of employee contributions

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Employee contributions. Each employee in
					 the employment of a covered employer shall be subject to a contribution to the
					 cost of providing disability benefits at the rate of one half of one percent of
					 the employee's wages paid to him on and after July 1, 1950, but not in excess
					 of the maximum set forth in section
					 362.2 
					 of this Part, except that:
(1) an employee
					 who has filed a waiver of benefits pursuant to section
					 359.5 
					 of this Title shall not be subject to the employee contribution;
(2) contributions of employees covered under
					 any plan or agreement or extension thereof authorized under subdivision 4 or 5
					 of section 211  of the Workers' Compensation Law shall be as provided in such
					 plan or agreement. Contributions of employees or of a class or classes of
					 employees in excess of the statutory amount provided in subdivision 3 of
					 section 209 of such law, may be withheld only by agreement and providing the
					 contribution is reasonably related to the value of the benefits as determined
					 by the chairman.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 1 - Regulations Under Disability Benefits Law › Part 362 - Permanent Contributions › Section 362.2 - Table to determine the maximum amount of employee contributions

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The
					 maximum contribution for an employee (per pay period) shall not exceed:
Per pay period
For employees paid daily .......
$.14
For employees paid weekly .......
.60
For employees paid every two weeks .......
1.20
For employees paid twice a month .......
1.30
For employees paid monthly .......
2.60
If an employee is paid, in whole or in part, at other
						intervals, his or her contribution shall be determined at the rate of one half
						of one percent of wages paid, but shall not be more than the equivalent of 60
						cents per week.
(b) If an
					 employee who is paid daily performs services for the same employer on three or
					 more days in the same calendar week, his or her contribution for such week
					 shall be computed on the same basis as for employees paid weekly.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 1 - Regulations Under Disability Benefits Law › Part 363 - Claims › Section 363.1 - Disability defined

Current through Register Vol. 46, No. 28, July 10, 2024
Whenever used in this Article:
(a) Disability during employment means the
					 inability of an employee, as a result of injury or sickness not arising out of
					 and in the course of an employment, to perform the regular duties of his
					 employment or the duties of any other employment which his employer may offer
					 him at his regular wages and which his injury or sickness does not prevent him
					 from performing.
(b) Regular wages
					 as used herein means the wages, as defined in section
					 357.1  of
					 this Title, that the employee would have earned if disability had not prevented
					 him from working.
(c) Disability
					 during unemployment means the inability of an employee, as a result of injury
					 or sickness not arising out of and in the course of an employment, to perform
					 the duties of any employment for which he is reasonably qualified by training
					 and experience.
(d) Injury and
					 sickness means accidental injury, disease, infection or illness or
					 incapacitation as a result of being an organ donor in a transplant
					 operation.
(e) Disability includes
					 disability caused by or in connection with a pregnancy. An employee is presumed
					 to have a disability caused by or in connection with a pregnancy for at least
					 the four weeks prior to the child's estimated due date and for the six weeks
					 after giving birth via vaginal delivery. An employee who delivers by Cesarean
					 section has a disability caused by or in connection with a pregnancy for eight
					 weeks after giving birth. Any further disability requires medical certification
					 of a complication due to pregnancy or childbirth.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 1 - Regulations Under Disability Benefits Law › Part 363 - Claims › Section 363.2 - Day of disability for computing waiting period

Current through Register Vol. 46, No. 28, July 10, 2024
In computing the waiting period for benefits, any day on
						which an employee was prevented from performing work because of disability and
						for which he has not received his regular remuneration, shall be deemed a day
						of disability, even though the employee was not scheduled to work on that
						day.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 1 - Regulations Under Disability Benefits Law › Part 363 - Claims › Section 363.3 - Normal workday and normal workweek for computing disability benefits

Current through Register Vol. 46, No. 28, July 10, 2024
Any day on which an employee regularly or customarily
						performs any work for a covered employer shall be deemed a normal workday.
						Normal workdays for purposes of computing daily disability benefits shall be
						the number of workdays usual to the employment in which the employee is or was
						last employed before disability. In the absence of such a normal workweek, or
						in the case of employees entitled to collect benefits from the special fund in
						accordance with the provisions of section 207  of the Workers' Compensation Law,
						the normal workweek shall be deemed to be Monday to Friday
						inclusive.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 1 - Regulations Under Disability Benefits Law › Part 363 - Claims › Section 363.4 - Fifty-two consecutive weeks

Current through Register Vol. 46, No. 28, July 10, 2024
Fifty-two consecutive calendar weeks shall be computed
						retroactively with respect to each day for which benefits are currently being
						claimed.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 1 - Regulations Under Disability Benefits Law › Part 363 - Claims › Section 363.5 - Concurrent employment

