A. 2891 2
SUBDIVISION, HAS APPLIED TO THE BOARD FOR RE-EVALUATION, HAS NOT
RETURNED TO WORK OR HAS RETURNED TO WORK EARNING LESS THAN THIRTY
PERCENT OF THE CLAIMANT'S AVERAGE WEEKLY WAGE AS A RESULT OF THE CLAIM-
ANT'S IMPAIRMENT, AND WHO HAS IN GOOD FAITH ATTEMPTED TO OBTAIN EMPLOY-
MENT COMMENSURATE WITH THE CLAIMANT'S PHYSICAL ABILITY TO WORK. SUPPLE-
MENTAL BENEFITS SHALL BE PAYABLE FOR A PERIOD NOT TO EXCEED FIVE HUNDRED
WEEKS INCLUDING ANY WEEKS OF TEMPORARY OR PERMANENT DISABILITY BENEFITS
PAYABLE ON ACCOUNT OF SUCH IMPAIRMENT. SUPPLEMENTAL BENEFITS SHALL BE
PAYABLE AT SIXTY-SIX AND TWO-THIRDS PERCENT OF THE DIFFERENCE BETWEEN
THE INJURED WORKER'S AVERAGE WEEKLY WAGES BEFORE AND AFTER INJURY, NOT
TO EXCEED THE RATE PROVIDED IN PARAGRAPH B OF THIS SUBDIVISION.
E. IN THE EVENT THE CLAIM IS CONTROVERTED PURSUANT TO SECTION TWENTY-
FIVE OF THIS ARTICLE AND THE CONTROVERSY IS RESOLVED IN FAVOR OF THE
CLAIMANT, THE CLAIMANT SHALL RECEIVE UP TO NINETY DAYS OF ADDITIONAL
BENEFITS BEYOND THE PERIOD PRESCRIBED IN PARAGRAPH D OF THIS SUBDIVISION
AND NOT TO EXCEED THE PERIOD DURING WHICH SUCH CLAIM WAS CONTROVERTED.
S 2. Paragraph (a) of subdivision 6 of section 15 of the workers'
compensation law, as amended by chapter 689 of the laws of 2007, is
amended to read as follows:
(a) Compensation for permanent or temporary total disability due to an
accident or disablement resulting from an occupational disease that
occurs, (1) on or after January first, nineteen hundred seventy-eight,
shall not exceed one hundred twenty-five dollars per week, that occurs
(2) on or after July first, nineteen hundred seventy-eight, shall not
exceed one hundred eighty dollars per week, that occurs (3) on or after
January first, nineteen hundred seventy-nine, shall not exceed two
hundred fifteen dollars per week, that occurs (4) on or after July
first, nineteen hundred eighty-three, shall not exceed two hundred
fifty-five dollars per week, that occurs (5) on or after July first,
nineteen hundred eighty-four, shall not exceed two hundred seventy-five
dollars per week, that occurs (6) on or after July first, nineteen
hundred eighty-five, shall not exceed three hundred dollars per week,
that occurs (7) on or after July first, nineteen hundred ninety, shall
not exceed three hundred forty dollars per week; and in the case of
temporary total disability shall not be less than thirty dollars per
week and in the case of permanent total disability shall not be less
than twenty dollars per week except that if the employee's wages at the
time of injury are less than thirty or twenty dollars per week respec-
tively, he or she shall receive his or her full weekly wages. Compen-
sation for permanent or temporary partial disability due to an accident
or disablement resulting from an occupational disease that occurs (1) on
or after January first, nineteen hundred seventy-eight, shall not exceed
one hundred five dollars per week, that occurs (2) on or after July
first, nineteen hundred eighty-three, shall not exceed one hundred twen-
ty-five dollars per week, that occurs (3) on or after July first, nine-
teen hundred eighty-four, shall not exceed one hundred thirty-five
dollars per week, that occurs (4) on or after July first, nineteen
hundred eighty-five, shall not exceed one hundred fifty dollars per
week, that occurs (5) on or after July first, nineteen hundred ninety,
shall not exceed two hundred eighty dollars per week; nor be less than
twenty dollars per week; except that if the employee's wages at the time
of injury are less than twenty dollars per week, he or she shall receive
his or her full weekly wages. In no event shall compensation when
combined with decreased earnings or earning capacity exceed the amount
of wages which the employee was receiving at the time the injury
occurred. Compensation for permanent or temporary partial disability, or
A. 2891 3
for permanent or temporary total disability due to an accident or disa-
