7

NEWS FOR
THIS WEEK

December 31, 2015
Thursday

COMMENTARY: A few thoughts as the year ends and some suggesions for next year.

DECISIONS: There are no decisions from the Third Department this week but seven new cases have been added to the Third Department's January hearing calendar.

Week
#367

Issue
#1

Contact The Insider at:    TheInsider@InsideWorkersCompNY.com                                                                         212-734-9450

Workers Comp Basics for Employers


I will answer general questions from employers but, for legal advice, the place to go will depend on the type of workers compensation coverage you have. As an employer, you will most likely fall under one of the four following categories.

SELF INSURED

These are firms with thousands of employees. Most self-insureds, specifically approved by the State of New York and the NYS Workers Compensation Board, hire third party administrators (TPA’s) to handle all the paper work dealing with claims and work closely with the firm’s Human Resources (HR) department. HR can and should answer all questions pertaining to possible claims.

GSIT (Group Self Insured Trust)

Beginning with the passage of legislation about 20 years ago, companies in the same trade/professional were allowed to join together, pooling insurance premiums into their own trust fund, acting as their own insurance company. The GSIT’s were to be managed by TPA’s. Unfortunately, many of these trusts were financially mismanaged and the NYS WCB took over management of many of them.

As a result, there are two types of questions these members may have.

  • Questions dealing with specific claims should be addressed to the trust managers, be it the WCB or a private TPA.
  • Many questions I have gotten by trust members deal with assessments by the NYC WCB for premium that the WCB claims should have been paid 5, 10 or even 15 years ago, some assessments large enough to bankrupt those companies.. This site website lists over a dozen Court decisions dealing with such issues (search for "GSIT") and, in most cases, I can direct you to firms dealing with these assessment issues.
INSURED

99.99% of all companies in New York are insured, either by New York State Insurance Fund (NYSIF - a state entity) or a private carrier, usually through a broker/agent. Under NYS workers compensation law, they and they alone are responsible for managing the claim, although the employer must file forms if there is an accident - your broker can help you with this, if you do not have a HR department. If there are any issues to be litigated, they will be litigated at the Board in front of an administrative law judge after which there are several levels of possible appeals of an unfavorable decision. For all basic purposes, other than suppling (1) information about the accident, (2) wage information for the injured workers, and (3) possibly witnesses, the employer has nothing to do with the claim.

How the carrier proceeds is up to the carrier; they may use their own lawyers or hire law firms that specialize in defending insurance companies. The employer has virtually nothing to say about the case. The employer pays premiums and the carrier handles the claim, just as if it were a car accident. Any questions should be directed to the broker who sold the insurance or to a contact at the insurance company to whom information about the incident was sent.

UNINSURED

This category ranges from the company who just feels it can get away without workers comp insurance, companies who have had the coverage cancelled, employers who did not know they need this insurance, and individuals, such as homeowners, who have hired someone whom they treated as a ‘contractor’ who may in fact be classified as an ‘employee.’

These claims are handled by an insurance company, actually the Uninsured Employer Fund (UEF), a NYS fund paid for by assessments against insurance companies to pay the medical expenses and lost wages for injured workers whose employers did/do not have insurance. Then the UEF sues the employer and/or its executive/owners for that money. The issue of whether that ‘employer’ is actually an employer for workers compensation purposes is something handled at the Board. Those employers/individuals who fall into this category really should have representation by someone familiar with workers compensation law.

Although the attorneys in the links on the bottom of this page usually represent injured workers, some of them will also represent uninsured employers. In addition, if you look at the cases in the DECISIONS pages, you will see the name of the prevailing attorneys and their firms, all of whom can be found on the internet.

SUMMARY

Having workers compensation insurance is just one of the costs and responsibilities of being an employer. Fortunately, for most small employers, they never have an injured worker and thus their only dealings with the workers compensation system is the payment of premiums for the policy and the posting of notices around the office. But for those who have an injured employee (real or alleged), it can be a daunting process. If this page  does not answer your question, feel free to contact me at: TheInsider@InsideWorkersCompNY.com


If you do need legal representation:
For  a list of Licensed Representatives:  Lic Rep List

The following is the name of the legal association of which most members of the injrued worker's attorneys are members:
               
   Workers Compensation Alliance   or   Injured Workers Bar Association