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Prove It to Move It

A publication of the

New York State Workers’ Compensation Board

Businesses and other parties applying for a government permit, license or contract must prove compliance with New York state workers’ compensation and disability benefits requirements. This manual explains the forms and processes necessary to move those applications through the process, and to stay in compliance with the law.

This document is solely provided for informational purposes. Only the New York State Workers' Compensation Board is authorized to determine entitlement to benefits, based on its application of the law to the specific facts of a case.Prove It to Move It New York State Workers' Compensation Board -- December, 2011 2

Table of Contents

Table of Contents............................................................................................................................ 2

The Prove It to Move It Program.................................................................................................... 4

Form CE-200 – Affidavit of Exemption................................................................................. 4

Other Important Highlights of the Prove It to Move It Program............................................ 5

Workers’ Compensation Requirements under Workers’ Compensation Law §57..................... 6

Disability Benefits Requirements under Workers’ Compensation Law §220(8) ....................... 6

WCL §57. Restriction on issue of permits and the entering into contracts unless compensation is secured. ............................................................................................................ 7

DISABILITY REQUIREMENTS .................................................................................................. 7

WCL §220. Subd. 8 .................................................................................................................... 7

Identifying an Independent Contractor ....................................................................................... 8

Workers’ Compensation and Disability Benefits Coverage Requirements for Members of Religious Organizations.............................................................................................................. 8

Workers’ Compensation Coverage Requirements for Religious Organizations ........................ 8

STATE & MUNICIPAL AGENCY COMPLIANCE WITH WCL §57...................................... 10

Section 57: Restriction on Issue of Permits and the Entering of Contracts unless Compensation Is Secured.................................................................................................................................. 10

Local Board Contacts for Government Officials .................................................................. 10

Instructions for Form CE-200 (12/08) .................................................................................. 11

Instructions for Obtaining Form CE-200.............................................................................. 13

Form CE-200 ........................................................................................................................ 14

Form C-105.2........................................................................................................................ 16

Instructions for Form U-26.3 – Certificate of NY Workers’ Compensation Insurance from the New York State Insurance Fund ..................................................................................... 17

Form U-26.3.......................................................................................................................... 18

Instructions for Form SI-12 -- Certificate of Workers’ Compensation Self- Insurance ....... 19

Form SI-12............................................................................................................................ 20

Form GSI-105.2 .................................................................................................................... 22

State Agency Letter from the NYS Department of Civil Service......................................... 24

Ascertaining Violations of the Law...................................................................................... 25

Personal Accountability........................................................................................................ 25

Liability for Claims Incurred by an Uninsured Employer for Workers’ Compensation Insurance -- Section 26-a of the Workers Compensation Law............................................. 25

Penalties for Noncompliance with Workers’ Compensation Mandatory Coverage Requirements ........................................................................................................................ 25

Additional Liability for Uninsured Employers ..................................................................... 26

STATE & MUNICIPAL AGENCY COMPLIANCE WITH....................................................... 27

GENERAL MUNICIPAL LAW §125.......................................................................................... 27

Form BP-1............................................................................................................................. 30

GOVERNMENT AGENCY COMPLIANCE WITH DISABILITY BENEFITS ...................- 32 -

Section 220 (8): Restriction on Issue of Permits and the Entering of Contracts Unless Disability Benefits Coverage Is Secured ..............................................................................- 32 -

Instructions for Form CE-200 (12/08) ..............................................................................- 33 -

Form CE-200 ....................................................................................................................- 34 -

FORM DB-120.1 ..............................................................................................................- 36 -Prove It to Move It New York State Workers' Compensation Board -- December, 2011 3

Instructions for Form DB-155 -- Certificate of NY Disability Benefits Self-Insurance ..- 37 -

FORM DB-155 .................................................................................................................- 38 -

Instructions for State Agency Letter from the NYS Department of Civil Service ...........- 39 -

Letter from the NYS Department of Civil Service ...........................................................- 40 -

Summary: WCL Sec. 57 & 220 (8), and General Municipal Law Sec. 125.........................- 41 -Prove It to Move It New York State Workers' Compensation Board -- December, 2011 4

The Prove It to Move It Program

Workers’ compensation law (WCL) requires the heads of all municipal and state entities to ensure that businesses applying for permits, licenses, or contracts carry workers’ compensation and disability benefits insurance. This requirement applies to both original issuances and renewals, whether the governmental agency is having the work done or is simply issuing the permit, license or contract.

Verification of insurance is necessary to ensure benefits are available, should workers get injured. It also levels the playing field for honest businesses, because they are less likely to be undercut by unscrupulous employers who gain a cost advantage by not carrying insurance. Enforcing these provisions of the law contribute to the betterment of New York’s economic climate. Municipal and state agency cooperation is a critical component of encouraging business compliance.

This instruction manual, Prove It to Move It, will further clarify the requirements. Under the Prove It to Move It program, applicants must prove compliance with NYS workers’ compensation and disability benefits requirements to move their government permit, license or contract along the approval process. This program reflects requirements under Workers’ Compensation Law §57 and §220(8), and General Municipal Law §125. The Prove It to Move It instruction manual formally names the program that has been in place, by statute, since 1922. Nothing has changed in enforcing this program since the last instruction manual was issued in December, 2008. However, based on requests from government agencies, this manual reflects more comprehensive instructions on the program’s requirements.

Government officials without access to the web may call (518) 486-6307 to have a copy of this instruction manual mailed to them.

Also included in the instruction manual is a copy of General Municipal Law Section 125, which requires all applicants to provide proof of workers’ compensation compliance when applying for a Building Permit.

Form CE-200 – Affidavit of Exemption

Form CE-200 reflects the process for granting exemptions from workers’ compensation and disability benefits insurance coverage requirements.

Applicants eligible for exemptions must file a new CE-200 for each and every new or renewed permit, license or contract issued by a government agency. Each CE-200 will specifically list the issuing government agency and the specific type of permit, license or contract requested by the applicant. Applicants for building permits will also need to supply additional information including identifying the specific job location and the estimated cost of the project.

Please ensure that Form CE-200 is signed and dated by the applicant and that your specific governmental agency is listed. CE-200 forms are ONLY valid for the government agency listed on Form CE-200.

The reason that a business is exempt from workers’ compensation and/or disability benefits will be clearly stated on Form CE-200. Based on their knowledge of the applicant’s business, government agencies must verify that the business is eligible for the workers’ compensation and/or disability benefits exemption reason described on the CE-200, and notify the Board’s investigative staff if there are discrepancies. Phone numbers for Board investigative staff are located on page 10 of the instruction manual.Prove It to Move It New York State Workers' Compensation Board -- December, 2011 5

Each CE-200 will have a certificate number printed on it. You can verify if the CE-200 provided to you by the applicant was actually issued by the Workers’ Compensation Board’s computer system by checking on the Board’s website at the following URL: http://www.wcb.ny.gov/content/ebiz/wc_db_exemptions/verifyCE200Overview.jsp .

The majority of CE-200 forms will be processed electronically. Applicants will be able to fill out the CE-200 on-line and upon completion, immediately print out a copy of the CE-200 that they will then submit to the government agency issuing the permit, license or contract. Computers with internet access are available for CE-200 electronic application processing at Customer Service Centers located in Workers’ Compensation Board Offices across the state. Applicants without access to a computer may obtain a paper application by writing or visiting any Workers’ Compensation Board district office, or by calling 866-298-7830. Applicants are strongly encouraged to use the Board’s electronic web program. They can receive their Form CE-200 immediately, whereas manual paper filing may take up to four weeks to process.

Please see pages 11-14 for more information on Form CE-200.

Other Important Highlights of the Prove It to Move It Program

An instruction sheet on page 6 of the instruction manual may be copied by municipal and state agencies as an insert in their application packages for government issued permits, licenses or contracts. This sheet describes all the required forms of this program and where applicants may obtain these forms.

Please note that ACORD forms are NOT acceptable proof of New York State workers’ compensation or disability benefits insurance coverage.

This manual identifies the specific forms that government agencies can accept to enforce these sections of the Workers’ Compensation Law and where applicants may obtain those forms. No other forms are acceptable as proof of compliance with New York State workers’ compensation or disability benefits.

Please ensure that the legal entity name and the Federal Employer Identification Number (FEIN) on certificates of insurance, self-insurance, or attestation for exemption exactly matches the legal entity name and FEIN of the applicant applying for the permit, license or contract that you are issuing.

Form BP-1, found on page 30, is the only form that municipal and state agencies may now reproduce themselves and distribute as part of this process.

Please notify the permit-issuing, license-issuing and contract-making agencies or departments within your jurisdiction of these requirements so that they may comply with the Workers’ Compensation Law. If you have any questions or require additional information, please call the Board at (518) 486-6307. Prove It to Move It New York State Workers' Compensation Board -- December, 2011 6

May, 2010

Workers’ Compensation Requirements under Workers’ Compensation Law §57

To comply with coverage provisions of the Workers’ Compensation Law (WCL), businesses must:

a) be legally exempt from obtaining workers’ compensation insurance coverage; or

b) obtain such coverage from insurance carriers; or

c) be a Board-approved self-insured employer; or

d) participate in an authorized group self-insurance plan.

To assist State and municipal entities in enforcing WCL Section 57, businesses requesting permits or licenses, or seeking to enter into contracts MUST provide ONE of the following forms to the government entity issuing the permit or entering into a contract:

A) Form CE-200, Certificate of Attestation of Exemption from NYS Workers' Compensation and/or Disability Benefits Coverage;

Form CE-200 can be filled out electronically on the Board’s website, www.wcb.ny.gov. Click on the button entitled “WC/DB Exemptions Form CE-200” (In bright yellow letters). Applicants filing electronically are able to print a finished Form CE-200 immediately upon completion of the electronic application. Applicants without access to a computer may obtain a paper application for the CE-200 by writing or visiting the Customer Service Center at any district office of the Workers’ Compensation Board. Applicants using the manual process may wait up to four weeks before receiving a CE-200. Once the applicant receives the CE-200, the applicant can then submit that CE-200 to the government agency from which he/she is getting the permit, license or contract; or

B) Form C-105.2, Certificate of Workers’ Compensation Insurance (the business’s insurance carrier will send this form to the government entity upon request). Please Note: The State Insurance Fund provides its own version of this form, the U-26.3; or

C) Form SI-12, Certificate of Workers’ Compensation Self-Insurance (the business calls the Board’s Self-Insurance Office at 518-402-0247), or GSI-105.2, Certificate of Participation in Worker’s Compensation Group Self-Insurance (the business’s Group Self-Insurance Administrator will send this form to the government entity upon request).