blement resulting from an occupational disease that occurs (1) on or
after July first, nineteen hundred ninety-one and prior to July first,
nineteen hundred ninety-two, shall not exceed three hundred fifty
dollars per week; (2) on or after July first, nineteen hundred ninety-
two AND PRIOR TO THE ESTABLISHING OF OBJECTIVE MEDICAL GUIDELINES FOR
THE DETERMINATION OF PERCENTAGE OF PERMANENT IMPAIRMENT PURSUANT TO
SECTION FIFTEEN-A OF THIS ARTICLE, shall not exceed four hundred dollars
per week; nor be less than forty dollars per week except that if the
employee's wages at the time of injury are less than forty dollars per
week, the employee shall receive his or her full wages. Compensation for
permanent or temporary partial disability, or for permanent or temporary
total disability due to an accident or disablement resulting from an
occupational disease that occurs (1) on or after July first, two thou-
sand seven shall not exceed five hundred dollars per week, (2) on or
after July first, two thousand eight shall not exceed five hundred fifty
dollars per week, (3) on or after July first, two thousand nine shall
not exceed six hundred dollars per week, and (4) on or after July first,
two thousand ten, and on or after July first of each succeeding year,
shall not exceed two-thirds of the New York state average weekly wage
for the year in which it is reported. Compensation for permanent or
temporary partial disability, or for permanent or temporary total disa-
bility due to an accident or disablement resulting from an occupational
disease that occurs on or after July first, two thousand seven shall not
be less than one hundred dollars per week except that if the employee's
wages at the time of injury are less than one hundred dollars per week,
the employee shall receive his or her full wages. In no event shall
compensation when combined with decreased earnings or earning capacity
exceed the amount of wages the employee was receiving at the time the
injury occurred. Compensation for permanent or temporary partial disa-
bility, or for permanent or temporary total disability due to an acci-
dent or disablement resulting from an occupational disease or injury
that occurred as a result of World Trade Center rescue activity by an
employee of a private voluntary hospital, who passed a physical examina-
tion upon employment as a rescue worker that failed to reveal evidence
of a condition that was the proximate cause of disablement or occupa-
tional disease or injury, shall not exceed three-quarters of a claim-
ant's wage on September eleventh, two thousand one. In no event shall
compensation when combined with decreased earnings or earning capacity
exceed the amount of wages the employee was receiving on September elev-
enth, two thousand one.
S 3. The workers' compensation law is amended by adding two new
sections 15-a and 15-b to read as follows:
S 15-A. OBJECTIVE MEDICAL GUIDELINES. 1. THE CHAIR SHALL WITHIN THIRTY
DAYS OF THE EFFECTIVE DATE OF THIS SECTION APPOINT A COMMITTEE OF FIVE
EXPERT MEDICAL CONSULTANTS TO DEVELOP OBJECTIVE MEDICAL GUIDELINES FOR
THE DETERMINATION OF PERCENTAGE OF PERMANENT IMPAIRMENT. THE PERCENTAGE
OF PERMANENT IMPAIRMENT SHALL BE KNOWN AS THE IMPAIRMENT RATING. THE
COMMITTEE SHALL WITHIN ONE HUNDRED TWENTY DAYS OF SUCH COMMITTEE'S
APPOINTMENT RECOMMEND OBJECTIVE MEDICAL GUIDELINES FOR THE DETERMINATION
OF PERCENTAGE OF PERMANENT IMPAIRMENT TO THE CHAIR. THE CHAIR SHALL
ADOPT OBJECTIVE MEDICAL GUIDELINES FOR THE DETERMINATION OF PERCENTAGE
OF PERMANENT IMPAIRMENT BASED ON THE RECOMMENDATIONS OF THE COMMITTEE
WITHIN THIRTY DAYS OF RECEIPT OF SUCH RECOMMENDATIONS.
2. ONCE OBJECTIVE MEDICAL GUIDELINES ARE ADOPTED, THE CHAIR SHALL BE
GRANTED THE AUTHORITY, WHEN HE OR SHE SEES FIT, TO APPOINT A COMMITTEE
A. 2891 4
PURSUANT TO SUBDIVISION ONE OF THIS SECTION TO MAKE RECOMMENDATIONS TO
AMEND THE OBJECTIVE MEDICAL GUIDELINES FOR THE DETERMINATION OF PERCENT-
AGE OF PERMANENT IMPAIRMENT.
