| 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 |
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| Scheduled Awards |
Section 2: Give injured workers only half of remaining scheduled
benefits if they return to work before scheduled benefits expire.
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| Benefit Increase |
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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. |
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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' |
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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. |
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| Prior authorization and fees for medical providers |
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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. |
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| Major Provisions |
S.5320 Libous/A.8862 Schimminger |
A.9736 John/S.6135 Velella |
Governor's Program Bill |
| Bad Act' Coverage |
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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. |
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| Reduction Second Injury Fund assessment |
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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. |
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| Union Designation of Insurance Carrier |
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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 |
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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 |
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| Earner Protection' Policy |
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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 |
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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 |
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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 |
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Section 3/Subsection 36g: Sets up a durable goods fee schedule that
covers things such as wheelchairs and other medically prescribed equipment.
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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 |
| |
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Section 6: establishes pharmaceutical fee schedule |
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| Electronic Deposit of benefits |
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Section 3/Subsection 36h: Would allow claimant to have lost wages
electronically deposited. |
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| Controverted Claims |
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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 |
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Section 7: Upon notice of an injury, the employer must electronically
transmit a report within 24 hours |
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| Notice of Appeals/Penalties |
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Section 8: Deals with notice of appeals and penalties |
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| Pre-hearing conferences |
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Section 9: Cuts the set-up time for pre-hearing controverted claim
conference from 60 days to 10 days |
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| Aggregate Trust Fund |
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Section 10: Makes changes to payments made into an Aggregate Trust
Fund |
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| AFL-CIO representatives |
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Section 11: Requires State Insurance Fund to add 9th commissioner
to act as representative from AFL-CIO |
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| Major Provisions |
S.5320 Libous/A.8862 Schimminger |
A.9736 John/S.6135 Velella |
Governor's Program Bill |
| Board report |
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Section 5: The Board is required to submit a report on their experience
with carriers/number of controversies, etc. |
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| Expedited timeframe |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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Section 15: authorize employers to provide temporary payments for
proscribed medicine in a case where liability is contested without
admitting liability |
| Pendency of Appeals |
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Section 16: clarifies what medical costs an employer or carrier
must pay during an appeals process. |
| Conciliation Process |
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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 |
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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 |
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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 |
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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 |
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Section 24: reserves set to ATF be discounted at 3.5 percent |
| Aggregate Trust Fund |
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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 |
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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 |
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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 |
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Section 28: would permit multiple comp insurance carriers to enter
into risk sharing plans with respect to an employers risk. |
| SIF investments |
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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 |
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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 |
|
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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 |
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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 |
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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 |
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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 |
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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 |
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Section 37: authorizes SIF to contract with a preferred provider
organization (PPO) for delivery of workers' comp benefits. |
| Pilot Programs for voluntary benefit delivery |
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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 |
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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 |
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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 |
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Section 42: permits risk sharing plans for workers' compensation
insurance. |
| Bill explanation |
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Section 43: amends Insurance Law to say that the next section of
the bill (section 44) would apply to SIF's policies |
| Liability Limits |
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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 |
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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 |
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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 |
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Section 50: extends the Alternative Dispute Resolution Program
for an additional five years, until December 31, 2010 |
| Invalid |
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Section 51: allows any provision of the bill found by a court of
'competent jurisdiction' to be "severed" |
| Effective dates |
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Section 52: provides various effective dates for the Act. |
