March 9, 2007
NY Workers' Compensation Reform Impact on Second Injury Fund
New York is phasing out the Special Disability Fund (Second Injury Fund) and this means fast action is needed to ensure maximum recoveries.
Both houses of the NY legislature recently passed identical versions of an extensive workers’ compensation reform bill that includes, as one of its major components, the phasing out of the Special Disability Fund (Second Injury Fund). The reform package is expected to be signed into law very soon.
The impact of this new legislation on the Special Disability Fund means that there is a much shortened window of opportunity to get claims accepted for Second Injury Fund reimbursement and that reimbursement requests for already accepted claims need to be brought up to date as soon as possible.
The bill includes the following provisions:
- No claims for reimbursement (i.e., C-250 notice forms) may be filed on claims with dates of injury on or after July 1, 2007. (The Fund is therefore closed to new claims with dates of injury on or after July 1, 2007)
- No new claims for reimbursement (i.e., C-250 notice forms) may be filed for any claims (regardless of the date of injury) after July 1, 2010.
- No written submissions or evidence may be submitted in support of a claim for reimbursement after July 1, 2010.
(Previously there was no time limitation on submitting evidence to the Fund once a C-250 had been filed. The bill does not provide any exceptions for claims in litigation, claims denied by the Fund and adjourned for the carrier/self-insured to provide additional evidence, or for claims where the claimant has not cooperated with the carrier’s second injury fund (“Section 15-8”) investigation. )
- For claims where the Special Disability Fund has been found liable (i.e., the provisions of Section 15-8 apply), reimbursement monies must be requested within 1) one year of the date of the reimbursable expense or 2) one year from the effective date of legislation, whichever is later.
(This provision precludes recovery of all accrued reimbursement value on even newly accepted claims beyond the previous one year’s worth. Therefore, a review of all accepted claims is critical to ensure no old expenses are left un-requested. Equally or more important is a thorough review of all non-accepted claims with C-250s filed that have already reached the threshold for reimbursement, or are within a year of reaching it, to ensure timely acceptance from the Fund so that retroactive reimbursement may be requested before this provision bars recovery.)
- A $250 filing fee is imposed, effective immediately for filing Forms C-250, with $200 reimbursable on accepted claims.
- A Waiver Agreement Management Office will be established to negotiate settlements on behalf of the Fund directly with claimants on claims where Section 15-8 has been found to apply. These settlement agreements will not require carrier or employer approval. The Waiver Agreement Management Office and the carrier/self-insured may also enter into joint settlement agreements where liability for payments to the claimant is apportioned.
Given the deadlines established by this legislation, it is imperative that all potential claims are uncovered as soon as possible and that work begin immediately on perfecting these claims and catching up on overdue reimbursement requests for already accepted claims.
Rather than dedicate the significant internal resources that would be required to tackle a project of this size during this shortened timeframe, you may want to utilize IRG resources for this timely and short term project. We have both the resources and the expertise you need to ensure that no recovery dollars are missed. We have successfully recovered over $600 million for our clients in NY alone, and will continue to dedicate our resources to NY during this critical period. For further information or assistance, please contact us as soon as possible to discuss implementing an aggressive and timely review and recovery “clean up” of all New York claims at www.irgfocus.com, your IRG contact, or you can click here.