Subject No. 046-107
To: Group Self-Insured Employers and Trust Administrators Providing Benefits Under the Workers' Compensation Law, the Volunteer Firefighters' Benefit Law, the Volunteer Ambulance Workers' Benefit Law and the Disability Benefits Law
Penalty Procedures for Group Self-Insured Employers
Date: June 6, 2002
Procedures and Timelines
As part of the Board's continuing efforts to improve accountability and thereby protect the interests of injured workers and their employers, and by virtue of the powers vested in me as Chair of the Workers' Compensation Board by Sections 50(3) and (3-a), 141, 211(3) and 241 of the Workers' Compensation Law, I have established the following procedures and timelines regarding Group Self Insurance penalties:
- If the Self Insurance Unit acquires proof that a Group Self Insurer has violated or is in violation of any provision of the Workers' Compensation Law or the Board's Rules and Regulations, it will make a finding of noncompliance and a determination of penalties. Such proof may be acquired through a hearing pursuant to Workers' Compensation Law § 111 or as a result of other documentation, data or information submitted to the Board regarding the Group Self Insurer.
- If a violation is found, the Director of Self Insurance or the Director of Licensing shall send a written notification to the Group Self Insurer stating that that Board has found a violation, specifically identifying the violation, imposing a penalty and stating the amount of the penalty.
- The Group Self Insurer shall have 20 days after the date of the notice of penalty to pay the penalty or submit a request for reconsideration along with evidence or documentation to the Self Insurance Unit that contradicts or excuses the findings in the written penalty notice. If the Group Self Insurer does not request reconsideration of the penalty within 20 days, the penalties issued pursuant to the written notification will be due.
- If the Group Self Insurer submits a timely request for reconsideration of the penalty notice, within 20 days thereafter the Self Insurance Unit shall review the evidence or documentation as well as the original proof of noncompliance and any other information the Board has on file regarding the Group Self Insurer and shall send a written notice of its decision either affirming, revising or withdrawing the penalty. The Director of Self Insurance or the Director of Licensing may also issue a proposed consent order with the revised notice of penalty.
- If the Self Insurance Unit affirms or revises the penalty so that a penalty remains, the Group Self Insurer shall have 20 days after the date of the notice of decision upon reconsideration to object to the final penalty and/or consent order. To object to a final penalty and/or consent order, the Group Self Insurer must send its objection to the Self Insurance Unit within 20 days of the date of the notice of decision upon reconsideration.
- The Self Insurance Director shall issue a Final Determination of the Board regarding the penalty within 20 days of receipt of a timely objection to a final penalty and/or consent order. The decision of the Self Insurance Director shall constitute the decision of the Chair and a Final Determination of the Board.
- If the penalty imposed is a revocation of the Group Self Insurer's authorization to operate or a penalty in excess of $75,000 or a penalty representing 5% of the Trust's assets, the Group Self Insurer shall have the right to a hearing before a panel of three Board representatives appointed by the Chair or his or her designee before the Final Determination of the Board is issued.
These procedures shall take effect immediately. If you have any questions, please contact the Director of Self Insurance at (518) 486-5126.
Thank you for your cooperation.
Robert R. Snashall