Disability Benefits Requirements under Workers’ Compensation Law §220(8)

To comply with coverage provisions of the WCL regarding disability benefits, businesses may:

a) be legally exempt from obtaining disability benefits insurance coverage; or

b) obtain such coverage from insurance carriers; or

c) be a Board-approved self-insured employer.

Accordingly, to assist State and municipal entities in enforcing WCL Section 220(8), businesses requesting permits or licenses, or seeking to enter into contracts must provide one of the following forms to the entity issuing the permit or entering into a contract:

A) CE-200, Certificate of Attestation of Exemption from NYS Workers' Compensation and/or Disability Benefits Coverage (see above);

B) DB-120.1, Certificate of Disability Benefits Insurance (the business’s insurance carrier will send this form to the government entity upon request); or

C) DB-155, Certificate of Disability Benefits Self-Insurance (the business calls the Board’s Self-Insurance Office at 518-402-0247).

NYS Agencies Acceptable Proof: Letter from the NYS Department of Civil Service indicating the applicant is a New York State government agency covered for workers’ compensation under Section 88-c of the Workers’ Compensation Law and exempt from NYS disability benefits.

Please note that for building permits only, certain homeowners of 1, 2, 3 or 4 family owner-occupied residences serving as their own General Contractor may be eligible to file Form BP-1 (The homeowner obtains this form from either the Building Department or on the Board’s website, http://www.wcb.ny.gov/content/main/forms/bp-1.pdf) Prove It to Move It New York State Workers' Compensation Board -- December, 2011 7

WORKERS’ COMPENSATION REQUIREMENTS

WCL §57. Restriction on issue of permits and the entering into contracts unless compensation is secured.

1. The head of a state or municipal department, board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, and notwithstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that compensation for all employees has been secured as provided by this chapter. Nothing herein, however, shall be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any compensation to any such employee if so employed.

2. The head of a state or municipal department, board, commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, notwithstanding any general or special statute requiring or authorizing any such contract, shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that compensation for all employees has been secured as provided by this chapter.

DISABILITY REQUIREMENTS

WCL §220. Subd. 8

(a) The head of a state or municipal department, board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in employment as defined in this article, and not withstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that the payment of disability benefits for all employees has been secured as provided by this article. Nothing herein, however, shall be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any disability benefits to any such employee if so employed.

(b) The head of a state or municipal department, board, commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in employment as defined in this article, and notwithstanding any general or special statute requiring or authorizing any such contract, shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that the payment of disability benefits for all employees has been secured as provided by this article.Prove It to Move It New York State Workers' Compensation Board -- December, 2011 8

Identifying an Independent Contractor

For purposes of compliance with Workers’ Compensation Law Section 57, an individual or legal entity MUST obtain and work under his/her/its own government issued operating permit, contract or authority to be an independent contractor.

Example 1 -- A trucking company is getting a government contract. The drivers of the trucks that the trucking company is using to fulfill the contract are NOT independent contractors. If the drivers were truly independent, each driver would be contracting separately with the government agency. In this example, the business hiring the drivers CAN NOT submit a CE-200 exemption form. (See page 11.)

Example 2 – A municipality is issuing one building permit for a job site. For purposes of Workers’ Compensation Law Section 57, individuals or other businesses hired by the contractor to perform work on that jobsite are NOT independent contractors but rather subcontractors. In this example, the contractor hiring the subcontractors CAN NOT submit a CE-200 exemption form. (See page 11.)

Example 3 -- A municipality is issuing a building permit and a separate electrical permit for a job site. The contractor getting the building permit is a sole proproietor doing all the work on the jobsite himself except for the electrical work. When a municipality issues separate building permits and electrical permits, for purposes of Workers’ Compensation Law Section 57,a general contractor obtaining the building permit does not have to count the electrician as a subcontractor since the electrician is working under his/her own operating authority and is thereby, an independent contractor. In this example, the sole proprietor CAN submit a CE-200 exemption form since the electrician is a true independent contractor and not a subcontractor. (See page 11.)

Workers’ Compensation and Disability Benefits Coverage Requirements for Members of Religious Organizations

If an enterprise is not owned by a religious organization itself, but instead is owned by an individual, partnership, corporation etc., then the enterprise must abide by the regular New York State coverage requirements for workers’ compensation and disability benefits insurance.

In other words, if someone owns a business, it doesn’t matter if he/she is Amish, Buddhist, Catholic, Christian Scientist, Hindu, Jehovah Witness, Jewish, Mennonite, Mormon, Muslim, Protestant, or a member of any other religion: regular New York State coverage requirements for workers’ compensation and disability benefits insurance apply to that business. Further, the private business is not covered by either the church’s insurance or a declaration by the church that its members are self-insured.

Workers’ Compensation Coverage Requirements for Religious Organizations

Workers’ compensation insurance coverage is not required for a religious organization that only pays its clergy (including sextons), and/or teachers, and/or individuals providing non-manual labor.

To be exempt, clergy must only perform religious duties, and the teachers must only perform teaching duties. Manual labor includes, but is not limited to, tasks such as filing; carrying materials (e.g., Prove It to Move It New York State Workers' Compensation Board -- December, 2011 9

pamphlets, binders, or books); cleaning such as dusting or vacuuming; playing musical instruments; moving furniture; shoveling snow; mowing lawns; and construction of any sort.

Workers’ compensation insurance is also not required for people receiving charitable aid from a religious or charitable institution (Section 501(c)(3) under the IRS tax code) who perform work in return for that aid and who are not under any express contract of hire, and certain persons receiving rehabilitation services in a sheltered workshop.

A religious organization is a nonprofit (Section 501(c)(3) under the IRS tax code) and as such does not require New York State workers’ compensation insurance coverage as long as its members are volunteering their services on activities or enterprises that benefit only that religious organization. For example, volunteering in a religiously owned store – a store owned by the religious community itself, NOT someone who is a member of that religion. Another example is parishioners volunteering their services to build a picnic shelter for their church.

Volunteers cannot receive compensation including stipends, room and board, and other “perks” that have monetary value. Money used solely to offset expenses incurred while performing activities for the nonprofit is not counted as stipends.

A religious organization that meets these exemption requirements can obtain a government issued permit, license or contract by completing and submitting form CE-200. If a religious organization does not meet the exemption requirements, it must provide proof of coverage on the approved forms in this manual.

For more information, see The Employers Handbook, available at: http://www.wcb.ny.gov/content/main/Employers/EmployerHandbook.pdfProve It to Move It New York State Workers' Compensation Board -- December, 2011 10

STATE & MUNICIPAL AGENCY COMPLIANCE WITH WCL §57

Section 57: Restriction on Issue of Permits and the Entering of Contracts unless Compensation Is Secured

Section 57 of the WCL requires the heads of all state and municipal entities, prior to issuing any permits, licenses or entering into contracts, to ensure that businesses applying for those permits, licenses or entering into contracts have appropriate workers’ compensation insurance coverage. This requirement applies to both original issuances and renewals, whether the governmental agency is having the work done or is simply issuing the permit, license or contract.

To comply with coverage provisions of the WCL, businesses must:

a) be legally exempt from obtaining workers’ compensation insurance coverage; or

b) obtain such coverage from insurance carriers; or

c) be a Board-approved self-insured employer

d) participate in an authorized group self-insurance plan.

To assist state and municipal entities in enforcing WCL Section 57, businesses requesting permits or seeking to enter into contracts must provide one of the following forms to the government entity issuing the permit or entering into a contract:

a) CE-200, Certificate of Attestation of Exemption from NYS Workers' Compensation and/or Disability Benefits Coverage;

b) C-105.2, Certificate of Workers’ Compensation Insurance. An insurance carrier will send this form to the government entity upon request. NOTE: The State Insurance Fund provides its own version of this form, the U-26.3; or

c) SI-12, Certificate of Workers’ Compensation Self-Insurance (the business calls the Board’s Self-Insurance Office at 518-402-0247), or GSI-105.2, Certificate of Participation in Workers’ Compensation Group Self-Insurance. A group self-insurance administrator will send this form to the government entity upon request.

d) Letter from the NYS Department of Civil Service indicating the applicant is a New York State government agency covered for workers’ compensation under Section 88-c of the WCL.

Please note: ACORD forms are not acceptable proof of workers’ compensation coverage.

Local Board Contacts for Government Officials

Government officials should call the Workers’ Compensation Board’s Enforcement Unit in the nearest district office to notify them of a non-compliant business:

Albany (518) 486-3349 Manhattan (212) 932-7576

Binghamton (607) 721-8179 Peekskill (914) 788-5804

Brooklyn (718) 802-6870 Queens (718) 523-8409

Buffalo (716) 842-2057 Rochester (585) 238-8335

Hauppauge (631) 952-6698 Syracuse (315) 423-1141

Hempstead (516) 560-7741

Please call the Board at (518) 486-6307 with any general questions regarding Section 57 of the workers’ compensation law.Prove It to Move It New York State Workers' Compensation Board -- December, 2011 11

Instructions for Form CE-200 (12/08)

Form CE-200, Certificate of Attestation of Exemption from NYS Workers' Compensation and/or Disability Benefits Coverage

(Form CE-200 replaces the old forms WC/DB-100, WC-DB-101 and C-105.21.):

Form CE-200 can ONLY be used to attest to a government entity that the applicant requesting a permit, license or contract from that government entity is not required to carry New York State specific workers’ compensation and/or disability benefits insurance.

IMPORTANT: These certificates cannot be used to waive the workers' compensation rights or obligations of any party. The applicant may NOT use this certificate to show either another business or that business’s insurance carrier that such insurance is not required.