S 15-B. BENEFIT EVALUATION COMMISSION. 1. A WORKERS' COMPENSATION
BENEFIT EVALUATION COMMISSION SHALL BE APPOINTED BEFORE JANUARY FIRST,
TWO THOUSAND TWELVE TO EXAMINE, EVALUATE AND REPORT ON THE SUFFICIENCY
OF BENEFIT LEVELS IN REGARD TO INFLATION AND THE OVERALL COST OF WORK-
ERS' COMPENSATION FOR EMPLOYERS.
2. THE COMMISSION CREATED BY THIS SECTION SHALL CONSIST OF FIVE
MEMBERS AS FOLLOWS: (I) THE CHAIR OF THE WORKERS' COMPENSATION BOARD, OR
HIS OR HER DESIGNEE, WHO SHALL ACT AS CHAIR OF SUCH COMMISSION; (II) ONE
MEMBER APPOINTED BY THE TEMPORARY PRESIDENT OF THE SENATE; (III) ONE
MEMBER APPOINTED BY THE SPEAKER OF THE ASSEMBLY; (IV) ONE MEMBER
APPOINTED BY THE MINORITY LEADER OF THE SENATE; AND (V) ONE MEMBER
APPOINTED BY THE MINORITY LEADER OF THE ASSEMBLY.
3. SUCH COMMISSION MAY EMPLOY AND AT PLEASURE REMOVE SUCH PERSONNEL AS
IT MAY DEEM NECESSARY FOR THE PERFORMANCE OF ITS FUNCTIONS AND FIX THEIR
COMPENSATION WITHIN THE AMOUNTS MADE AVAILABLE THEREFOR.
4. THE COMMISSION MAY MEET WITHIN AND WITHOUT THE STATE, SHALL HOLD
PUBLIC HEARINGS, AND SHALL HAVE ALL THE POWERS OF A LEGISLATIVE COMMIT-
TEE PURSUANT TO THE LEGISLATIVE LAW.
5. THE MEMBERS OF THE COMMISSION SHALL RECEIVE NO COMPENSATION FOR
THEIR SERVICES, BUT SHALL BE ALLOWED THEIR ACTUAL AND NECESSARY EXPENSES
INCURRED IN THE PERFORMANCE OF THEIR DUTIES PURSUANT TO THIS SECTION.
6. TO THE MAXIMUM EXTENT FEASIBLE, THE COMMISSION SHALL BE ENTITLED TO
REQUEST AND RECEIVE, AND SHALL UTILIZE AND BE PROVIDED WITH SUCH FACILI-
TIES, RESOURCES AND DATA OF ANY COURT, DEPARTMENT, DIVISION, BOARD,
BUREAU, COMMISSION OR AGENCY OF THE STATE OR ANY POLITICAL SUBDIVISION
THEREOF AS IT MAY REASONABLY REQUEST TO PROPERLY CARRY OUT ITS POWERS
AND DUTIES PURSUANT TO THIS SECTION.
7. THE COMMISSION SHALL MAKE A REPORT TO THE GOVERNOR, TEMPORARY PRES-
IDENT OF THE SENATE, SPEAKER OF THE ASSEMBLY, MINORITY LEADER OF THE
SENATE AND MINORITY LEADER OF THE ASSEMBLY OF ITS FINDINGS, CONCLUSIONS
AND RECOMMENDATIONS ON OR BEFORE OCTOBER FIRST, TWO THOUSAND THIRTEEN ON
WHETHER COST SAVINGS MEASURES ESTABLISHED BY THE COMMISSION PURSUANT TO
THIS SECTION WOULD ALLOW THE MAXIMUM BENEFIT RATE TO INCREASE TO
TWO-THIRDS THE STATE'S AVERAGE WEEKLY WAGE ON JANUARY FIRST, TWO THOU-
SAND FOURTEEN, WITHOUT INCREASING COSTS TO EMPLOYERS. SUCH REPORT SHALL
BE MADE AVAILABLE TO THE PUBLIC AND INCLUDE SUCH LEGISLATIVE PROPOSALS
AS SHALL BE NECESSARY TO IMPLEMENT THE COMMISSION'S RECOMMENDATIONS.
S 4. Paragraph (f) of subdivision 1 of section 25 of the workers'
compensation law, as amended by chapter 635 of the laws of 1996, is
amended to read as follows:
(f) Whenever compensation is withheld solely because a controversy
exists on the question of liability as between insurance carriers, sure-
ty companies, the special disability fund, the special fund for reopened
cases, or an employer, the board [may] SHALL WITHIN NINETY DAYS direct
that any carrier, surety company, the special disability fund, the
special fund for reopened cases shall immediately pay compensation and
bills for medical care to the extent payable in accordance with sections
thirteen-g, thirteen-k, thirteen-l and thirteen-m of this chapter, pend-
ing determination of such issue. Any such payment or payments shall not
be deemed an admission against interest by the carrier, surety company,
special disability fund or the special fund for reopened cases. After
final determination, the parties shall make the necessary and proper
reimbursement including the payment of simple interest at the rate
A. 2891 5
established by section five thousand four of the civil practice law and
rules in conformity with such determination.
