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Comparison of Workers' Compensation Benefit Legislation

Major Provisions S.5320 Libous/A.8862 Schimminger A.9736 John/S.6135 Velella Governor's Program Bill
S.6841 Rules / A.10975 Rules at the request of John
Bill Note   Section 3 of A9736 adds a new article 2-A titled "Workers' Compensation Benefit and Improvement Act" There are different subsections under section 3 of the bill which are numbered 36-36h  
Scheduled Awards Section 2: Give injured workers only half of remaining scheduled benefits if they return to work before scheduled benefits expire.    
Benefit Increase   Section 2: Increase Maximum benefit to $625, 2/3 of NYS average weekly wage by Dec. 2006 and indexes thereafter to reflect increases in the average weekly wage. Section 11: Increases maximum benefit to $500/week.
Permanent Partial Disability Section 2: Limit, to 10 years, the duration of benefits given to injured or sick workers in cases in which benefits are not prescribed by statutory schedules.   Section 9: Establish a system of tiered benefit levels for those claimants who have been classified as permanently partially disabled.
Elimination of 'Exclusive Rule Remedy'   Section 3/Subsection 36: Elimination of the Exclusive Remedy Rule. The legislation states that a worker.may elect to waive all benefits and compensation.and may commence a cause of action against the employer.  
Prior authorization and fees for medical providers   Section 12: Raises the threshold at which a claimant must seek permission from the carrier for treatment from $500 to $2000. Requires all medical providers and support staff to be trained on processing medical bills. Would charge medical professionals $100 training fee. Section 5: Raises the threshold at which a claimant must seek permission from the carrier for treatment from $500 to $1000.
Social Security and Pension Offset Section 3: Provide for Social Security and pension offsets-that is, reductions in workers' compensation benefits applied when workers receive Social Security and/or pension benefits.    
Major Provisions S.5320 Libous/A.8862 Schimminger A.9736 John/S.6135 Velella Governor's Program Bill
Bad Act' Coverage   Section 3/Subsection 36a: Optional bad act coverage: Employers may purchase additional coverage to provide protection for injury of an employee due to an unsafe workplace. All employees shall be informed of safety requirement citations at the work site.  
Reduction Second Injury Fund assessment     Section 13: Reduces the assessment for the Second Injury Fund from 150 percent of the prior year's disbursement to 125 percent of the prior year's disbursement.
Objective Medical Criteria Section 4: Implement meaningful objective medical guidelines to determine the degree of disability and the ability of workers receiving benefits.    
Union Designation of Insurance Carrier   Section 3/Subsection 36b: Designation of insurance carrier: Choice of Carriers. Where collective bargaining is required, the labor representative may choose, on an annual basis, either the carrier used by the employer or the State Insurance Fund.  
Major Provisions S.5320 Libous/A.8862 Schimminger A.9736 John/S.6135 Velella Governor's Program Bill
Medical Care   Section 3/Subsection 36c: Requires the insurer or health benefits plan maintained by the employer to make payments for medical and hospital care for injured worker pending the outcome of a controverted claim. Also sets up medical trust fund  
Earner Protection' Policy   Section 3/ Subsection 36d: High wage earner policy may be purchased by the employee from the carrier or the state insurance fund. If the benefits are not used, the money is returned to the worker upon retirement. Section 45: would amend Insurance Law 3215(g) to provide that only the existing provisions of such section do not apply to group life insurance policies or group annuity contracts. Section 46: adds a new subsection to Insurance Law that would allow group annuity contracts to provide disability benefits to supplement the maximum workers' compensation benefit. Section 47: adds a new subsection to Insurance law that would allow group life insurance policies to provide death benefits that supplement the maximum weekly death benefit provided by workers' comp.
Incarceration Policy   Section 3/ Subsection 36e: Employers must begin paying workers' compensation within 30 days of an application from an individual released from a felony incarceration who applied to the Board for reinstatement of comp benefits (and supplied proof that they are, indeed, out of jail) Section 1: Ends the practice of payment of workers compensation for those who were injured during the commission of a crime. Section 2: would prohibit the payment of workers' compensation to those who are incarcerated (although those individuals will be allowed to reapply for benefits upon release)
Carrier Evaluation   Section 3/ Subsection 36f: Every carrier will be rated by the board on a set of universal factors. Those ratings (and the factors the ratings were based upon) will then be published Section 34: Requires that the Chair of the WCB prepare an annual report on the performance of insurance carriers, self-insured employers, third party administrators, and most other professionals that provide workers' compensation services.
Fee Schedule for durable goods and pharmaceuticals   Section 3/Subsection 36g: Sets up a durable goods fee schedule that covers things such as wheelchairs and other medically prescribed equipment. Section 8: provides a pharmaceutical fee schedule.