If appropriate, the applicant requesting a permit, license or contract from a government entity must complete Form CE-200, print a copy of it, sign it and give it to the government entity issuing the permit, license or contract.

ATTENTION GOVERNMENT AGENCIES:

1. ONLY applicants eligible for exemption must file a new CE-200 for each and every new or renewed permit, license or contract issued by a government agency.

2. Each CE-200 must specifically list the issuing government agency and the specific type of permit, license or contract requested by the applicant. Government agencies must ensure that the legal entity name on Form CE-200 exactly matches the legal entity name applying for the permit, license or contract that is being issued. Form CE-200s are ONLY valid for the Government Agency listed on Form CE-200.

3. Applicants for building permits MUST supply additional information including identifying the specific job location and the estimated cost of the project.

4. Government agencies must also ensure that Form CE-200 is signed and dated by the applicant.

5. Each CE-200 will have a certificate number printed on it. Government agencies should verify if the CE-200 provided by the applicant was actually issued by the Workers’ Compensation Board. To verify a certificate of exemption, access the CE-200 application on the Board's website at: www.wcb.ny.gov. Click on the button entitled “WC/DB Exemptions Form CE-200” (In bright yellow letters). Click Verify WC/DB Exemption (Form CE-200), follow the prompts. The following is the hyperlink to the Verify Exemption Certificates (Form CE-200).

6. Government agencies must also verify that the business is eligible for the workers’ compensation and/or disability benefits exemption reason described on the CE-200 and notify the Board’s investigative staff if there are discrepancies (Board Enforcement Unit phone numbers are listed on page 10 of the instruction manual). For example, if you are licensing a 150 seat restaurant and the applicant indicates on the CE-200 exemption form that he/she is a sole proprietor with no employees, this may indicate a problem.

Prove It to Move It New York State Workers' Compensation Board -- December, 2011 12

ATTENTION APPLICANTS:

Please remember that applicants are submitting the CE-200 under penalty of perjury, a felony carrying a penalty of four years of jail time. Applicants are attesting that the information contained in the CE-200 is accurate – the Board does not initially verify this information. However, the Board may investigate entities using this certificate to claim exemption from the coverage requirements of the Law. Any false statement, misrepresentation or concealment will subject business owners to felony criminal prosecution, including jail and civil liability in accordance with the Workers' Compensation Law and all other New York State laws.

To make this process as easy and as efficient as possible for business owners, the vast majority of these forms will be processed electronically on-line. Applicants with access to the internet will be able to fill out the CE-200 on the internet and immediately upon completion, be able to print out a hard copy of the CE-200 that they will then submit to the government agency issuing the permit, license or contract. Computers with internet access are also available for CE-200 electronic application processing at Customer Service Centers located in Workers’ Compensation Board District Offices.

Filling out the electronic Form CE-200 on the internet is very similar to filling out a hotel reservation request on the internet for frequent travelers. Applicants will be issued a pin number and a password (Mother’s maiden name) so that they can easily access their information. Once an applicant enters his/her basic information on the Board’s website, it can be retrieved by that applicant in the future by using that pin number and password when the applicant is applying for another permit, license or contract.

Applicants without access to a computer may obtain a paper application by writing or visiting any Workers’ Compensation Board district office, or by calling 866-298-7830. Applicants are strongly encouraged to use the Board’s electronic web program since they can receive their Form CE-200 immediately, whereas the manual paper filing may take up to four weeks to process. Once the applicant receives the CE-200, the applicant can then submit that CE-200 to the government agency from which he/she is getting the permit, license or contract. This delay results from Workers’ Compensation Board staff having to manually enter information from the applicant’s paper application into the web based application. Accordingly, to avoid delays, all applicants for exemptions are strongly encouraged to use the on-line Form CE-200 on the Board’s website, www.wcb.ny.gov. Click on the button entitled “WC/DB Exemptions Form CE-200” (In bright yellow letters).Prove It to Move It New York State Workers' Compensation Board -- December, 2011 13

Instructions for Obtaining Form CE-200

The CE-200 is now an on-line application. Please remember that applicants are submitting the CE-200 under penalty of perjury, a felony carrying a penalty of four years of jail time. Accordingly, all statements on the CE-200 must be true.

Applicants may access the CE-200 application on the Board’s website: www.wcb.ny.gov

1. Click on the button entitled “WC/DB Exemptions Form CE-200” (In bright yellow letters).

2. Click on Request for WC/DB Exemption (Form CE-200).

3. Click the gray button on the bottom (Select to Access Web-based Application).

4. Applicants should create their own PIN number (a number that they will remember in the future, such as a birthday).

5. Follow the rest of the prompts.

It should only take about five minutes to fill it out the first time. Applicants should print, sign and date Form CE-200 and send it to the government agency issuing their permit, license or contract from.

If the applicant is having difficulty in printing the CE-200, please call the Board’s CE-200 Hotline at 866-546-9322, then press 1 and then press 3, and leave a voice message with the certificate number, the name of the business and a contact phone number. The CE-200 will be sent to the business address on the CE-200 within one business day.Prove It to Move It New York State Workers' Compensation Board -- December, 2011 14

Form CE-200Prove It to Move It New York State Workers' Compensation Board -- December, 2011 15

Instructions for Form C-105.2 -- Certificate of NY Workers’ Compensation Insurance from Private Insurance Carriers

1. Applicants covered by private New York licensed insurance carrier should contact their carrier or their licensed New York (NY) insurance agent of that carrier to obtain a C-105.2.

2. The C-105.2 is only issued by private insurance carriers that are licensed to write NYS workers’ compensation insurance and their licensed NY insurance agents. Insurance brokers are not authorized to issue it. Form C-105.2 may not be used to show proof that an insured is insured by the State Insurance Fund.

3. The authorized representative or licensed agent of the insurance carrier must print his/her name, title and telephone number and sign Form C-105.2.

4. To issue Form C-105.2, NY must be listed at Item 3A on the information page of a workers’ compensation insurance policy.

5. Form C-105.2 can be required by government agencies and by private businesses to show proof of New York workers' compensation insurance coverage.

6. Form C-105.2 can be used for multiple permits, licenses or contracts that a business has with a specific government agency.

7. Unless the insurer notifies the government agency (listed as the certificate holder in Box 2 on the C-105.2) that the policy has been cancelled, the C-105.2 is valid for the earlier of one year after this form is approved by the insurance carrier or its licensed agent, or the policy expiration date listed in box “3c".

8. The Insurance Carrier will notify the certificate holder (listed in Box 2 on Form C-105.2) within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.)

9. Upon the cancellation of the workers’ compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certificate of Workers’ Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers’ Compensation Law.

10. Only one legal name and Federal Employer Identification Number can be listed on each Form C-105.2. Multiple legal entities MUST NOT be listed. The NYS Unemployment Insurance Employer Registration Number of an insured is not required.

11. The legal entity name and the Federal Employer Identification Number (FEIN) on Form C-105.2 MUST exactly match the legal entity name and FEIN of the applicant applying for the permit, license or contract that the government agency is issuing.

12. Municipalities cannot demand the address of the insured listed in Box 1a be in their municipality. New York State workers’ compensation policies cover all locations that a business works.

13. Form C105.2 is only valid for the government agency listed as the Certificate Holder in Box 2 on that form. Municipalities issuing permits licenses or contracts must not accept Form C-105.2s that have another municipality’s address listed as the certificate holder.

14. Coverage contained on the certificates may be verified. To verify a Certificate of Insurance, visit the Board's website: www.wcb.ny.gov. Go to the blue question mark at the bottom of the page (Does Employer Have Coverage). Enter the information and see if the coverage matches. If coverage does not match, please call 518-486-6307.

Prove It to Move It New York State Workers' Compensation Board -- December, 2011 16

Form C-105.2Prove It to Move It New York State Workers' Compensation Board -- December, 2011 17

Instructions for Form U-26.3 – Certificate of NY Workers’ Compensation Insurance from the New York State Insurance Fund

1. Businesses insured by the New York State Insurance Fund (NYSIF) may obtain a U-26.3 at the Fund’s website: www.nysif.com. Click on Create/Validate Certificate of Insurance and follow the prompts. Please contact the NYSIF Customer Service Center at 888-875-5790 if you have any questions.

2. Form U-26.3 is only issued by the New York State Insurance Fund. Licensed insurance agents and insurance brokers are not authorized to issue it.

3. Form U-26.3 indicates that the insured is fully covered by a New York workers’ compensation insurance policy and that NY is listed on Item 3A of the information page on a workers’ compensation insurance policy issued by the New York State Insurance Fund.

4. Form U-26.3 can be used for multiple permits, licenses or contracts that a business has with a specific government agency.

5. Unless the New York State Insurance Fund notifies the government agency (listed as the certificate holder) that the policy has been cancelled, the U-26.3 is valid for the earlier of one year after this form is approved by the insurance carrier or its licensed agent, or the policy expiration date listed on the U-26.3.

6. The New York State Insurance Fund will notify the certificate holder within 10 days if a policy is canceled. (These notices may be sent by regular mail.)

7. Upon the cancellation of the workers’ compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certificate of Workers’ Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers’ Compensation Law.

8. Only one legal name and Federal Employer Identification Number can be listed on each Form U-26.3. (Multiple legal entities MUST NOT be listed.)

9. The legal entity name and the Federal Employer Identification Number (FEIN) on Form U-26.3. MUST exactly match the legal entity name and FEIN of the applicant applying for the permit, license or contract that the government agency is issuing. The FEIN number is the number above the State Insurance Fund address above Policy Holder on Form U-26.3. (Please note the State Insurance Fund blocks Social Security numbers from appearing on this form. Employers that only have a Social Security number will not show anything under an FEIN, and this is acceptable. Coverage for legal entities that only have a Social Security number can be confirmed solely based on an exact legal name match.)

10. Municipalities cannot demand the address of the insured on Form U-26.3 be in their municipality. New York State workers’ compensation policies cover all locations that a business works.

11. Form U-26.3s are only valid for the Government Agency listed as the Certificate Holder. Municipalities issuing permits, licenses or contracts must not accept Form U-26.3s that have another government agency’s address listed as the certificate holder.