S 5. Section 50 of the workers' compensation law is amended by adding
a new subdivision 3-f to read as follows:
3-F. THE STATE INSURANCE FUND AND ANY OTHER INSURER THAT ISSUES POLI-
CIES OF WORKERS' COMPENSATION INSURANCE MAY REQUIRE NOMINAL CO-PAYMENTS
TO BE PAID BY THE EMPLOYEE OF UP TO FIVE DOLLARS FOR PHARMACEUTICALS
PRESCRIBED UNDER A WORKERS' COMPENSATION POLICY. IN ADDITION, PREMIUM
REDUCTIONS, IN ACCORDANCE WITH METHODOLOGY APPROVED BY THE SUPERINTEN-
DENT OF INSURANCE SHALL BE APPLIED TO ANY POLICY WRITTEN WHICH REQUIRES
SUCH PHARMACEUTICAL CO-PAYMENTS. SUCH PREMIUM REDUCTIONS SHALL BE DETER-
MINED BEFORE THE APPLICATION OF ANY EXPERIENCE MODIFICATION PREMIUM
SURCHARGE OR PREMIUM DISCOUNT.
S 6. Section 13 of the workers' compensation law is amended by adding
a new subdivision (j) to read as follows:
(J)(1) WHEN A CLAIMANT SUBMITS A CLAIM TO THE EMPLOYER OR ITS CARRIER
FOR PAYMENT OF PRESCRIBED MEDICINE OR FOR REIMBURSEMENT OF THE COST OF
PRESCRIBED MEDICINE WHICH THE EMPLOYER IS REQUIRED TO PROVIDE UNDER THIS
SECTION, THE EMPLOYER OR CARRIER SHALL PAY THE AMOUNT PRESCRIBED BY THE
FEE SCHEDULE ADOPTED UNDER SECTION THIRTEEN-O OF THIS ARTICLE, OR IF THE
PRESCRIBED MEDICINE IS NOT INCLUDED ON THE CURRENT FEE SCHEDULE, THE
USUAL AND CUSTOMARY CHARGES FOR SUCH PRESCRIBED MEDICINE, WITHIN FORTY-
FIVE DAYS OF RECEIPT OF THE CLAIM, UNLESS THE LIABILITY OF THE EMPLOYER
TO PAY FOR THE PRESCRIBED MEDICINE IS NOT REASONABLY CLEAR.
(2) WHERE THE LIABILITY OF THE EMPLOYER OR CARRIER FOR THE CLAIM FOR
PAYMENT OF PRESCRIBED MEDICINE OR REIMBURSEMENT FOR PAYMENT OF
PRESCRIBED MEDICINE IS NOT REASONABLY CLEAR, THE EMPLOYER OR CARRIER
SHALL PAY ANY UNDISPUTED PORTION OF THE CLAIM IN ACCORDANCE WITH THIS
SECTION AND NOTIFY THE CLAIMANT IN WRITING WITHIN FORTY-FIVE DAYS OF
RECEIPT OF THE CLAIM:
(A) THAT THE CLAIM IS NOT BEING PAID AND EXPLAINING THE REASONS FOR
NONPAYMENT; OR
(B) TO REQUEST ALL ADDITIONAL INFORMATION REASONABLY NEEDED TO DETER-
MINE THE EMPLOYER'S OR CARRIER'S LIABILITY FOR THE CLAIM.
UPON RECEIPT OF THE INFORMATION REQUESTED IN SUBPARAGRAPH (B) OF THIS
PARAGRAPH, THE EMPLOYER OR CARRIER SHALL COMPLY WITH PARAGRAPH ONE OF
THIS SUBDIVISION.
