Agent/Broker FAQs

Do brokers have access to Safety Groups 497, 491, and 554?


Yes, insureds have the option to access these safety groups directly or through their local agent.




Does the Safety Group Manager charge a service fee?


Yes, the Group Manager’s fee for members of the Safety Group is charged at 10% of their SIF Base Premium. Since NYSIF does not pay brokers or Group Managers a commission, our fee is billed and paid separately.




Does the Safety Group Manager pay a commission to agents and brokers?


Please contact our Director of Risk Control and Sales, Mickey McIntire at 518-917-3289 or mickey@fleuryrisk.com, for more information.




What are the submission requirements for the Safety Group?


We typically require an ACORD application with payrolls by class code, five years of currently valued Workers' Compensation (WC) loss runs and five years of WC premium history. The population served is required for VFBL submissions and the number of first response vehicles is required for VAWBL submissions. View our submission checklist here.




If organizations are already with the State Insurance Fund, can they transfer into a Safety Group?


Yes, as long as they meet the underwriting guidelines of the Safety Group they can transfer, but only on the renewal date of their NYSIF Group 90 policy.




If someone is in a Safety Group, who is listed as the representative on the NYSIF policy?


The Safety Group Manager must always be listed as the representative on the safety group member’s policy. Local agents and brokers are categorized as the sub-brokers by the Group Manager and are not recognized by NYSIF. The Group Manager will provide the sub-brokers with all of the policy information they request and they are encouraged to work with the Group Manager to assist their mutual customer.




When are dividends paid to Safety Group members?


Dividends, when declared, are typically paid 8-9 months after the expiration of the policy.




If your customer is in a self-insured pool, does the organization have to give prior notice if it wants to leave?


Yes, by law a minimum of 30 days' reservation of rights notice needs to be provided to the group self-insurer if a member elects to terminate their participation in the group.




What is the difference between being full-insured and a self insured pool?


A fully-insured insurance policy is a complete risk transfer. By paying your policy premium you transfer all of the liability of any WC claims for that policy period to the insurance carrier. A self-insured pool is typically a risk-sharing model where the WC claim liability can be transferred back to the employer if the pool becomes financially insolvent.




Have public entity self-insured pools ever become insolvent and assessed their pool members?


Yes, a number of statewide and regional public entity self-insurance pools have closed due to financial shortfalls, leaving their members to make up the difference. It is important for any self-insured pool member or prospective member to review and understand the pool’s financial position as well as its membership agreement.





 

Claims FAQs

If an employee is injured, when am I required to file a Workers' Compensation claim?


In New York State, an employer is required to file a claim with the carrier when there is any lost time from duties beyond the injury date OR medical treatment for the injury results in the generation of a medical bill.




Can I self-pay for the minor medical treatment performed for a work-related injury?


An employer can self-pay for up to two medical bills. If there is any lost time beyond the date of injury, the employer cannot self-pay medical bills.




When does the employer need to file a claim with the carrier?


The employer must file the claim WITHIN 10 DAYS from the date of injury. By law, an injured employee has 30 days to provide notice of sustained injury to his/her employer. Make reporting sustained injuries within your organization a priority!




Where do I file a Workers' Compensation claim for an employee, volunteer firefighter, or volunteer ambulance worker?


Paper claim forms are no longer accepted by NYSIF and the NY Workers’ Compensation Board. All WC claims (including claims for volunteer firefighters and volunteer ambulance workers) are now filed online via NYSIF eFROI. Once the claim is successfully submitted online, a carrier case number will automatically be generated.




I have filed a WC claim for an employee; what should I do next?


Provide the injured employee with a Claimant Information Packet. If the claim resulted in LOST TIME for the employee, the employer should complete and submit to NYSIF the C-11 and C-240 forms. If the employer continued to pay the claimant while out on Workers’ Compensation, then the employer would also need to complete and submit the C-107 form to NYSIF.




I have completed a C-107 form requesting employer reimbursement and have not received the reimbursement. How can I confirm the status of this request?


Has the injured worker returned to work? Has a C-11 form noting the return-to-work date been submitted? If yes, please contact either the assigned NYSIF Case Manager or Fleury Risk Management for a status update. Please note that employer reimbursements must be confirmed by the NY Workers’ Compensation Board before NYSIF can issue a reimbursement.




I have filed a WC claim for a volunteer firefighter/volunteer ambulance worker, what should I do next?


If the injury resulted in LOST TIME from the volunteer’s duties, the fire department/ambulance company must note this when completing the eFROI OR notify the NYSIF Case Manager with specific dates that disability began (and ended). Lost Time Benefits are payable to volunteer firefighters/ambulance workers from day one and would be based on earning capacity and degree of disability and NOT their regular employment wages.




Do I need to provide a Claimant Information Packet to an injured volunteer firefighter/ambulance worker?


No, this packet would NOT apply to a volunteer firefighter and/or volunteer ambulance worker. The injured volunteer is encouraged to complete and submit to NYSIF a VF-3 (volunteer firefighters) or a VAW-3 (volunteer ambulance workers).




How would my injured employee, volunteer firefighter and/or volunteer ambulance worker obtain prescriptions for a work-related injury?


Complete a temporary prescription form and present it at a participating pharmacy. A temporary prescription form can be found on the NYSIF website or within the Claimant Information Packet.




How long does the employer need to keep a record of any sustained injuries?


The employer must keep a record of all sustained injuries for 18 years.




I suspect fraud with a new or existing WC claim. How do I notify the carrier of my concerns?


Contact the assigned NYSIF case manager by phone and notify him or her of SPECIFIC CONCERNS that may be fraudulent. After you speak to the case manager, follow up with a written explanation of your specific concerns. The case manager can then issue a request for surveillance or other necessary measures if they determine there is a potential fraud case.




What resources does NYSIF use to confirm that a Workers' Compensation Insurance claim is valid?


NYSIF does have resources to proactively research a claim to help determine its validity. These include claimant and employer interviews, independent medical exams (IMEs) and/or surveillance, which all have the ability to be presented to the Workers’ Compensation Board (WCB). The WCB does have the final say in determining a claim’s validity and the claimant’s scope of injury.





 

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