12. Coverage contained on the U-26.3 certificates may be verified. To verify a Certificate of Insurance, visit www.nysif.com. Click on Create/Validate Certificate of Insurance. If coverage does not match, please call 518-486-6307.

Prove It to Move It New York State Workers' Compensation Board -- December, 2011 18

Form U-26.3Prove It to Move It New York State Workers' Compensation Board -- December, 2011 19

Instructions for Form SI-12 -- Certificate of Workers’ Compensation Self- Insurance

1. Employers that are authorized as fully self-insured for New York State workers’ compensation may obtain Form SI-12 by calling the Board’s Self-Insurance Office at 518-402-0247.

2. Form SI-12 is only issued by the Self-Insurance Office of the NYS Workers’ Compensation Board. Insurance brokers and insurance agents are not authorized to issue it. Only legal entities that are authorized by the Workers’ Compensation Board as fully self-insured are eligible for Form SI-12.

3. Form SI-12 indicates that the listed legal entity is fully covered for workers’ compensation in New York State.

4. Form SI-12 can be required by government agencies and by private businesses to show proof of New York workers' compensation insurance coverage.

5. Form SI-12 can be used for multiple permits, licenses or contracts that a business has with a specific government agency.

6. Form SI-12 is valid for one year after this form is approved by the Secretary of the NYS Workers’ Compensation Board.

7. Only one legal name and Federal Employer Identification Number can be listed on each Form SI-12. (Multiple legal entities must not be listed.)

8. The legal entity name and the Federal Employer Identification Number (FEIN) on Form SI-12 MUST exactly match the legal entity name and FEIN of the applicant applying for the permit, license or contract that the government agency is issuing.

9. Municipalities cannot require the address of the self-insured entity to be in their municipality. New York State workers’ compensation covers all locations that a business works.

10. Coverage contained on the certificates may be verified. To verify a SI-12 go to the Board's website: www.wcb.ny.gov. Go to the blue question mark at the bottom of the page (Does Employer Have Coverage). Enter the information and see if the coverage matches. If coverage does not match, please call 518-486-6307.

Prove It to Move It New York State Workers' Compensation Board -- December, 2011 20

Form SI-12Prove It to Move It New York State Workers' Compensation Board -- December, 2011 21

Instructions for Form GSI-105.2 -- Certificate of Participation in New York State Workers’ Compensation Group Self-Insurance

1. Form GSI-105.2 is only issued by administrators of Group Self-Insurance Plans. Insurance brokers and insurance agents are not authorized to issue it.

2. The Group Self-Insurance Plan Administrator’s authorized representative must print his/her name, title and telephone number and sign Form GSI-105.2.

3. Form GSI-105.2indicates that the listed legal entity is fully covered for workers’ compensation in New York State.

4. Form GSI-105.2 can be required by government agencies and by private businesses to show proof of New York workers' compensation insurance coverage.

5. Form GSI-105.2 can be used for multiple permits, licenses or contracts that a business has with a specific government agency.

6. Unless the Group Self-Insurance Plan Administrator notifies the government agency (listed as the certificate holder in Box 2 on the Form GSI-105.2) that the policy has been cancelled, the Form GSI-105.2 is valid for one year from the date certified by the Group Self-Insurer.

7. The Insurance Carrier will notify the certificate holder (listed in Box 2 on Form GSI-105.2) within 10 days IF a policy is canceled. (These notices may be sent by regular mail.)

8. Upon the cancellation of the workers’ compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certificate of Workers’ Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers’ Compensation Law.

9. Only one legal name and Federal Employer Identification Number can be listed on each Form GSI-105.2. Multiple legal entities MUST NOT be listed. The NYS Unemployment Insurance Employer Registration Number of an insured is not required.

10. The legal entity name and the Federal Employer Identification Number (FEIN) on Form GSI-105.2 must exactly match the legal entity name and FEIN of the applicant applying for the permit, license or contract that the government agency is issuing.

11. Municipalities cannot demand the address of the insured listed in Box 1a be in their municipality. New York State workers’ compensation policies cover all locations that a business works.

12. GSI-105.2s are ONLY valid for the Government Agency listed as the Certificate Holder in Box 2 on Form GSI-105.2. Municipalities issuing permits licenses or contracts must not accept Form GSI-105.2s that have another municipality’s address listed as the certificate holder.

13. Coverage contained on the certificates may be verified. To verify a Certificate of Insurance, go to the Board's website: www.wcb.ny.gov. Go to the blue question mark at the bottom of the page (Does Employer Have Coverage). Enter the information and see if the coverage matches. If coverage does not match, please call 518-486-6307.

Prove It to Move It New York State Workers' Compensation Board -- December,

§15-8 is a section of the NYS WC law relating to disability following previous permanent physical impairment. §15-8 no longer applies for loss dates after June 30, 2007.   

§25-A is a section of the NYS WC law that applies to cases closed (NFA), in which the date of accident is more than seven (7) years ago, and in which the date of the last indemnity payment is more than three (3) years ago. If the WCB establishes 25-A, then medical and indemnity payments will be made by Special Funds Conservation Committee, and not the employer or insurance carrier.

A-Rate

An "A-Rated Classification" is a classification with no predefined manual rate shown in the rate pages of the NYCIRB Manual.

Accident Date

Refers to either (a) the date the accident is deemed to have occurred or (b) the date of onset assigned to an occupational disease.  The accident date is officially established by a WCLJ.

Accident Notice and Causal Relationship (ANCR)

The finding made by WCLJ that the claimant sustained an accidental injury arising out of and in the course of employment; that timely notice was given to the employer; and that the disability is causally related to the accidental injury. (WC law § 2, Sub. 7; § 18)

Accident (Work Related)

An event, arising out of and in the course of employment, which results in personal injury to a worker.

Actuary

A person who calculates insurance and annuity premiums, reserves and dividends.

Adjourn (a hearing)

The Workers' Compensation Board WCLJ can put off or suspend until a future time, without making any findings.

Adjusted manual rate premium

A premium level charged a risk under a NYSIF workers' compensation policy, produced by applying an experience modification to the manual rate premium on either a deposit premium bill or an audit bill.

ADL

Activities of Daily Living.

Administrative Decision (AD)

In an effort to reserve the hearing calendar process for more complex cases, the WCB can make determinations on cases outside of the regular hearing process by administrative decisions.

Admiralty Law

The Merchant Marine Act of 1920 also known as the Jones Act (46 U.S. Code, § 688). This federal law, which is part of Admiralty Law, provides that masters and members of crews of vessels have the right to sue their employers for damages in Admiralty Courts for injuries sustained in the course of employment.

Advocate for Business

The New York State Workers' Compensation Board Advocate for Business assists employers by resolving problems and answering questions about the New York State workers' compensation system.

Advocate for Injured Workers

The New York State Workers' Compensation Board Advocate for Injured Workers accepts complaints concerning matters related to workers' compensation, and investigates and attempts to resolve them. In addition, the Advocate provides information to injured workers to enable them to protect their rights in the workers' compensation system.

Affidavit

A written statement under oath or affirmation made or taken before an officer having authority to administer such oath.

Aggregate Trust Fund (ATF)

A trust fund established in 1935, under NYS WC law § 27, entrusting NYSIF as the administrator for the Trust to assure payment of workers' compensation in claims involving permanent partial disability, permanent total disability, the loss of major members (limbs or eyes) and fatal injuries.

Anniversary Date

The date each year upon which the policy is renewed; usually based on the original inception date.

Appeal (Workers' Compensation)

A legal action taken by one of the parties to reverse or amend a decision or direction made by a WCLJ, WCB board panel or the WCB Chair.

Applicant

The person or entity requesting insurance.

Apportionment

A proportionate division of all or part of the liability in a case between two or more sources of disability for the same claimant. Apportionment can involve another NYSIF case, another carrier's case, or a prior existing medical condition of the claimant.

Arbitration

The adjudication process that determines the fair value of a disputed medical bill rendered by a physician, chiropractor, physical therapist, occupational therapist, podiatrist, or psychologist authorized to render treatment under the WC law.

Arising Out of and in the Course of Employment

Two necessary conditions that must be met to establish a work-connected accidental injury. (WC law § 2, Subd. 7)

Assignment of Interest

The transfer of an insurance policy from one person or entity to another.

Assured

See: insured

ATF (Aggregate Trust Fund)

See Aggregate Trust Fund

Attorney Fees

Fees approved by the WCB for claimant attorneys in workers' compensation cases, which will be a lien on the award.  (WC law §24)

Audit (NYSIF Premium)

The act of inspecting the accounting books, electronic accounts and tax records of a policyholder to determine the actual exposures, which existed during a specified period of time, in order to develop the proper premium.

Authorized Chiropractor

New York State licensed chiropractor authorized by the WCB Chair to render chiropractic care under the WC law within the limits prescribed by the Education Law.

Authorized Physician

New York State licensed physician authorized by the WCB Chair to render medical care or treatment under the WC law. (WC law § 13-b, Subd. 2)

Authorized Podiatrist

New York State licensed podiatrist authorized by the WCB Chair to render podiatry care or treatment under the WC law. (WC law § 13-k)

Authorized Psychologist

New York State licensed psychologist authorized by the WCB Chair to render psychological care under the WC law within the limits prescribed by the Education Law.

Authorized Representative

An individual or company whom the assured or applicant selects (in writing) to act as that assured's agent. Some common examples of an authorized representative are an insurance broker, an insurance agent, an attorney and an accountant. When the assured is in a Safety Group, the Group Manager automatically becomes the assured's representative.

Average Weekly Wage (AWW)

A calculation that reflects the employees' average pay rate used as a basis for determining benefits in workers' compensation insurance. (WC law § 14)

Award

Decision given by a WCLJ at a hearing to pay or not pay compensation and/or medical expenses to a claimant.

Binder

An agreement to furnish protection until an insurance policy can be issued. NYSIF does not use binders for workers' compensation coverage.

Board Panel Review

Where a WCLJ's decision is disputed, the aggrieved party may file an application for a review. (WC Law § 23, §224 and Board Rule 13)

Board Rates

The premium rates as defined by the New York Compensation Insurance Rating Board without any modification by a NYSIF discount or surcharge.

