Ask Tim

Disability Benefits For An Organ Donation?

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​Photo by martakat83. Used under a Creative Commons Attribution 2.0 Generic license.

Question from a Big I New York member: One of our employees is considering donating a kidney. Would the disability that follows be covered under the New York State Disability Benefits Law?

Answer: Yes. The New York State Disability Benefits Law is found in Article 9 of the New York Workers’ Compensation Law.

• That article says that “Disability benefits shall be payable to an eligible employee for disabilities …”
• The definitions section of the article says that “disability” is “the inability of an employee, as a result of injury or sickness not arising out of and in the course of an employment, to perform the regular duties of his employment …”
• The same section says that the terms “injury” and “sickness” include “incapacitation as a result of being an organ donor in a transplant operation.”

Since incapacitation as a result of being an organ donor in a transplant operation is “injury or sickness,” and disability results from injury or sickness, then it follows that an eligible employee may receive disability benefits for some period of time after a kidney donation.

Two ... No, Make That 15 Minutes With Tim: How a Research Question Gets Answered

​Watch the excitement of an insurance geek researching the answer to a member's question and finding out he told the member the wrong thing!

 

 

NY High Court Upholds Backdated Effect of Reopened Case Fund Closure

A few weeks ago, New York's highest court rendered a decision that could impact the state's Workers' Compensation insurance market, and not necessarily in a good way.

The New York State Workers' Compensation system used to have a special fund that paid for claims that were not as closed as insurers thought. The fund, known as the Special Fund for Reopened Cases, covered benefits for injured workers whose claims had been closed and who qualified for additional benefits at least seven years after the injury and three years after the last claim payment. For example, treatment for a new flare-up of pain from an old injury thought to have been successfully treated would have been covered by this fund. Workers' Compensation insurance premium surcharges financed it. Cases transferred to the fund were often based on speculation about what might happen in the future, and disputes over them tended to end up in front of a judge.

Do Carriers Have To Send Conditional Renewal Notices on Disability Policies?

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Question from an IIABNY member: It is my understanding that New York State requires conditional renewal notices for changes in rates, terms or conditions for New York Statutory Disability policies. Can you confirm?

Answer: That is not correct. The answer is a little bit complicated. Here is my logic: 

1. The New York Disability Benefits Law is contained within Article 9 of the New York Workers' Compensation Law.

2. New York Insurance Law Section 1113 states in part,

"(a) The kinds of insurance which may be authorized in this state, subject to other provisions of this chapter, and their scope, are set forth in the following paragraphs…

(3) 'Accident and health insurance,' means (i) insurance against death or personal injury by accident or by any specified kind or kinds of accident and insurance against sickness, ailment or bodily injury, including insurance providing disability and family leave benefits pursuant to article nine of the workers' compensation law, except as specified in item (ii) hereof; and (ii) non-cancellable disability insurance, meaning insurance against disability resulting from sickness, ailment or bodily injury (but excluding insurance solely against accidental injury) under any contract which does not give the insurer the option to cancel or otherwise terminate the contract at or after one year from its effective date or renewal date."

This means that New York law considers DBL to be a type of accident and health insurance.

New State Rules: New WC Credit, Nurse Practitioners Can Certify Medical Marijuana Patients

Some people look at Wednesday as merely the halfway point of the work week, the day when the soul-crushing despair of Monday morning slowly begins to give way to the Snoopy dance of Friday afternoon. Such people overlook the true significance of the fourth day of the week, the reason why some of us bounce out of bed that day filled to overflowing with anticipation and excitement.

Wednesday, you see, is the day that the New York State Department of State publishes the new issue of New York State Register, the official compendium of the state government’s regulatory activity.

New Workers' Comp Safe Patient Handling Credit For Health Care Risks

Effective immediately, health care facilities that implement and maintain safe patient handling programs will receive Workers’ Compensation insurance premium credits. The requirement comes from an emergency regulation the New York State Department of Financial Services published this morning. Regulation 119 appeared in today’s issue of theNew York State Register, the official publication of all state rule-making activity. Insurers, agents and brokers who write Workers’ Comp policies for health care risks need to be aware of these new rules.

Is the New Owner Stuck With the Old Owner's Lousy WC Experience Mod?

Question from an IIABNY member: One of my accounts is a new owner of a business since November 2014. The name changed but they kept part of the old company name under a "doing business as" name. The experience modification factor for the old owner was 1.13, but there was a claim and when the new owner took over his mod was now 1.31. Would the new owner have to keep this mod for his business if he took over? Wouldn’t he start with 1.00 mod? He kept a few of the employees, put a safety practice in place and hired a safety consultant.

Answer: Under the New York Experience Rating Plan Manual rules, “The experience for any entity undergoing a change in ownership will be retained or transferred to the experience ratings of the acquiring, surviving or new entity unless specifically excluded by this Plan.” The rules go on to say,

The New York Times and Amazon.com: The Insurance Lessons

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Over this past weekend, the New York Times ran a rather unflattering article about the employment practices at Amazon.com. Titled Inside Amazon’s Thrilling, Bruising Workplace, the article by Jodi Kantor and David Streitfeld described an atmosphere that borders on slave-driving and cruel. They wrote about employees receiving emails after midnight and follow-up text messages when the recipients fail to respond. They quoted an employee who said nearly every person he worked with cried at their desks at some point.

Two Minutes With Tim - the Transporation Industry Workers' Compensation Trust

​IIABNY members have been asking about the status of the assessments against members of this trust. Here's the story.

No-Fault or Workers' Comp For On-The-Job Injury?

Question from an IIABNY member: I have a client who drives a delivery truck. After delivering the packages, he injured his shoulder closing the rear roll down door. He submitted a Workers' Compensation claim, but is he entitled to Personal Injury Protection (PIP), too?  If so, under who’s policy -- the employer’s PIP on the commercial vehicle he was using, or his own under his Personal Auto Policy?

Answer: The PIP endorsement to the Business Auto Policy states that the insurer “will pay first-party benefits to reimburse for basic economic loss sustained by an eligible injured person on account of personal injuries caused by an accident arising out of the use or operation of a motor vehicle …” It certainly sounds like his injuries were caused by an accident arising out of the use of a motor vehicle. Also, the definition of “eligible injured person” includes:

Any (person other than the named insured or a relative) who sustains personal injury arising out of the use or operation of the insured motor vehicle in the State of New York while not occupying another motor vehicle …

Therefore, the employee falls within the definition of eligible injured person. None of the exclusions in the endorsement appear to apply, so I believe he is eligible for PIP benefits. 

I’m not sure whether he is also eligible for PIP under his personal policy. While the definition of eligible injured person includes, “The named insured and any relative who sustains personal injury arising out of the use or operation of any motor vehicle,” the Exclusions state:

This coverage does not apply to personal injury sustained by:

(c) The named insured or relative while occupying, or while a pedestrian through being struck by, a motor vehicle in New York State, other than the insured motor vehicle, with respect to which the coverage required by the (New York no-fault law) is in effect …

The question becomes whether he was considered to be “occupying” the truck or whether he was a pedestrian who was struck by it. If the answer is yes, then his personal PIP coverage won’t apply. If no, then both policies will share the loss on a pro-rata basis, based on the total limits available.

Finally, the amount of the PIP recovery is reduced by the amounts he recovers under Workers’ Comp.

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