Major Provisions S.5320 Libous/A.8862 Schimminger A.9736 John/S.6135 Velella Governor's Program Bill
    Section 6: establishes pharmaceutical fee schedule  
Electronic Deposit of benefits   Section 3/Subsection 36h: Would allow claimant to have lost wages electronically deposited.  
Controverted Claims   Section 4: Assessing attorney fees against a carrier that controverts a claim. Section 17: Requires that where the employer controverts a case the WCB must schedule a pre-hearing conference within 45 days of notice. This is a reduction from the current 60 days.
Expediting injury reports   Section 7: Upon notice of an injury, the employer must electronically transmit a report within 24 hours  
Notice of Appeals/Penalties   Section 8: Deals with notice of appeals and penalties  
Pre-hearing conferences   Section 9: Cuts the set-up time for pre-hearing controverted claim conference from 60 days to 10 days  
Aggregate Trust Fund   Section 10: Makes changes to payments made into an Aggregate Trust Fund  
AFL-CIO representatives   Section 11: Requires State Insurance Fund to add 9th commissioner to act as representative from AFL-CIO  
Major Provisions S.5320 Libous/A.8862 Schimminger A.9736 John/S.6135 Velella Governor's Program Bill
Board report   Section 5: The Board is required to submit a report on their experience with carriers/number of controversies, etc.  
Expedited timeframe     Section 20: WC cases that have not been resolved within one year will be scheduled for an expedited hearing. The timeframe is would be two years.
Removal of physicians found guilty of misconduct     Section 6: would allow the Chair to remove physicians found guilty of professional misconduct from the list of authorized physicians to provide medical care under the WCL. Section 7 would allow the Chair to temporarily suspend or limit the practice of any physician found guilty of professional misconduct or incompetence by the Dept. of Health.
Alternate Dispute Resolution     Section 19: Extends the Alternative Dispute Resolution program to unionized employers in the manufacturing sector. This provision now only applies to the construction industry.
Major Provisions S.5320 Libous/A.8862 Schimminger A.9736 John/S.6135 Velella Governor's Program Bill
PPO     Section 38: Under current law, PPO's must provide five medical specialties and three hospitals from which the employee may choose care. This proposal would change that number to provide two medical specialties and two hospitals from which the employee could choose care.
Fee Schedule     Section 3: adds dental care and prosthetic devises to the list treatments and devices employers MUST provide to injured employees. This section would also further expand the fee schedule and services established by the Chair to include medical, dental surgical, optometrist, and other services and devices such as eye-glasses, false teeth, artificial eyes, orthotics, and prosthetics.
Major Provisions S.5320 Libous/A.8862 Schimminger A.9736 John/S.6135 Velella Governor's Program Bill
Prescribed medicine     Section 4: Would require employers and/or carriers to pay the scheduled fee for prescription drugs within 45 days, unless the liability of the employer for the cost of the prescribed medicine is not reasonably clear. This section would also require the carrier to pay any undisputed portion of a prescription claim and notify the claimant within 45 days of the claim if the claim is not being paid. The section also attaches penalties to employers found in violation of the new requirements.
Determination of wage earning capacity     Section 10: eliminating presumptions that the wage earning capacity of a partially disabled claimant who has no actual earnings cannot exceed 75 % of such injured employee's former full time earnings. The section would allow the WCB or any party in interest to make a motion to determine wage earning capacity.
With holding reimbursements     Section 12: would allow the Board to withhold second injury fund reimbursements from any carrier or self-insured who has unpaid obligations due under section 15-8,25-a, or 151. It would also require carriers and self-insured to submit reimbursement claims within one year of the payment of the benefit, or within one year after the Board has determined the carrier or employer is entitled to reimbursement.
Increase death benefit     Section 14: increases maximum death benefit to be consistent with the increased maximum wage
Major Provisions S.5320 Libous/A.8862 Schimminger A.9736 John/S.6135 Velella Governor's Program Bill
Payment without prejudice     Section 15: authorize employers to provide temporary payments for proscribed medicine in a case where liability is contested without admitting liability
Pendency of Appeals     Section 16: clarifies what medical costs an employer or carrier must pay during an appeals process.
Conciliation Process     Section 18: allows the Board to review all claims for possible transfer to the conciliation process regardless of the expected benefit duration.
Major Provisions S.5320 Libous/A.8862 Schimminger A.9736 John/S.6135 Velella Governor's Program Bill
Aggregate Trust Fund     Section 21: Would require that payments into the Aggregate Trust Fund on death benefits be based on the assumption that any child between the ages of 18-23 will continued to be enrolled as a full-time student in an accredited educational institution and if so, provide the child benefits until the age of 23, or or out of school. If the child misleads the Board, the provision allows for appropriate refund. Also makes various interest provisions with the 3.5 discount rate.