Broker

See: Insurance Broker

C-105

WCB prescribed form  "Notice of Compliance, WC Law"  informs employees at their place of employment of their rights under the WC law. Employers must obtain this form from their insurance carrier or licensed agent.

C-107

WCB prescribed form "Employer's request for reimbursement"

C-11

WCB prescribed form "Employer's Report of Injured Employee's Change in Employment Status resulting From Injury"

C-2

WCB prescribed form "Employers' Report of Work-Related Accident/Occupational Disease" filed by employers within 10 days after an accident occurs, as required by WC law § 110.

C-240

WCB prescribed form  "Employer's Statement of Wage Earnings (Preceding Date of Accident)" used to determine the claimant's average weekly wage.

C-250

WCB prescribed form  "Notice of Claim for Reimbursement Out of Special Disability Fund Under WC law §15-8."  A carrier cannot file a C-250 on cases with accident dates after June 30, 2007.

C-27

WCB prescribed form  "Medical Proof of Change in Condition in Support of Application for Reopening," filed in a closed case to show change in medical condition supporting the reopening of a claim.  

C-3

WCB prescribed form  "Employee's Claim for Compensation" that should be completed by the injured worker and submitted to the WCB within two years of the accident or onset date. The C-3 form contains much of the same information as the C-2.

C-32

WCB prescribed form  "Settlement Agreement for WC law §32"   

C-4

"Attending Doctor's Report and Carrier/Employer billing form" provides information about claimant identification, injury history, diagnosis, treatment, disability, causal relation of accident to disability, and degree of impairment.  The form includes procedures performed and billing charges.  The form is to be filed by the doctor within two days of initial treatment, with additional reports during continued treatment, including a final report.  http://www.wcb.state.ny.us/content/main/Forms.jsp

C-7

WCB prescribed form  "Notice That Right to Compensation is Controverted." If a carrier or self-insured employer is challenging a claim, they must file on or before the 18th day after disability or within 10 days after the employer first had knowledge of the alleged injury, whichever period is greater.

C-8.1

WCB prescribed form  "Notice of Treatment Issue/Disputed Bills" used to deny authorization for medical services or treatment and to object to a medical bill on the basis of necessity, causal relationship or other issues to be adjudicated by a WCLJ.

C-8 or C-8.6

WCB prescribed form  "Notice That Payment of Compensation has been Stopped or Modified." This notice must be filed by the insurance carrier or self-insured employer within 16 days after the date on which benefit payments were stopped or modified. C-8 is for Indemnity Benefits, and C-8.6 is for Death Benefits.

Cancellation

The act of terminating an insurance policy before its expiration date, either by the policyholder or by the company.

Carrier

An insurance company.

Carrier Case Number (CC#)

A unique identifier assigned by the insurance company at the time a case is created for a work-related injury or illness. This number is different than the WCB case number.

Causal Relationship

The connection between the claimant's injury or illness and the work-related accident or disease. (WC law § 2, Subd. 7)

Cause of Accident

Workers' Compensation Board definition: Object, substance or condition that directly contributed to the occurrence of an accident.

Certificate of Insurance

A document that provides evidence of the existence and terms of a particular policy.
Workers' Compensation Certificate of Insurance
Disability Certificate of Insurance

Certified Safety Consultant

Safety and health staff designated as New York State Certified Safety Consultants (CSC) by the New York State Department of Labor. This credential can be used only by those persons who have qualified for and been issued a verification under the Workplace Safety and Loss Prevention Program (Industrial Code Rule 59, NYS Workers' Compensation Law).

Chiropractic Fee Schedule

The schedule established by the WCB with charges and fees for chiropractic treatment and care furnished to workers' compensation claimants. (WC law  § 13-1)

Claim

A demand for an amount alleged to be due under an insurance policy following the occurrence or event against which the coverage protects.

Classification Code

A system of insurance risk classification based on industrial or occupational categories.

Classification Rate

See Rate

Clause

See  Endorsement 

CMS-1500

A uniform claim form created by the Centers for Medicare & Medicaid Services (CMS) used to bill for medical service rendered. (Formerly known as form HCFA-1500)

Compulsory

Required

Conciliation

A WCB process established to resolve, in an expeditious and informal manner (e.g. through meeting or telephone conferences), issues involving non-contested claims in which the expected duration of benefits is 52 weeks or less.  Failure to reach an agreement through the conciliation process results in the case being scheduled for a hearing.

Concurrent Employment

If a claimant has more than one job, the compensation rate is calculated by adding the wages from all of the claimant's jobs.

Consequential Accident

A second accident resulting from a prior accidental injury which arose out of and in the course of employment.  (WC law § 2, Subd. 7)

Continue (a Case)

Completion of a hearing on a case without closing the case, leaving additional matters to be resolved at a future hearing.

Controverted Claim

A claim challenged by the insurer on stated grounds.  The WCB sets a pre-hearing for the determination of the grounds and directs the parties to appear and present their case. (WC law § 25)

Coverage

Protection afforded by an insurance policy.

CPT

(Current Procedural Terminology) The CPT is a uniform coding system consisting of descriptive terms and identifying codes that are used primarily to identify medical services and procedures furnished by physicians and other health care professionals.

Death Benefit Award

 Awarded by the WCB when the death of a claimant is causally related to the accident that initiated the claim.  Benefits are payable in order of priority to: surviving spouse, then children, then all others with equal priority such as dependent parents, grandparents, grandchildren, brothers and sisters.  Dependency is determined as of the date of the accident.

Death Claim

Claimant died as a result of a work-related injury.

Debtor in Possession

This term refers to a debtor that keeps possession and control of its assets while undergoing a reorganization under chapter 11 of U. S. Bankruptcy Code, without the appointment of a case trustee.

Decision

Determination arrived at after consideration by the WCB. 

Declaration

A document issued by an insurance company on a new policy which contains specific information identifying the insured and the coverage afforded. Also known as a New Information Page.

Deductible

A policy provision that requires an insurer to only pay that amount of any loss which is in excess of a specified amount.

Deficiency Compensation

The compensation and medical benefits payable after the carrier has exhausted its credit against the claimant's net third party recovery.

Department of Insurance (NYS)

The Department of Insurance is responsible for supervising and regulating all insurance business in New York State.

Dependent

A person eligible to receive death benefits in a work related fatal injury case. (WC law § 15)

Deposition

Witness testimony ascertaining the facts.  Depositions are taken where witnesses cannot appear at a hearing before the WCB. The questions and answers are part of a proceeding before an official person. (WC law § 121; Board Rule 19)

Deviated Rates

Rates used which are different from those issued by a rating bureau (e.g. New York Compensation Insurance Rating Board)

Diagnostic Testing Network

A legally and properly organized network of providers or facilities that perform diagnostic tests, x-ray examinations, magnetic resonance imaging (MRI), or other radiological tests for claimants.

Differential

A premium rate charged by NYSIF that is greater than the sum of the loss cost in effect for the classification of employees and the applicable expense factor used by NYSIF.

Disability Benefits Insurance

New York State  disability benefits insurance provides temporary cash benefits paid to an eligible wage earner when he/she is disabled by an off the job illness or injury, and for disabilities arising from pregnancies. Employers with one or more employees are subject to the provisions of the New York State Disability Benefits Law. The Disability Benefits Law provides weekly cash benefits to replace, in part, wages lost due to illness or injury that do not arise out of or in the course of employment. Disability benefits include cash payments only. Medical care is the responsibility of the claimant. Medical care is not paid for by the employer or insurance carrier.

Disability Insurance Rates

Disability insurance rates are determined by each insurer and approved by the Superintendent of Insurance. Currently, NYSIF rates are .20 cents per male employee and .40 cents per female employee, per $100 of payroll to a maximum weekly payroll of $340 per employee.

Disability (Partial)

Disability which allows a claimant to engage in some kind of gainful employment.  The difference between the claimant's pre-accident earnings and post-accident earnings is determinative of the reduced earnings rate.  (WC law § 15, Sub.5, 5-a)

Disability (Total)

Disability which precludes a claimant from earning any wages. (WC law § 15, Sub.1,2)

Disfigurement

Serious and permanent disfigurement to the face, head or neck may entitle the injured worker to compensation up to a maximum of $20,000, depending upon the date of the accident.

Dividend

A portion of the premium which may be distributed to a Disability Policyholder or Safety Group policyholder.

Earning Capacity

The ability of a claimant, who has suffered a work-related disabling injury, to earn wages in the labor market.  (WC Law § 15, Sub. 5-a)

Effective Date

The date coverage begins on a policy.

eFROI

Employer's First Report of Injury via the Internet.  eFROI

Employee

One who, for a wage or salary, or as a volunteer, performs services for another under a contract of hire, acting under the direction and control of the person by whom she/he is hired. (WC Law § 2, WC Law § 201)

Employer's Liability

The responsibility of an employer to reimburse an injured employee for accidents occurring in the course of employment. Such liability is separate from and is in addition to any statutory liability created under Workers' Compensation Law. Employer's liability is usually insured by a separate section (1B) under a workers' compensation policy.

Endorsement

A form attached to a policy in order to modify its terms.

Entity

A person, partnership, corporation or political subdivision that can be shown as a named insured in a policy. A legal entity can be served with legal notice and sued in a court of law.

EOB

See Explanation of Benefits

Excess Loss Limit

Within the context of a NYSIF safety group, it is a monetary amount above which the remaining cost of a claim is paid by reinsurance or the NYSIF and is not deducted as a loss against a safety group's contingent balance or surplus.

Exclusion

A provision in an insurance policy that indicates what is denied coverage under that policy.

Exclusive Remedy

The legislature has established the Workers' Compensation Law as the exclusive remedy of an employee and his /her dependents in a death case, against the employer who has secured workers' compensation.  It is the sole recourse that the injured employee, dependents or representatives have against the employer for injuries or death resulting from a work-connected accident or occupational disease.  If an employer who is required to secure workers' compensation insurance fails to do so, the employee, if disabled due to a work-connected injury, has the right to elect to either claim workers' compensation or to maintain an action against the uninsured employer for damages. (WC Law § 11)

Executive Officer

A corporate president, vice-president, secretary or treasurer appointed in accordance with the charter or by-laws of such corporation.