(3) EACH CLAIM FOR PAYMENT OF PRESCRIBED MEDICINE OR REIMBURSEMENT FOR
PAYMENT OF PRESCRIBED MEDICINE THAT IS PROCESSED IN VIOLATION OF THIS
SECTION SHALL CONSTITUTE A SEPARATE VIOLATION. IN ADDITION TO THE OTHER
PENALTIES PROVIDED IN THIS CHAPTER, ANY EMPLOYER OR CARRIER THAT FAILS
TO REIMBURSE THE CLAIMANT AS REQUIRED IN THIS SECTION SHALL BE OBLIGATED
TO PAY TO THE CLAIMANT THE AMOUNT PRESCRIBED ON THE FEE SCHEDULE ADOPTED
UNDER SECTION THIRTEEN-O OF THIS ARTICLE, OR IF THE PRESCRIBED MEDICINE
IS NOT INCLUDED ON THE CURRENT FEE SCHEDULE, THE USUAL AND CUSTOMARY
CHARGES FOR THE PRESCRIBED MEDICINE PLUS SIMPLE INTEREST AT THE RATE SET
FORTH IN SECTION FIVE THOUSAND FOUR OF THE CIVIL PRACTICE LAW AND RULES.
(4) NOTHING IN THIS SUBDIVISION SHALL PROHIBIT EMPLOYERS OR CARRIERS
FROM AGREEING TO OR ARRANGING FOR DIRECT BILLING BY THE PHARMACY TO THE
EMPLOYER OR CARRIER FOR THE COST OF PRESCRIBED MEDICINE, IN ORDER FOR
CLAIMANTS TO MORE PROMPTLY RECEIVE PRESCRIBED MEDICINE FOR WHICH EMPLOY-
ERS AND CARRIERS ARE LIABLE UNDER THIS SECTION.
S 7. Section 13-a of the workers' compensation law is amended by
adding a new subdivision 5-a to read as follows:
(5-A) THE BOARD MAY, AT ITS DISCRETION, PRESCRIBE REGULATIONS TO PRE-
AUTHORIZE CERTAIN SPECIALIST CONSULTATIONS, SURGICAL OPERATIONS,
A. 2891 6
PHYSIOTHERAPEUTIC OR OCCUPATIONAL THERAPY PROCEDURES, X-RAY EXAMINATIONS
OR SPECIAL DIAGNOSTIC LABORATORY TESTS FOR SPECIFIED TYPES OF INJURIES
THAT COST OVER ONE THOUSAND DOLLARS.
S 8. Subparagraph 4 of paragraph (h) of subdivision 8 of section 15 of
the workers' compensation law, as amended by chapter 139 of the laws of
2008, is amended to read as follows:
(4) As soon as practicable after May first in the year nineteen
hundred fifty-eight, and annually thereafter as soon as practicable
after January first in each succeeding year, the chair of the board
shall assess upon and collect from all self-insurers, except group self-
insurers, the state insurance fund, all insurance carriers and group
self-insurers, (A) a sum equal to one hundred [fifty] FIFTEEN per centum
of the total disbursements made from the special disability fund during
the preceding calendar year (not including any disbursements made on
account of anticipated liabilities or waiver agreements funded by bond
proceeds and related earnings), less the amount of the net assets in
such fund as of December thirty-first of said preceding calendar year,
and (B) a sum sufficient to cover debt service, and associated costs
(the "debt service assessment") to be paid during the calendar year by
the dormitory authority, as calculated in accordance with subparagraph
five of this paragraph. Such assessments shall be allocated to (i) self-
insurers except group self-insurers and the state insurance fund based
upon the proportion that the total compensation payments made by all
self-insurers except group self-insurers and the state insurance fund
bore to the total compensation payments made by all self-insurers except
group self-insurers, the state insurance fund, all insurance carriers
and group self-insurers, (ii) insurance carriers based upon the propor-
tion that the total compensation payments made by all insurance carriers
bore to the total compensation payments by all self-insurers except
group self-insurers, the state insurance fund and all insurance carriers
and group self-insurers during the fiscal year which ended within said
preceding calendar year, and (iii) group self-insurers based upon the
proportion that the total compensation payments made by all group self-
insurers bore to the total compensation payments made by all self-insur-
ers, the state insurance fund and all insurance carriers during the
fiscal year which ended within said preceding calendar year. Insurance
carriers and self-insurers shall be liable for all such assessments
regardless of the date on which they came into existence, or whether
they have made any claim for reimbursement from the special disability
fund. The portion of such sum allocated to self-insurers except group
self-insurers and the state insurance fund that shall be collected from
each self-insurer except a group self-insurer and the state insurance
fund shall be a sum equal to the proportion of the amount which the
total compensation payments of each such self-insurer except a group
self-insurer or the state insurance fund bore to the total compensation
payments made by all self-insurers except group self-insurers and the
state insurance fund during the fiscal year which ended within said
preceding calendar year. The portion of such sum allocated to insurance
carriers that shall be collected from each insurance carrier shall be a
sum equal to that proportion of the amount which the total premiums
written by each such insurance carrier bore to the total written premi-
ums reported by all insurance carriers during the fiscal year which
ended within said preceding calendar year. The portion of such sum allo-
cated to group self-insurers that shall be collected from each group
self-insurer shall be a sum equal to that proportion of the amount which
