Current through Register Vol. 46, No. 12, March 20, 2024
(a) Any group of
employers seeking initial authorization to operate as a group self-insurer in
accordance with subdivision (3-a) of section 50 of the Workers' Compensation
Law shall satisfy the qualifications set forth in section
317.3
of this Part and shall submit an application to the chair as prescribed below.
This application shall contain:
(1) a current
payroll report filed by classification code for each participating employer of
the employer group for the preceding annual fiscal period. Such payroll shall
only include amounts paid to workers in New York State who are covered by the
self-insured group;
(2) a
description of the safety program, if any, proposed for the employer
group;
(3) applications for
participation duly executed by each employer participating in the group in a
form prescribed by the chair;
(4)
copies of the following items, certified by the group's board of trustees and
group administrator:
(i) the bylaws of the
group self-insurer which shall provide for all of the prescribed terms as set
forth in section
317.12 of this
Part;
(ii) a list of the names and
addresses of all trustees, specifically identifying voting trustees. At least
two-thirds of the voting trustees shall be officers, partners, members or
employees of group members;
(iii) a
list of the names and addresses of each of the officers, directors and general
managers of the group administrator;
(iv) a description of the group's
organization for the administration of claims as well as the duly executed
contract between the board of trustees, the group administrator and the claims
administrator; and
(v) any duly
executed contract between the board of trustees and either an attorney-at-law
licensed to practice in New York State or a representative of self-insured
employers licensed by the Workers' Compensation Board pursuant to subdivision
(3-b) or (3-c) of section 50 of the Workers' Compensation Law, pertaining to
the representation of group members before the Workers' Compensation
Board;
(5) with the
exception of groups consisting exclusively of municipal corporations:
(i) the trust agreement, with language
prescribed by the chair and in a form approved by the chair, which must be
shared with all prospective members of the group and which must be signed by
each of the trustees of the group;
(ii) the participation agreement, with
language prescribed by the chair and in a form approved by the chair, which
must be shared with all prospective members of the group and which must be
individually executed by each member of the group, and which shall include an
acknowledgment that the prospective member has been provided a copy of the
trust agreement and has reviewed that agreement, specifically the provisions
related to joint and several liability, the methodology utilized to determine
member contributions, the annual adjustment to contributions, and to membership
terms;
(6) documentation
from the group administrator consisting of:
(i) evidence of experience in the
administration of group insurance or group self-insurance programs or other
relevant experience such as that of an attorney-at-law, a certified public
accountant, or a qualified actuary who has experience in providing professional
services to such groups;
(ii) two
professional references associated with recent group administration services or
other relevant experience; and
(iii) if incorporated in New York, a
certificate of incorporation or, if not incorporated or incorporated in a state
other than New York, proof of an actual place of business in New York, within
the meaning of section 308 of the Civil Practice Law and Rules;
(7) a properly executed
application from as prescribed by the chair, whereby the group self-insurer
acknowledges its commitment:
(i) to pay to or
on behalf of injured employees and to the dependents of deceased employees all
compensation and medical benefits as required by the provisions of the Workers'
Compensation Law;
(ii) to pay
annually its proportionate share of the expense of administration or other
expenses or assessments as provided by the Workers' Compensation Law;
(iii) to pay any awards commuted pursuant to
section 27 of the Workers' Compensation Law into the aggregate trust fund, if
required by the chair;
(iv) to
permit the chair's authorized representatives access to the premises and to
audit relevant records of the group administrator, the trustees of the employer
group, and/or any individual member of the employer group for the purpose of
examining operations and records;
(v) to notify the chair, in writing, within
10 days of the election, resignation or removal of any member of the board of
trustees;
(vi) to notify the chair,
in writing, within 10 days of the hiring of any new independent law firm, or
third party administrator licensed by the Workers' Compensation Board pursuant
to subdivision (3-b) or (3-d) of section 50 of the Workers' Compensation Law,
to represent the group before the board, and to file with the chair a properly
executed and certified copy of the contract or service agreement;
(vii) to notify the chair, in writing, within
10 days of the appointment of any new group administrator and to file with the
chair a properly executed and certified copy of the contract or the service
agreement, as well as documentation from the new group administrator as
required by subdivision (a) of this section;
(viii) to produce full, truthful and timely
reports as required by the chair in section
317.19
of this Part; and
(ix) to notify
the chair and all group members, in writing, within 10 days of any alteration,
modification or amendment to terms of the group's trust document, participation
agreement or bylaws;
(8)
with the exception of groups consisting exclusively of municipal corporations,
groups shall:
(i) deposit with the chair and
maintain securities, cash, surety bond or irrevocable letters of credit, in a
form and an amount as determined by the chair in accordance with section
317.5 of this
Part;
(ii) maintain excess
insurance as defined in section
317.2(f)
of this Part; and
(iii) have each
group member execute a participation agreement as prescribed by this
section.
(b)
Groups which do not consist exclusively of municipal corporations shall also be
required to submit:
(1) a description of the
nature of the group members' business activities and evidence that they perform
related activities and evidence that they perform related activities in a given
industry in accordance with section
317.3(a)
of this Part;
(2) an actuarial
feasibility study directed and certified by an independent qualified actuary;
and
(3) a report identifying the
projected rate of contribution and assessments to be paid by each member for
the first year of the group's operation, and the manner in which such
contributions and assessments were calculated. Such report shall be closely
reviewed by the chair for purposes of determining the adequacy, consistency and
rationality of the projected contributions.
(c) If, upon examination of the application
and supporting documentation, the chair is satisfied as to the ability of the
employer group to make payment of all claims and to fulfill all other
obligations, authorization to operate as a group self-insurer may be granted
subject to the conditions set forth in this Part.