Expense Constant

A policy fee charged on every WC policy, regardless of premium size, to compensate for the basic costs of administering the policy.

Expense Factor

See Loss Cost Multiplier.

Experience

The record of losses that is used in predicting future losses and in developing premium rates.

Experience Modification

A percentage higher than or less than 100% by which the Manual Rate Premium is increased (experience rate charge) or decreased (experience rate credit) when a risk is eligible for the Experience Rating Plan.

Experience Rating

A form of individual risk rating which takes into consideration the loss experience of the particular risk as a credit or a debit to the manual rate for the employer's classification.

Explanation Of Benefits (EOB)

An itemization of services provided, amount billed, amount paid, and an explanation of the difference for all payments included in a check (also known as 'draft').

Facial Disfigurement Award

An award of compensation for serious permanent facial or head disfigurement. (WC Law § 15, Sub. 3)

Final Adjustment (FA) Hearing

WCB hearing held in cases involving the loss or scheduled loss of extremities, sight, hearing, or facial disfigurement in which the principal issue is the extent of loss or loss-of-use. (WC Law § 15, Sub. 3)

Fraud

Any person who, knowingly and with intent to defraud, presents causes to be presented, or prepares with knowledge or belief that it will be presented to or by an insurer or purported insurer, or any agent thereof, any written statement as part of or in support of, an application for the issuance of or the rating of an insurance policy for compensation insurance or a claim for payment or other benefit pursuant to a compensation policy which he or she knows to (i) contain a materially false statement or representation concerning any fact material thereto, or (ii) omits any fact material thereto, shall be guilty of a class E felony.

FROI

An acronym used in the insurance industry for First Report of Injury.

Functional Capacity Evaluation (FCE)

Type of medical exam which helps to verify and determine a claimant's physical capacity.

Fund for Reopened Cases

A fund created under the WC law to assume liability for claims of compensation in certain "stale" cases where specified time limits have elapsed. (WC law §  25a, § 51, Volunteer Firefighters' Benefit Law and Volunteer Ambulance Workers' Benefit Law)

General Contractor

An individual or business firm who contracted to perform all or part of a specified job.

General Employer

The general employer is the regular or parent employer who makes the employee available to a special employer.  The general employer usually exercises indirect control.  Either may be liable for the compensation due to the injured employee. (WC law § 2, Sub.3,4)

General Liability Insurance

Coverage for an insured when negligent acts and/or omissions result in bodily injury and/or property damage to a third party.

Governing classification

The classification which describes the operations of the employer and produces the greatest amount of payroll.

Guaranteed Cost

A premium charged on a prospective basis, fixed or adjustable, or on a specified rating basis, but never on the basis of loss experience. In other words, the cost is guaranteed to the extent that it will not be adjusted based on the loss experience of the insured during the period of coverage. Contrast with Retrospective Rating.

Hazard

Situation or condition which either causes or increases chances of a peril taking place.

HCFA-1500

Obsolete form from the Health Care Financing Administration. Updated to a Centers of Medicare and Medicaid Services CMS-1500 Health Insurance Claim Form.

HCPCS

(Healthcare Common Procedural Coding System) HCPCS is a standardized coding system that is used primarily to identify products, supplies, and services not included in the CPT codes, such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies.

Hearing

The WC law provides that "no case shall be closed without notice to all interested parties and without giving to all such parties an opportunity to be heard." These "hearings" are held before a WCLJ who hears and determines claims for compensation for the purpose of ascertaining the substantial rights of the parties. (WC law § 20, 150)

Hearing Point

Locations where the WCB holds hearings.

HIPAA

The Health Insurance Portability and Accountability Act of 1996. A law enacted by Congress requiring the U.S. Health and Human Services Department to adopt  standards for transmission of information between parties while carrying out financial or administrative activities related to health care. These standards also must address security of protected health information.

Inception Date

The date on which coverage takes effect.

Incurred Cost

The total anticipated ultimate cost of a claim.  The incurred cost is the sum of all past payments and a reserve for all future payments.

Indemnity

The act of providing restitution for a loss or claim that has been discharged or paid by another liable party.

Indemnity Benefits

Compensation paid to the Workers' Compensation claimants for lost time resulting from an injury or illness. 

Independent Contractor

One who undertakes to do a specific job and retains control of the means, method and manner of performance.

Indexed Claim

A claim case folder that has been assembled and assigned a case number by the WCB Claims Unit. (WC law § 141)

Information Page

A document issued by an insurance company on a new policy which contains specific information identifying the insured and the coverage afforded. Also known as the Declaration page.

Insurance

A contractual arrangement under which one party agrees to indemnify another against loss or damage from an unknown event for a certain sum called a premium.

Insurance Agent

An insurance agent represents the insurance company and can enter into contractual obligations on the insurance company's behalf. NYSIF does not have insurance agents.

Insurance Broker

An insurance broker is someone licensed to represent an insurance applicant in the negotiating for insurance. Also see: Authorized Representative.

Insurance Fraud

A fraudulent insurance act is committed by any person who, knowingly and with intent to defraud, presents causes to be presented or prepares with knowledge or belief that it will be presented to or by an insurer or purported insurer, or any agent thereof, any written statement as part of, or in support of, an application for the issuance of, or the rating of an insurance policy for commercial insurance, or a claim for payment or other benefit pursuant to an insurance policy for commercial or personal insurance which he knows to: (i) contain materially false information concerning any fact material thereto; or (ii) conceal, for the purpose of misleading, information concerning any fact material thereto.

Insured

The person or entity to be indemnified by the insurer in the event of a covered loss or damage.

Joint and Several Liability

A condition where two or more persons or legal entities are jointly and severally responsible for an obligation.

Joint Venture

Two or more employers (usually contractors) who associate and collaborate for the purpose of undertaking one or more projects. The projects under taken by a Joint Venture are usually of a limited duration with specified objective(s).

Jones Act

The Merchant Marine Act of 1920 also known as the Jones Act (46 U.S. Code, § 688). This federal law, which is part of Admiralty Law, provides that masters and members of crews of vessels have the right to sue their employers for damages in Admiralty Courts for injuries sustained in the course of employment.

Judge

See Workers' Compensation Law Judge

Judgment

The final order or decision by a court or referee on a legal action.

Jurisdiction

The WCB has jurisdiction over cases with employment in New York State. Notable exclusions from WCB jurisdiction in NYS include: federal government workers and certain employees of local government. Workers covered by separate compensation systems under federal laws (maritime employment, merchant seafarers, interstate railroad employees, etc.) may elect to submit to NYS jurisdiction by waiving their federal rights and remedies. 

Liability

An obligation imposed by law or equity.

Licensed Representative

A person other than an attorney who is authorized by the WCB to represent claimants, or carriers before the WCB. (WC law § 24a, 50-3b, 225, Board Rule Licenses)

Limited Partnership

A partnership formed by two or more persons, having as members one or more general partners and one or more partners limited in his or her obligation for the debts of the firm to the amount of his or her capital contribution and limited in his or her right or power to take part in the control of the business.

Limit of Liability

The maximum monetary sum payable under an insurance policy.

Longshore and Harbor Workers' Compensation Act

Federal law which provides for payments of compensation and other benefits to employees such as longshoreman, harbor workers, and ship repairers.  It applies to such employees while working on navigable waters, adjoining piers, and terminals.  It does not cover members of a crew of a vessel.  U.S. Code (1946), Title 33  §  901-950.

Loss Cost

The portion of a premium rate that represents the anticipated costs of claims and associated loss adjustment expenses, including one or more trend factors, but which does not include provisions for insurer-specific expenses such as acquisition costs, overhead and taxes, or profit. Loss costs are based on loss data provided by all workers' compensation insurers and are filed by the rate service organization for workers' compensation (the New York Compensation Insurance Rating Board) with the New York State Insurance Department.

Loss Cost Multiplier

The portion of the premium rate not included in the loss costs filed by the rate service organization for workers' compensation (the New York Compensation Insurance Rating Board), which includes insurer-specific expenses such as acquisition costs, overhead, taxes and profit.

Loss Ratio

The losses incurred expressed as a percentage of earned premium.

Loss Reserves

Funds set aside for the payment of losses which have been incurred, but are not yet due.

Lost Time

This is the time lost from work directly related to a workers' compensation claim. A claimant is not entitled to lost time wages ( Indemnity Benefits) until after the statutory waiting period of seven (7) days.

Lump Sum Settlement

A negotiated and WCB approved agreement between a claimant with a non-schedule permanent partial disability and the insurer(s).  As a result of the agreement the claimant receives a sum of money representing all future compensation for his/her disability, and the case is considered closed.  WC law §15(5-b)

Managing Agent

A person or organization appointed by the owner of a property (usually a landlord) to act on his or her behalf, usually in collection of rents or maintenance of the property.

Manual Rate Premium

Premium level charged to a risk under a workers' compensation policy, produced by totaling the product of the classification code rates, by the unit upon which premiums for that code is determined.

Manual Rates

The listed premium, stated as dollars per $100 of weekly earnings for each employee, in a state's current schedule; in New York the manual rates are linked to the Classification Code system (i.e., rates are stated for each work classification code used in the state).

Maximum Medical Improvement (MMI)

Based on medical judgement the claimant has recovered from the work injury to the greatest extent that is expected and no further change in condition is expected.  A finding of maximum medical improvement is a normal precondition for determining the permanent disability level of a claimant.

Medical Benefits

Medical treatment provided, under the WC law, to injured workers as a result of injuries arising out of and in the course of employment.

Medical Fee Schedule

The schedule established by the WCB Chair of charges and fees for medical treatment and care furnished to workers' compensation claimants. (WC law § 13, Sub. A)

Medical Treatment

Care (other than first aid) administered by a physician, chiropractor or podiatrist or on a physician's referral, by a psychologist, or physical or occupational therapist.

Minimum Premium

The least amount required in order for a policy to be issued.

Motion Calendar Hearing

The Motion Calendar has been replaced by the  Administrative Decision process. A Motion Calendar case was previously a case with no controversy or outstanding issue.