the pure premium calculation for each such group self-insurer bore to
A. 2891 7
the total pure premium calculation for all group self-insurers for the
calendar year which ended within the preceding state fiscal year. The
payments from the debt service assessment, unless otherwise set forth in
the special disability fund financing agreement, are hereby pledged
therefor and shall be deemed the first monies received on account of
assessments in each year. For the purposes of this paragraph, "direct
premiums written" means gross premiums, including policy and membership
fees, less return premiums and premiums on policies not taken. For
purposes of this paragraph "pure premium calculation" means the New York
state annual payroll as of December thirty-first of the preceding year
by class code for each employer member of a group self-insurer multi-
plied by the applicable loss cost for each class code as determined by
the workers' compensation rating board in effect on December thirty-
first of the preceding year, and for a group or individual self-insurer
who has ceased to self-insure shall be based on payroll at the time the
group or individual self-insurer ceased to self-insure reduced by a
factor reflecting the reduction in the group or individual self-
insurer's self-insurance liabilities since ceasing to self-insure. An
employer who has ceased to be a self-insurer or a group that ceases to
be licensed as a group self-insurer shall continue to be liable for any
assessments into said fund on account of any compensation payments made
by him or her on his or her account during such fiscal year, and the
security fund, created under the provisions of section one hundred seven
of this chapter, shall, in the event of the insolvency of any insurance
company, be liable for any assessments that would have been made against
such company except for its insolvency. No assessment shall be payable
from the aggregate trust fund, created under the provisions of section
twenty-seven of this article, but such fund shall continue to be liable
for all compensation that shall be payable under any award or order of
the board, the commuted value of which has been paid into such fund.
Such assessments when collected shall be deposited with the commissioner
of taxation and finance for the benefit of such fund. Unless otherwise
provided, such assessments, shall not constitute an element of loss for
the purpose of establishing rates for compensation insurance but shall
for the purpose of collection be treated as separate costs by carriers.
All insurance carriers and the state insurance fund, shall collect such
assessments, from their policyholders through a surcharge based on
premiums in accordance with rules set forth by the New York workers'
compensation rating board, as approved by the superintendent of insur-
ance. Such surcharge shall be considered as part of premium for purposes
prescribed by law including, but not limited to, computing premium tax,
reporting to the superintendent of insurance pursuant to section nine-
ty-nine of this chapter and section three hundred seven of the insurance
law, determining the limitation of expenditures for the administration
of the state insurance fund pursuant to section eighty-eight of this
chapter and the cancellation by an insurance carrier, including the
state insurance fund, of a policy for non-payment of premium. The
provisions of this paragraph shall not apply with respect to policies
containing coverage pursuant to subsection (j) of section three thousand
four hundred twenty of the insurance law relating to every policy
providing comprehensive personal liability insurance on a one, two,
three or four family owner-occupied dwelling. The state insurance fund
shall, notify its insureds that such assessments, shall be, for the
purpose of recoupment, treated as separate costs, respectively for the
purpose of premiums billed on or after October first, nineteen hundred
ninety-four.
A. 2891 8
For the purposes of this paragraph, except as otherwise provided: the
term "insurance carrier" shall include only stock corporations, mutual
corporations and reciprocal insurers authorized to transact the business
of workers' compensation insurance in this state; the term "self-insur-
er" shall include any employer or group of employers permitted to pay
compensation directly under the provisions of subdivision three, three-a
or four of section fifty of this chapter;
S 9. Subdivisions 1, 2 and 3 of section 114 of the workers' compen-
sation law, as added by chapter 635 of the laws of 1996, are amended to
read as follows:
1. 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 applica-
tion 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 false
statement or representation concerning any fact material thereto; or
(ii) omits any fact material thereto, shall be guilty of WORKERS'
COMPENSATION FRAUD IN THE FOURTH DEGREE WHEN HE OR SHE COMMITS A FRAUDU-
LENT WORKERS' COMPENSATION ACT AND THEREBY TAKES OR OBTAINS BENEFITS,
AND WHEN THE VALUE OF THE WORKERS' COMPENSATION BENEFITS EXCEEDS ONE
THOUSAND DOLLARS. WORKERS' COMPENSATION FRAUD IN THE FOURTH DEGREE IS a
class E felony.
