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Glossary of WCB Terms

Waiver Agreement Management Office (WAMO)


Overview

Purpose: To negotiate and seek Board approval for waiver agreements on behalf of the Special Disability Fund

Special Disability Fund Assessments

  • Computed and charged annually
  • Calculation
    Preceding calendar year’s SDF payouts
    x 150%
    $$$$$$
    -- Cash on hand in SDF as of 12/31 of preceding calendar year
    $$$$$$ (Amount of annual assessment)

Where We Were: 2007-2009

NYS Special Disability Fund

  • Largest in the nation, twice as large as the next biggest
  • Approximately 60,000 open, established claims
  • Estimated present value of the SDF’s projected liabilities ~$18 billion

Solutions to SDF Problems

  • Close Special Disability Fund (SDF) to new claims. Claims with a date of accident or date of disability on or after July 1, 2007, are ineligible for SDF reimbursement
  • All claims must be filed with all documentary evidence by July 1, 2010
  • Creation of WAMO. WAMO may enter directly into WCL Sect. 32 settlement agreements with individual claimants
  • WAMO is not required to consult with nor obtain the approval of any carrier, self-insured or SIF relative to any such settlements
  • Settlements are limited to cases where SDF liability has been established and retention period has been met
  • WAMO may contract with a third party Administrator (TPA) to manage, administer or settle claims on its behalf, as defined in WCL §(i)(1). Required procurement process and contract(s) already completed for this
  • The Chair, subject to SDF Advisory Committee approval, may procure one or more private entities to assume liability for and management, administration or settlement of all or a portion of the SDF claims, as defined in WCL §32 (i)(2)
  • Buy Backs (“wholesale”): Qualified carriers, self-insured employers, or the New York State Insurance Fund (SIF) may assume the liability for claims, or the management, administration or settlement of those claims where SDF liability was established

Funding

  • Statute authorizes the Dormitory Authority of the State of New York (DASNY) to issue bonds or commercial paper to fund the WAMO initiative
  • Using the bond proceeds will not constitute payments by the SDF. Thus, successful use of the bond proceeds will result in stabilized SDF payouts, which in turn will stabilize SDF assessments
  • Up to approximately $4.5 billion in bonding is authorized (25% of the SDF projected liabilities)
  • The statute provides for a separate assessment for debt service relative to the DASNY bonds
  • However, the bottom line for carriers, self-insured employers, and SIF should be an initial stabilization and ultimate reduction in the overall annual assessment associated with SDF and that WAMO payments are direct [i.e., no need to payout and then seek reimbursement]

Initial Focus

  • In consultation with DOB and State Insurance Dept. (SID), it was decided to focus initial efforts on pursuing buy back/wholesale agreements with the major carriers
  • As the carriers already have primary liability for their claims, this option would eliminate delays in transfer of liability, and permit swift settlement of claims with interested claimants, via WCL §32 agreements
  • Buy back/wholesale of a carrier’s complete SDF portfolio equals immediate and meaningful reduction in SDF payouts and, therefore, reduction of assessments

Where We Are: 2012

What’s Happening Now

  • Focus on Retail rather than Buy Back/ Wholesale due to lack of interest in latter
  • First Issuance of Bonds: December 2010
  • Letters to Major Carriers concerning retail program sent in early 2011; also emails recently sent to these same carriers offering to meet periodically to review group of priority cases, this offer has also been extended to TPAs, attorneys, etc. who are working with WAMO staff on cases

WAMO, Carriers & Self-Insureds Cooperate

  • Carriers, TPAs and Self-Insureds know their own clients and their clients’ claimants, and can help to identify cases that could settle at a fair price
  • Solution: Carriers, TPAs & Self-Insureds provide the labor to negotiate §32 agreements with their own clients and their clients’ claimants. WAMO staff then review files, make recommendations and provide settlement approvals as appropriate. WAMO directly funds these settlements (i.e., carrier/self-insured not have to wait to be reimbursed)

Type of Cases to Act on as a Priority with WAMO

  • Carriers/TPAs/Self-Insureds should know their cases and can “triage” the cases based on this . For example, consider factors such as which clients and which claimants are interested in settlements
  • Carriers/TPAs/Self-Insureds approach WAMO to negotiate §32 settlements for their interested clients

What Will WAMO Pay?

  • WAMO will fund the §32 agreements in the first instance, to the extent that SDF liability is established. For example:
    1. One case, 100% SDF liability: WAMO funds the entire settlement
    2. Two cases, SDF liability established in one case only; cases apportioned 50/50; WAMO pays half
  • WAMO will fund the Medicare set-aside agreements (to the extent of the established SDF liability) – but WAMO will not pay cost of obtaining a Medicare set-aside

Procedures

  • Flexibility: WAMO can be flexible…let’s see what works best for claimants, carriers, self-insureds. WAMO is willing to do Indemnity only settlements but only if carrier/self-insureds agree, as a signatory on the Section 32, to Section 25-a waiver
  • Suggestions: Reach out to your SDF claimants to gauge interest in fair value §32 settlements
  • Negotiate Fair Settlements: WAMO has two responsibilities.
    1. A fiduciary duty regarding paying out on the Section 32
    2. As an arm of the WCB, a duty to protect the best interests of claimants

Closing the Deal

  • WAMO will be signatory to the §32 settlement and WAMO will be the payor to the extent of SDF’s apportioned or limited (accepted) liability
  • Note: Special Funds will not be a signatory
  • New Form W-32R created
    1. Substantially the same as EC-32
    2. Different Form designation for data tracking purposes
    3. Developed and continuing to develop other forms and templates to make process more efficient

Results of Settlements with WAMO

  • A win/win/win scenario:
    1. Claimants have the opportunity to settle cases at reasonable amounts
    2. Self-insureds and carriers close cases and reduce administrative costs
    3. WAMO pays settlements directly so carriers and self-insureds do not have to wait for reimbursement
    4. The entire carrier/SIF/self-insured community benefits via reduced assessments when cases are removed from the SDF payment stream

WAMO Contact Information

Waiver Agreement Management Office
NYS Workers’ Compensation Board
328 State Street
Schenectady, NY 12305-2318

E-Mail: wamo@wcb.ny.gov

***Carrier/TPA/Self-Insureds/Claimant representatives/Attorneys should send all new cases to this email box.***