Named Insured

The person or entity named in a policy as being protected by such policy.

National Council on Compensation Insurance (NCCI)

An association of WC insurers which serves as the WC rating organization in about two-thirds of the states.  The group establishes standards for use in rate making, develops policy forms, collects statistics, and provides statistical support and services.

National Drug Code

The National Drug Code (NDC) is a unique code that identifies the vendor (manufacturer), product and package size of a drug recognized by the Food and Drug Administration.

National Institute for Occupational Safety and Health (NIOSH)

An agency within the U.S. Department of Health and Human Services.  Part of the Center for Disease Control and Prevention and is generally responsible for conducting research and making recommendations for the prevention of work-related illnesses and injuries.

National Provider Identifier (NPI)

Standard unique identifier that must be used by health care providers for electronic health care transactions covered under HIPAA.

Negligence

An act or omission in which there is a failure to use the ordinary care that a prudent person ought to use under the circumstances. Negligence can cause or create a legal liability.

New York Compensation Insurance Rating Board (NYCIRB)

An association of workers' compensation insurers licensed by the Superintendent of Insurance as the rate service organization (RSO) for workers' compensation in New York. It collects and analyzes loss data and, as the designated RSO, files loss costs with the Insurance Department for rate making purposes. It also administers experience rating and classifications of employers for determining premium. As RSO for workers' compensation, NYCIRB is governed by a board of nine voting members including four representing private insurers writing workers' compensation insurance, one NYSIF representative, a member appointed by the Superintendent of Insurance and one member each, subject to the approval of the Superintendent of Insurance, appointed by the Workers' Compensation Board, the Business Council of New York State, and the New York State AFL-CIO.

No Compensable Lost Time (NCLT)

Claimant has not lost time from employment beyond the statutory waiting period (the first seven days of disability) as a result of work related injuries. (WC Law § 12)

No Further Action (NFA)

A decision of no further action (NFA) is based on a  WCLJ determination that no issues need to be adjudicated by the WCB at the time of the finding. If or when further WCB action is required, a hearing must be requested by one of the parties to the claim.

No Lost Time (NLT)

Claimant has not lost time from employment beyond the date of the accident as a result of a work-related injury.  (WC Law § 12)

Non-Insurer

An employer who has failed to provide for the payment of benefits to  employees under the WC law or under the Disability Benefits law. (WC law § 50, 220)

Notice (VFFBL & VAWBL)

Under the Volunteer Firefighters' Benefit Law and the Volunteer Ambulance Workers' Benefit Law, notice of injury or death must be given by the injured volunteer firefighter or ambulance worker or dependents within 90 days after the injury or death.

Notice (WC Law)

Employees who are injured on the job must give their employers notice in writing of the occurrence as soon as possible but not later than 30 days thereafter.  The WCB may excuse the failure to give notice on the ground that notice for some sufficient reason could not have been given on the ground that the employer had knowledge of the accident or on the ground that the employer had not been prejudiced thereby. In addition, a claim must be filed with the WCB within two years.  Failure to file a claim may bar an award of compensation unless the employer has made advance payments to the injured worker or has failed to raise the issue at the first hearing at which all parties were present. (WC law § 18, 28, 40, and 45)

NYCIRB

See New York Compensation Insurance Rating Board

NYSIF Claim Number

NYSIF's carrier case number also known as a claim number or loss id (e.g. 12345678 - 123 ).  The last three numbers is typically the NYSIF claim unit handling this claim.

Occupational Disease (OD)

A disease arising from employment conditions for a class of worker, with the disease occurring as a natural incident for particular occupations, distinct from and exceeding the ordinary hazards and risks of employment.  To be considered an occupational disease, there must be some recognizable link between the disease and some distinctive features of the worker's job. (WC law § 2 (15), 3(2), 37)

OSHA

Occupational Safety and Health Act of 1970. Under this federal law, the US Department of Labor has responsibility of formulating safety and health standards for all businesses engaged in interstate commerce. www.osha.gov

Partial Disability

Disability which allows a claimant to engage in some kind of gainful employment.  The difference between the claimant's pre-accident earnings and post-accident earnings is determinative of the reduced earnings rate.  (WC law § 15, Sub.5, 5-a)

Party of Interest (POI)

The claimant (claimant's attorney), employer (employer's representative) , medical provider, carrier and may also be any statutory fund that may be liable in the particular case.

PBM

See  Prescription Benefits Manager

Permanent Partial Disability (PPD)

Part of the employee's wage-earning capacity has been permanently lost on the job.  Benefits are payable as long as the partial disability exists, except for schedule loss of use.  If there are no reduced earnings as the result of the partial disability, only medical benefits are payable.

Permanent Partial Disability (PPD) Cap

The maximum number of weeks of compensation, from 225 to 525, that a claimant classified as PPD may receive, based on percentage finding of lost earning capacity. The cap applies only to non-scheduled PPD cases with a date of accident on or after March 13, 2007.

Permanent Partial Disability (PPD) Extreme Hardship

An Extreme Hardship redetermination may be made in a capped PPD case where the claimant was classified with a finding of lost earning capacity which exceeds 80%. The claimant may request a reclassification at the WCB for a  Permanent Total Disability (PTD) or Total Industrial Disability (TID).  (WC Law § 35)

Permanent Total Disability (PTD)

The employee's wage-earning capacity is permanently and totally lost.  There is no limit on the number of weeks payable.  In certain instances, an employee may continue to engage in business or employment, if his/her wages, combined with the weekly benefit, do not exceed the maximums set by law.

Physical Hazard

A physical hazard is a feature in the construction, maintenance, use or condition of a work location that creates the possibility of an accident.

Policyholder

A party to whom a policy is issued, and who pays a premium to an insurer in consideration of the latter's promise to provide insurance protection.

Policy Number

The number that is assigned to your insurance policy.

Policy Year

The year commencing with the effective date of a policy or with the renewal date of that policy, to be distinguished from calendar year, which always starts January 1.

PPD

See Permanent Partial Disability.

PPO

See Preferred Provider Organization.

Pre-Existing Condition

Injuries, sickness or medical conditions existing prior to the injury or onset of the occupational disease.

Preferred Provider Organization (PPO)

Network of medical providers that renders services (at contracted rates) for the treatment of workers' compensation injuries and illnesses to employees of participating policyholders.

Pre-Hearing Conference

If a case is controverted, the WCB must schedule a pre-hearing conference before a WCLJ judge within 60 days of the receipt of notice of controversy from carrier or employer.  This hearing is for the purpose of identifying witnesses, limiting issues and, if possible, to establish the case upon the agreement of the parties

Premium

The rate that an insured is charged reflecting their expectation of loss or risk.

Prescription Benefits Manager (PBM)

A network of pharmacies and mail order services under the direction of an organization, which provide prescription benefits under contract or agreement with a carrier or employer.

Primary Insurance

Insurance that responds first to a claim (i.e., it provides coverage on a first-dollar basis), sometimes subject to a deductible.

Professional Employer Organizations (PEO)

Professional Employer Organizations (PEOs) are employee leasing firms that provide long-term or ongoing employee leasing to client businesses. PEOs must be registered with the New York State Department of Labor in accordance with Article 31 of NYS Labor Law.

Protection and Indemnity Insurance

Broad form of marine liability insurance that covers the operator of a ship for such things as liability to crew members and other individuals on board the vessel, and for damage to fixed objects, such as docks, resulting from the insured's negligence.

Protracted Healing Period

In the case of temporary total disability and permanent partial disability both resulting from the same schedule injury, if the period of temporary total disability continues for a longer period than the normal healing period as set forth in WC law §15, Sub. 4-a, the period of temporary total disability in excess of such normal healing period is added to the schedule award. (WC law §15, Sub. 4-a, WC law and § 9, VFBL and VAWBL)

Rate

Cost of insurance per unit used as a means or base for the determination of premium.

Rate Service Organization (RSO)

A Rate Service Organization (RSO) is an entity designated by the Superintendent of the New York State Department of Insurance for the collection and analysis of workers' compensation data.

Rating Date

The anniversary rating date is the effective month and day of the policy in effect and each annual anniversary thereafter unless a different date has been established by the Rating Board. Normally the anniversary rating date is the same as the policy effective date. However, the rating date can be different from the policy effective date, e.g., if a policy has been short termed on an experience rated policy for which the rating date remains the same. The rating date determines which rates are to be applied for a given period regardless of the policy anniversary date.

Reduced Earnings (RE)

A compensation rate based on the claimant's reduced earning or reduced earning capacity due to a condition related to a compensable injury (WC law § 15).

Rehabilitation

The process of restoring injured workers to productive employment through physical means, medical procedures, vocational retraining, selective placement, and social readjustment.  Rehabilitation is an integral part of the medical care and other services furnished a claimant under the law. (WC law  §13, Sub. a)

Remarriage Award

An award of two years' compensation paid in a lump sum, to the surviving widow or surviving widower of a fatally injured worker upon his or her remarriage. (WC law § 16, Sub. 2)

Renewal

A document issued by an insurance company extending the terms of a policy for a subsequent period of time. It reestablishes the in-force status of a policy. All NYSIF policies with in-force status are automatically renewed unless instructed otherwise by the policyholder or their representative.

Reopened Case

A case that has been closed by a WCLJ or the WCB, and is subsequently made active again to determine the claimant's eligibility for benefits. (WC law §  22, 23, and 224)

Rescind (a Decision)

A WCB Panel memorandum of decision which voids or annuls a WCLJ decision.  Decisions to rescind are usually issued without prejudice in order to allow the parties to present evidence or testimony not previously presented to a WCLJ.

Reserve

The amount of money set aside to pay the potential future cost of a claim.

Retrospective Rating

An insurance plan for which the final premium is not determined until the end of the coverage period and is based on the insured's own loss experience for that same period.

Risk

The entity, property or other exposure to be insured.  Also used to signify uncertainty about financial loss.

Return to Work (RTW)

A Return to Work program is a written plan designed to get employees back to work as soon as medically possible following an on-the-job injury or illness, and can be initiated by either the employer or the carrier. It is mutually beneficial to both employees and employers.