A PERSON IS GUILTY OF WORKERS' COMPENSATION FRAUD IN THE THIRD DEGREE
WHEN HE OR SHE COMMITS A FRAUDULENT WORKERS' COMPENSATION ACT AND THERE-
BY TAKES OR OBTAINS BENEFITS, AND WHEN THE VALUE OF THE WORKERS' COMPEN-
SATION BENEFITS EXCEEDS THREE THOUSAND DOLLARS. WORKERS' COMPENSATION
FRAUD IN THE THIRD DEGREE IS A CLASS D FELONY.
A PERSON IS GUILTY OF WORKERS' COMPENSATION FRAUD IN THE SECOND DEGREE
WHEN HE OR SHE COMMITS A FRAUDULENT WORKERS' COMPENSATION ACT AND THERE-
BY TAKES OR OBTAINS BENEFITS, AND WHEN THE VALUE OF THE WORKERS' COMPEN-
SATION BENEFITS EXCEEDS FIFTY THOUSAND DOLLARS. WORKERS' COMPENSATION
FRAUD IN THE SECOND DEGREE IS A CLASS C FELONY.
A PERSON IS GUILTY OF WORKERS' COMPENSATION FRAUD IN THE FIRST DEGREE
WHEN HE OR SHE COMMITS A FRAUDULENT WORKERS' COMPENSATION ACT AND THERE-
BY TAKES OR OBTAINS BENEFITS, AND WHEN THE VALUE OF THE WORKERS' COMPEN-
SATION BENEFITS EXCEEDS ONE MILLION DOLLARS. WORKERS' COMPENSATION
FRAUD IN THE FIRST DEGREE IS A CLASS B FELONY.
Upon conviction, the court in addition to any other authorized
sentence, may order forfeiture of all rights to compensation or payments
of any benefit, and may also require restitution of any amount received
as a result of a violation of this subdivision.
2. An employer or carrier, or any employee, agent, or person acting on
behalf of an employer or carrier, who knowingly makes a false statement
or representation as to a material fact in the course of reporting,
investigation of, or adjusting a claim for any benefit or payment under
this chapter for the purpose of avoiding provision of such payment or
benefit shall be guilty of WORKERS' COMPENSATION FRAUD IN THE FOURTH
DEGREE WHEN HE OR SHE COMMITS A FRAUDULENT WORKERS' COMPENSATION ACT AND
THEREBY TAKES OR OBTAINS BENEFITS, AND WHEN THE VALUE OF THE WORKERS'
COMPENSATION BENEFITS EXCEEDS ONE THOUSAND DOLLARS. WORKERS' COMPEN-
SATION FRAUD IN THE FOURTH DEGREE IS a class E felony.
A PERSON IS GUILTY OF WORKERS' COMPENSATION FRAUD IN THE THIRD DEGREE
WHEN HE OR SHE COMMITS A FRAUDULENT WORKERS' COMPENSATION ACT AND THERE-
BY TAKES OR OBTAINS BENEFITS, AND WHEN THE VALUE OF THE WORKERS' COMPEN-
A. 2891 9
SATION BENEFITS EXCEEDS THREE THOUSAND DOLLARS. WORKERS' COMPENSATION
FRAUD IN THE THIRD DEGREE IS A CLASS D FELONY.
A PERSON IS GUILTY OF WORKERS' COMPENSATION FRAUD IN THE SECOND DEGREE
WHEN HE OR SHE COMMITS A FRAUDULENT WORKERS' COMPENSATION ACT AND THERE-
BY TAKES OR OBTAINS BENEFITS, AND WHEN THE VALUE OF THE WORKERS' COMPEN-
SATION BENEFITS EXCEEDS FIFTY THOUSAND DOLLARS. WORKERS' COMPENSATION
FRAUD IN THE SECOND DEGREE IS A CLASS C FELONY.
A PERSON IS GUILTY OF WORKERS' COMPENSATION FRAUD IN THE FIRST DEGREE
WHEN HE OR SHE COMMITS A FRAUDULENT WORKERS' COMPENSATION ACT AND THERE-
BY TAKES OR OBTAINS BENEFITS, AND WHEN THE VALUE OF THE WORKERS' COMPEN-
SATION BENEFITS EXCEEDS ONE MILLION DOLLARS. WORKERS' COMPENSATION FRAUD
IN THE FIRST DEGREE IS A CLASS B FELONY.