Penalties     Section 22: increases employer penalty when the employer fails to secure compensation for an injured employee from the variable amount prescribed under current law to a fixed sum of $5,000
Aggregate Trust Fund     Section 23: payments into the ATF will be discounted on an interest rate of 3.5 percent on claims for accidents occurring after January 1, 2001
Aggregate Trust Fund     Section 24: reserves set to ATF be discounted at 3.5 percent
Aggregate Trust Fund     Section 25: carriers or self insured employer that paid the present value of an award into the ATF would not be entitled to a refund any portion of the deposit in the event that the ATF enters into a settlement agreement with the claimant.
Section 32 agreements     Section 26: would allow the ATF to enter into settlement agreements about payment of workers' comp benefits. The agreements would be subject to Board approval- ATF section 32s
Major Provisions S.5320 Libous/A.8862 Schimminger A.9736 John/S.6135 Velella Governor's Program Bill
Joint and several liability     Section 27: would find that the president, vice-president, secretary and treasurer of a corporation are jointly and severally liable for insurance obligation due to a workers' compensation insurer or group self-insurer
Risk-sharing plans     Section 28: would permit multiple comp insurance carriers to enter into risk sharing plans with respect to an employers risk.
SIF investments     Section 29: would allow the SIF to invest up to ten percent of its surplus and reserve funds in certain securities.
Workers' comp security fund     Section 30: reduces the maximum payment to the Comp Security fund from $1 million to $300,000 for third party liability claims under an employer's liability portion of a comp policy. This section would also exempt the fund from payment of interest or penalty.
Major Provisions S.5320 Libous/A.8862 Schimminger A.9736 John/S.6135 Velella Governor's Program Bill
Workers' comp security fund expands Superintendent's authority     Section 31: allows the Superintendent of Insurance to increase assessments on every compensation carrier if the Superintendent decides that the comp security's funds are insufficient to satisfy all claims for comp or death benefits.
Utilization of stenographic recordings     Section 32: would allow the Board to use methods other than stenography to record its hearings and have the recordings used as evidence.
Claimants restitution     Section 33: requires individuals convicted of a crime related to an injury for which benefits were received, to make restitution to the employer, or carrier.
Technology award programs     Section 35: allows the chair to institute programs to encourage WCB participants to use the most advanced technology consistent with that of the WCB when interacting with the Board.
Major Provisions S.5320 Libous/A.8862 Schimminger A.9736 John/S.6135 Velella Governor's Program Bill
Technology award programs     Section 36 : authorizes chair to establish an award program for WCB participants who have integrated their technology resources with those of the Board.
SIF PPO     Section 37: authorizes SIF to contract with a preferred provider organization (PPO) for delivery of workers' comp benefits.
Pilot Programs for voluntary benefit delivery     Section 39: establishes a pilot program that would encourage voluntary delivery of comp and medical benefits to injured workers without intervention by the Board. It would be subject to the Board's supervision, though.
Volunteer Firefighters     Section 40: amends Volunteer Firefighters Benefits Law to permit claims by workers or their dependents, to be settled in the same way as a workers' comp claim under WCL
Volunteer Ambulance Workers     Section 41: amends Volunteer Ambulance Workers' Benefits law to permit claims by workers or their dependents, to be settled in the same way as a workers' comp claim under WCL
Major Provisions S.5320 Libous/A.8862 Schimminger A.9736 John/S.6135 Velella Governor's Program Bill
Risk-sharing plans     Section 42: permits risk sharing plans for workers' compensation insurance.
Bill explanation     Section 43: amends Insurance Law to say that the next section of the bill (section 44) would apply to SIF's policies
Liability Limits     Section 44: mandates a new minimum coverage limits on employers' liability insurance of $100,000 for bodily injury, $100,000 for bodily injury by disease, and $500,000 for bodily injury by disease during a single policy period to all employees. Bodily injury includes death. Carriers would not be prohibited from offering additional coverage in return for an annual premium.
Workers' Comp Security Fund     Section 48: permits the Superintendent of Insurance to seek court approval for early access distribution of assets of liquidated companies to the Workers' Compensation Security Fund
Bill explanation     Section 49: authorizes the Superintendent of Insurance and the Chairman of the WCB to take action to implement the program bill
Alternate Dispute Resolution expansion date     Section 50: extends the Alternative Dispute Resolution Program for an additional five years, until December 31, 2010
Invalid     Section 51: allows any provision of the bill found by a court of 'competent jurisdiction' to be "severed"
Effective dates     Section 52: provides various effective dates for the Act.