Third-Party Administrators (TPA) filing claims on behalf of insurers or self-insured employers must be licensed by the New York State Workers' Compensation Board.
- Licenses are issued or renewed for a period not to exceed three years.
- There are no fees collected for applying to become a TPA or for renewing a TPA license.
To be eligible to become a Third-Party Administrator, you must be:
- a business formed in the State of New York [50(3-b)]
- a business formed in the State of New York for the sole purpose of administering claims but are not a subsidiary of an insurance carrier licensed to write Workers' Compensation policies [50(3-d)]
- Be licensed to adjust claims by the New York State Department of Financial Services (DFS).
- or, an insurance carrier licensed by the New York State Department of Financial Services to write Workers' Compensation policies in New York State, or a subsidiary of one [50(3-d)]
- Insurance carriers or subsidiaries must also include a certificate from the NYS Department of Financial Services showing that they are authorized to write Workers' Compensation policies.
- In addition to the requirements for all applicants, you must also provide a certificate from the NYS Department of State indicating that the corporation is licensed to do business in New York State.
How to Apply/Renew a TPA License
The license application and the license renewal form are identical.
Follow this step-by-step process to apply for or renew your license as a Third-Party Administrator:
- Complete the Application for License to Appear on Behalf of, or Represent, Insurers and/or Self-Insurers under Section 50(3-b) or 50 (3-d) of the Workers' Compensation Law (Form OC-403)
- Provide proof of current insurance policies or exemption:
- For Workers' Compensation policies, use Certificate of NYS Workers' Compensation Insurance Coverage (Form C-105.2).
- For Disability Benefits policies, use Certificate of Insurance Coverage under the NYS Disability and Paid Family Leave Benefits Law (Form DB-120.1).
- For Exemption, use Certificate of Attestation of Exemption (Form CE-200).
- Provide a valid surety bond Self-Insurer's Representative's Bond (Form OC-407).
- Provide a list of corporate officers that includes the name and officer position of the qualifying officer.
- For initial applications or any change in qualifying officer, a resolution is also required. The corporate resolution, or resolution of the members of an LLC, must indicate that the corporation or LLC named the qualifying officer as an officer of the entity, and the officer's title.
- If the qualifying officer is an attorney, provide a certificate of good standing.
- Email your completed application and supporting documentation to: email@example.com
Corporate entities must designate an officer of the corporation as the person responsible for ensuring that the corporate entity complies with all the laws, regulations, policies, procedures, and directives relating to the administration of workers' compensation claims in New York State.
Requirements of a Qualifying Officer of a TPA corporation, partnership, or LLC
- An officer of a corporation or LLC is called the "qualifying officer" for the entity
- Qualifying officers shall be required to evidence their fitness, knowledge and understanding of the Workers' Compensation Law, Disability and Paid Family Leave Benefits Law, Volunteer Ambulance Workers' Benefit Law and Volunteer Firefighters' Benefit Law and the procedures established thereunder by submitting to a written examination and oral review a the board's discretion. If the qualifying officer is an attorney-at-law of New York State, that officer does not need to pass a written examination, but is required to submit to oral review periodically.
- Be a permanent resident of New York State or have a regular place of business in New York State;
- Be over 18 years of age;
- Be a citizen of the U.S.A. or a noncitizen lawfully admitted for permanent residence in the U.S.A.;
- Be of good moral character;
- Be a high school graduate with a diploma or equivalent thereof
- Be knowledgeable about the law and regulations relating to workers' compensation matters;
- Be qualified to render service to your clients;
- Be able to furnish references of five persons who are acquainted with your character and reputation for the past five years;
- Be fingerprinted and have a name search with fingerprint verification obtained from the Division of Criminal Justice Services;
- Take an oath or affirmation before the issuance of a license or renewal;
- Complete an orientation program, unless the qualifying officer is an attorney-at-law duly admitted to practice in the State of New York; and
- Workers' Compensation Law §§ 50 (3-b) and (3-d)
- List of Licensed Third-Party Administrators
- Workers' Compensation Law § 24-a(4)
- 12 NYCRR Part 302
If you have questions, please contact the Workers' Compensation Board Licensing Unit at firstname.lastname@example.org