3. A person who knowingly makes a false statement or representation as
to a material fact for the purpose of obtaining, maintaining or renewing
insurance under this chapter, whether for himself or herself or for any
other person or entity or for the purpose of evading the requirements of
section fifty of this chapter shall be guilty of WORKERS' COMPENSATION
FRAUD IN THE FOURTH DEGREE WHEN HE OR SHE COMMITS A FRAUDULENT WORKERS'
COMPENSATION ACT AND THEREBY TAKES OR OBTAINS BENEFITS, AND WHEN THE
VALUE OF THE WORKERS' COMPENSATION BENEFITS EXCEEDS ONE THOUSAND
DOLLARS. WORKERS' COMPENSATION FRAUD IN THE FOURTH DEGREE IS a class E
felony.
A PERSON IS GUILTY OF WORKERS' COMPENSATION FRAUD IN THE THIRD DEGREE
WHEN HE OR SHE COMMITS A FRAUDULENT WORKERS' COMPENSATION ACT AND THERE-
BY TAKES OR OBTAINS BENEFITS, AND WHEN THE VALUE OF THE WORKERS' COMPEN-
SATION BENEFITS EXCEEDS THREE THOUSAND DOLLARS. WORKERS' COMPENSATION
FRAUD IN THE THIRD DEGREE IS A CLASS D FELONY.
A PERSON IS GUILTY OF WORKERS' COMPENSATION FRAUD IN THE SECOND DEGREE
WHEN HE OR SHE COMMITS A FRAUDULENT WORKERS' COMPENSATION ACT AND THERE-
BY TAKES OR OBTAINS BENEFITS, AND WHEN THE VALUE OF THE WORKERS' COMPEN-
SATION BENEFITS EXCEEDS FIFTY THOUSAND DOLLARS. WORKERS' COMPENSATION
FRAUD IN THE SECOND DEGREE IS A CLASS C FELONY.
A PERSON IS GUILTY OF WORKERS' COMPENSATION FRAUD IN THE FIRST DEGREE
WHEN HE OR SHE COMMITS A FRAUDULENT WORKERS' COMPENSATION ACT AND THERE-
BY TAKES OR OBTAINS BENEFITS, AND WHEN THE VALUE OF THE WORKERS' COMPEN-
SATION BENEFITS EXCEEDS ONE MILLION DOLLARS. WORKERS' COMPENSATION FRAUD
IN THE FIRST DEGREE IS A CLASS B FELONY.
In addition to any other remedy, the carrier providing insurance shall
be entitled to restitution of any amount obtained or withheld as a
result of a violation of this subdivision.
S 10. The workers' compensation law is amended by adding a new section
114-d to read as follows:
S 114-D. WORKERS' COMPENSATION LAW HOTLINE. THE CHAIRMAN SHALL ESTAB-
LISH A TOLL-FREE TELEPHONE HOTLINE TO ANSWER QUESTIONS AND PROVIDE GUID-
ANCE TO BUSINESSES AND INDIVIDUALS ABOUT THE STATE'S WORKERS' COMPEN-
SATION LAW AND FRAUD. SUCH TOLL-FREE HOTLINE SHALL BE STAFFED BY PERSONS
TRAINED IN THE LAWS, RULES, AND REGULATIONS APPLICABLE TO THE WORKERS'
COMPENSATION LAW.
S 11. Subdivision 3 of section 136 of the workers' compensation law is
amended by adding a new paragraph (b-1) to read as follows:
(B-1) TO PROSECUTE VIOLATIONS OF LAWS, RULES AND REGULATIONS PERTAIN-
ING TO THE WORKERS' COMPENSATION SYSTEM INCLUDING WORKERS' COMPENSATION
FRAUD;
S 12. The third undesignated paragraph of subdivision 3 of section
25-a of the workers' compensation law, as amended by chapter 6 of the
laws of 2007, is amended to read as follows:
A. 2891 10
Such assessment and the payments made into said fund shall not consti-
tute an element of loss for the purpose of establishing rates for work-
ers' compensation insurance as provided in the insurance law but shall
for the purpose of recoupment be treated as separate costs by carriers.
Carriers shall assess such costs on their policyholders in accordance
with rules set forth by the New York workers' compensation rating board,
as approved by the superintendent of insurance. THE SUPERINTENDENT OF
INSURANCE SHALL PROMULGATE RULES AND REGULATIONS REGARDING HOW THE NEW
YORK COMPENSATION INSURANCE RATING BOARD COLLECTS AND RELEASES, FOR
PUBLIC INFORMATION, DATA ON PREMIUMS AND LOSSES.
S 13. This act shall take effect immediately; provided, however, that
the provisions of section nine of this act shall take effect on the
thirtieth day after it shall have become a law.