Current through Register Vol. 46, No. 28, July 10, 2024
An employee is in concurrent employment when he is
						regularly and customarily in the employ of more than one covered employer
						within the same calendar week under circumstances which make him concurrently
						eligible for benefits in such employments as provided in subdivision 2 of
						section 204  of the Workers' Compensation Law.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 1 - Regulations Under Disability Benefits Law › Part 363 - Claims › Section 363.6 - Four-week period following termination of employment

Current through Register Vol. 46, No. 28, July 10, 2024
The period of four consecutive weeks after termination of
						employment shall end on the 28th consecutive calendar day following the last
						day worked except that employment shall not be deemed terminated during any
						period when an employee is eligible to receive benefits under section 204  of
						the Workers' Compensation Law, with respect to such employment and the four
						consecutive week period after termination of employment shall, in such case,
						end on the 28th consecutive calendar day following the last day for which
						benefits were paid to such employee.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 1 - Regulations Under Disability Benefits Law › Part 363 - Claims › Section 363.7 - Attachment to labor market

Current through Register Vol. 46, No. 28, July 10, 2024
In determining continued attachment to the labor market,
						consideration shall be given to evidence of recent past work record,
						registration at labor employment office, frequency and regularity of
						application for employment and other relevant circumstances.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 1 - Regulations Under Disability Benefits Law › Part 363 - Claims › Section 363.8 - Benefits

Current through Register Vol. 46, No. 28, July 10, 2024
[Workers' Compensation Law, §201(12) ]
(a) Payment. The first payment of benefits
					 shall be due at the completion of the first week of disability or lesser period
					 for which benefits are payable and benefits for that period shall be paid
					 directly to the employee within four business days thereafter or within four
					 business days after the filing of required proof of claim, whichever is later.
					 Thereafter, benefits shall be due and payable biweekly in like manner. Benefits
					 may be paid weekly. Benefits may be paid monthly or semimonthly if wages were
					 so paid.
(b) Proration. When an
					 employee is concurrently eligible for benefits to be provided by more than one
					 employer, the liability of each employer shall be determined in the manner
					 provided in subdivision 2 of section 204  of the Workers' Compensation Law
					 except where proration of benefits has been waived by one or more employers,
					 but not by all employers. Those employers who have not waived proration of
					 benefits shall pay the same amount for which they would be liable if all
					 employers were prorating benefits.
(c) Successive periods of disability.
(1) Successive periods of disability caused
					 by the same or related injury or sickness shall be deemed a single period of
					 disability if separated by less than three months only after an employee has
					 been paid or became entitled to be paid benefits for at least one day during
					 the prior occurrence of the disability.
(2) When successive periods of disability,
					 recurring while an employee is in covered employment, or is unemployed, and in
					 either event is eligible for benefits, are deemed a single period of
					 disability, as defined in subdivision 1 of section 204  of the Workers'
					 Compensation Law, benefits shall be paid by the latest covered employer (or
					 employers, if concurrently eligible for benefits to be provided by more than
					 one covered employer) immediately preceding the latest period of disability,
					 except that if such period occurs more than four weeks after termination of
					 employment, benefits shall be paid under section 207 by the special
					 fund.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 1 - Regulations Under Disability Benefits Law › Part 363 - Claims › Section 363.10 - Out-of-state physician; out-of-state podiatrist; out-of-state chiropractor; out-of-state dentist. Statement of disability

Current through Register Vol. 46, No. 28, July 10, 2024
[L. 1973, ch. 940 L. 1979, ch. 628, L. 1981, ch.
						130]
(a) If a claimant who is entitled
					 to benefits under the Disability Benefits Law, Workers' Compensation Law, art.
					 9, resides outside New York State and is regularly under the care of his
					 physician, podiatrist, chiropractor, or dentist in the place of his residence,
					 the statement of such physician may be accepted as proof of
					 disability.
(b) If a claimant who
					 is entitled to benefits under the Disability Benefits Law resides outside New
					 York State and is regularly under the care of his podiatrist in the place of
					 his residence, the statement of such podiatrist may be accepted as proof of
					 disability in connection with any condition which may lawfully be treated by a
					 duly registered and licensed podiatrist of the State of New York.
(c) If a claimant who is entitled to benefits
					 under the Disability Benefits Law resides outside New York State and is
					 regularly under the care of his chiropractor in the place of his residence, the
					 statement of such chiropractor may be accepted as proof of disability in
					 connection with any condition which may lawfully be treated by a duly
					 registered and licensed chiropractor of the State of New York, but shall not be
					 controlling.
(d) If a claimant who
					 is entitled to benefits under the Disability Benefits Law resides outside New
					 York State and is regularly under the care of his dentist in the place of his
					 residence, the statement of such dentist may be accepted as proof of disability
					 in connection with any condition which may lawfully be treated by a duly
					 licensed dentist of the State of New York.
(e) The chairman may by rule prescribe
					 exceptions.