Safety Group

Safety Group is a loss sensitive insurance program that enables employers in the same industry to pool their insurance premiums with the goal of reducing the cost of workers' compensation insurance.

Schedule Award

An award made by the WCB when the claimant suffers the loss of use of an extremity, sight, hearing, or facial disfigurement, regardless of lost time. A table of scheduled awards, listing body parts and percentage of loss, is used to determine the number of weeks of compensation. (WC law §15, VFBL §10, VAWBL §10)

Scheduled Loss of Use (SLU)

Permanent physical or functional impairment to an extremity, loss of hearing or sight, or in a facial disfigurement.

Schedule Loss

The number of weeks of compensation payable for permanent partial disability due to the loss of use of certain members of the body or organs as listed in WC law § 15, VFBL § 10, VAWBL § 10.

Second Injury Fund

Unofficial name for the Special Disability Fund established to encourage employers to hire workers with physical handicaps. When workers with pre-existing conditions suffer further work-related injuries, or disease, that results in a greater disability, the employer, through the insurer, is responsible for only part of the benefits. The Second Injury Fund is responsible for the rest (WC law § 15, Sub. 8). This provision no longer applies for loss dates after June 30, 2007. 

Second Injury Law

This law is designed to encourage the employment of people with disabilities by limiting the liability of an employer in the event of the injured worker sustaining a permanent disability due to work connected injury. (WC law § 15, Sub. 8)

Section 32 Settlement

WC Law § 32 Waiver Agreement.  § 32 waiver agreements allow for complete, full and final resolution of a WC claim.

Self-Insurance

A method by which an employer or group of employers may secure the payment of workers' compensation or disability benefits for its employees by depositing securities, cash, letters of credit or a surety bond in an amount required by the WCB Chair. (WC law § 50, § 211)

Short Rate Cancellation

Termination of a NYSIF WC policy before its normal expiration date which in turn causes a refund of premium which is less than that which would ordinarily be due to the insured for the proportion of time that coverage was in force.

Sole Proprietorship

Individual ownership of a business or other institution.

Special Funds

Funds established under the WC law to assure payments of benefits associated with claims, usually by transferring all or part of the liability to Special Funds. (WC law § 15-8, § 25-a, § 15-9, § 25-b, § 26-a, § 107, § 214 and § 319)

Special Funds Conservation Committee (SFCC)

The Special Funds Conservation Committee was established in 1938 for the purpose of maintaining and defending the Special Disability Fund and the Fund for Reopened Cases under § 15-8 and § 25-a of the Workers' Compensation Law.

Subcontractor

An individual or business firm contracting to perform part of or all of another's contract. See Independent Contractor, General Contractor.

Subpoena

A legal writ commanding a designated person to appear and give testimony at a compensation hearing under penalty for failure to do so.  The Chair, Board Members, Judges, officers of the WCB designated by the Chair and any attorney may sign and issue a subpoena, or a subpoena duces tecum, the latter requiring the production of records. (WC law § 119, 142 -3, 231)

Subrogation

The right of a secondary party (e.g., insurance company) to stand in the place of another (e.g., a policyholder or claimant) after making payment to a creditor (e.g., claimant) to enforce the creditor's right against the party primarily liable for such payment in order to obtain indemnity from such primary party.

Symptomatic Treatment

Medical treatments aimed at providing relief from the symptoms of a disease or injury, rather than providing a permanent remedy to the underlying condition.

Temporary Partial Disability (TPD)

The wage earning capacity is lost only partially, and on a temporary basis.

Temporary Reduced Earnings (TRE)

A temporary reduced earnings rate of compensation pending adjudication of the actual amount of reduced earnings or the determination of the claimant's reduced wage earning capacity.

Third Party Action

In workers' compensation cases, the term often refers to lawsuits against parties such as equipment manufacturers, facility owners and other non-employer entities whose products or services contributed to the occurrence of an accident.

Third Party Administrator (TPA)

An independent organization that has been contracted to administer identified services. These services may include claims administration, premium collection, enrollment and other administrative functions.

Third Party Settlement

When a claimant's work related injury is the result of negligence or wrongdoing of a party other than the employer or a fellow employee, the claimant may sue.  A carrier that has paid compensation or disability benefits has a lien on any sums recovered in a third party action. (WC law § 20, 29, 227 and VFBL and VAWBL)

Total Disability

No wage earning capacity. (WC Law § 15, Sub. 1,2)

Total Industrial Disability (TID)

Complete loss of earning capacity due to claimant's permanent partial disability. This is based on medical factors, combined with other vocational factors (such as limited education), which render the claimant incapable of any gainful employment.

Trade Name

The arbitrarily adopted name under which an organization conducts business.

Trial Calendar Hearing

A regularly scheduled hearing on a case conducted by a WCLJ that is designed to permit the introduction of evidence and/or witnesses and the presentation of arguments by the parties.

Underwriter

The person authorized by an insurance company to bind coverage and make changes to policy terms.

Uninsured Employers' Fund (UEF)

A special fund that provides for the payment of workers' compensation in cases where the employer was not insured or self insured. (WC law § 26-a)

VESID (Vocational Educational Services for Individuals with Disabilities)

A division of New York State Education Department providing services for individuals with disabilities.  www.vesid.nysed.gov

Voluntary Compensation

An addition to a workers' compensation policy that covers benefits to employees who are not required to be covered by a state's WC law.

Volunteer Ambulance Workers' Benefit Law (VAWBL)

WC Law Chapter 64-B provides medical and compensation benefits or, in the case of death, death and survivor benefits to their dependents for volunteer ambulance workers. (WC law chapter 64-B)

Volunteer Firefighters' Benefit Law (VFFBL)

 WC Law Chapter 64-A provides medical and compensation benefits or, in the case of death, death and survivor benefits to their dependents for volunteer firefighters. (WC law chapter 64 - A)

WA-1 (Work Activity Form)

A NYSIF form periodically sent to claimants requesting certification of current employment status and continued entitlement to worker's compensation benefits.

Wage Expectancy

The wages of a claimant who is under the age of 25 when the accident occurs are presumed to increase under normal conditions. The WCB may consider this fact in establishing the claimant's compensation rate if the injuries are permanent. (WC law § 14, Sub. 5)

Wage Replacement

The proportion of pre-injury wages replaced by workers' compensation benefits.

Wages

The money rate at which employment with an employer is recompensed under the contract of hiring with the employer and shall include the reasonable value of board, rent, housing, lodging or similar advantage received under the contract of hiring. (WC law § 2, Sub. 9, § 201, Sub. 12)

Waiting Period

Period covering the first seven days of disability resulting from a work-connected injury or illness.  Workers' compensation indemnity benefits are not allowable for the first seven days of disability, except in cases where the disability period exceeds 14 days, indemnity awards are allowed from the date of disability (WC law  § 12, § 204 and § 211).  There is no waiting period for VAWBL and VFBL cases (WC law § 43, VFBL, and VAWBL).

Waiver Agreement Management Office (WAMO)

The 2007 Workers' Compensation Reform Act established a Waiver Agreement Management Office (WAMO) under the supervision of the chair of the Workers' Compensation Board. WAMO will be dedicated to expediting  Section 32 Settlements on §15-8 (Second Injury) established cases, pursuant to WC Law.

Waiver of Subrogation

A voluntary release or relinquishment of a right of action (e.g., right to sue) on behalf of another.

WCB Case Number

A reported work injury or illness, which has been assembled and assigned a case number (indexed) by an indexing unit of the WCB.

WCB Examiner

Workers' Compensation Board Examiner performs examining work, applying knowledge of WC law and of WCB rules, regulations, policies and procedures to compensation and disability benefit case information. Among the actions regarding workers' compensation cases that examiners may perform are:

·         determining whether a case should be indexed;

·         evaluating claim forms and developing information required by judges for case decisions;

·         requesting information (by phone, letter, etc.) needed for case development;

·         evaluating whether a compensation case may be processed on an informal calendar;

·         referring appropriate cases to the conciliation process; and

·         preparing formal notices of decision based on judge's directions.

Without Prejudice

The term implying employers or their insurance carriers may provide non-binding compensation or medical payments, including payments for medication, for up to one year without admitting liability or giving up specific legal rights.

Workers' Compensation Board (WCB)

A state agency, the Workers' Compensation Board administers the provisions of the NYS WC law, including: the Workers' Compensation Law; the Disability Benefits Law; the Volunteer Firefighters' Benefit Law; the Volunteer Ambulance Workers' Benefit Law; and the Workers' Compensation Act for Civil Defense Volunteers on behalf of injured workers and employers.

Workers' Compensation Insurance

New York State Workers' Compensation insurance provides injured workers with medical and compensation benefits or, in the case of death, death and survivor benefits to their dependents for on-the-job injuries.

Workers' Compensation Insurance Rates

Rates are determined by the New York Compensation Insurance Rating Board (NYCIRB) and published in the Rating Board Manual. These rates are usually per $100 of payroll, with the rate being determined by job classification. There are several classifications, however, where the rate is not on a payroll basis, but rather on a per capita, per location, population or per policy.

Workers' Compensation Law

Chapter 67 of the Consolidated Laws, governing the workers' compensation system; separate laws cover compensation benefits for volunteer firefighters and volunteer ambulance workers.

Workers' Compensation Law Judge (WCLJ)

An officer appointed by the WCB Chair to hear and determine claims and to conduct hearings and investigations and make such orders, decisions and determinations as may be required in the adjudication of the claim.  A Judge's decision is deemed the decision of the WCB unless the WCB modifies or rescinds such decision.

Workers' Compensation Professional (WCP)

The American Society of Workers' Comp Professionals, Inc., ( AMCOMP) developed an education program, Workers' Compensation Professional (WCP), to help raise professional standards in the field of workers' compensation. The WCP designation signifies that an individual has completed a rigorous workers' compensation curriculum and successfully passed course examinations demonstrating a broad-based knowledge and understanding of workers' compensation.

Wrap-up Insurance

A policy that covers all exposures for a large group that has something in common.  For example, wrap-up insurance is written for all the various businesses working together on a particular project, to provide coverage for losses arising out of that work only.