2. Summary of New Laws

         3. Workers Compensation Board

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         These bills ensure that 9/11 rescue workers receive benefits by:       

1. Insurers are expected to provide authorizations or denials within 30 days of a request for medical treatment. This provision will direct the Chair of the Workers’ Compensation Board to authorize procedures when a claimant is left to languish for more than 30 days without a response from the insurer.

2. Provides immediate relief for workers injured at Ground Zero or related activities by using a portion of the $50 million grant from the Federal government to provide benefits to volunteers to pay for medical treatment during the period in which a claimant’s workers’ compensation case is being controverted by the insurer.

3. The Governor has directed all relevant State agencies to continue to review programs, laws and rules and take necessary action to ensure that treatment and compensation for injuries and illnesses suffered as a result of involvement in the rescue, recovery and clean-up efforts resulting from 9/11 is accessible to every one of our heroes.

Workers’ Compensation is a no-fault wage replacement and health care system that provides benefits to individuals who are injured or become ill as a result of their employment. In New York State, businesses that have employees are required to provide insurance coverage or self-insure to pay for workers’ compensation benefits. To date, the Workers’ Compensation Board has indexed 10,779 claims related to the World Trade Center attacks. Of those claims, 94% are classified as having been fully resolved. The Workers’ Compensation Board maintains jurisdiction over these workers’ compensation claims and will reopen claims when circumstances dictate.

If you believe that you have suffered physical injury as a result of your work on the rescue, recovery and cleanup operations following the September 11, 2001 terrorist attacks on the World Trade Center, contact your health care provider immediately and then begin the claims process with the Workers’ Compensation Board. If you are not sure that you have suffered an injury, please file the forms with the Workers’ Compensation Board in the event that you eventually do. Forms and instructions are available on the web at

http://www.wcb.state.ny.us/index.htm

The Board also provides application forms for volunteers, and non-uniformed workers who participated in the disaster rescue, recovery and cleanup efforts. You need not be uniformed personnel to apply.

One must fill out these forms in a timely manner to be considered in the future for WTC Workers’ Compensation Claims. This means that even if you and your health care provider have not noticed any harmful aftereffects of your participation in the rescue, recovery and cleanup, you must apply with the Board before August 14, 2007 to be considered for future benefits. Article 8-A of the Workers' Compensation Law (WCL) extends the time for employees and volunteers, who participated in rescue, recovery and cleanup operations following the September 11, 2001 terrorist attacks on the World Trade Center, to file claims for workers' compensation benefits, provided they register with the Board before August 14, 2007.

The filing of the registration form, Form WTC-12, does NOT constitute the filing of a claim. The filing of the sworn statement does, however, extend the time to file a claim. With respect to claims that were previously filed and denied as untimely under WCL §18 or §28, upon the filing of the sworn statement the claim will be reopened by the Board to reconsider this claim. This new legislation is effective immediately and is deemed to have been in effect since September 11, 2001. It will apply retroactively to 09/11/01.

The definitions below help in deciding what constitutes participation in the rescue, recovery and cleanup efforts and what boundaries of the WTC site are being considered. For further information on these issues, do not hesitate to contact the Board directly at 1-(877) 632-4996 and visit their home page http://www.wcb.state.ny.us/index.htm. The application also includes detailed maps and instructions to guide your process. Please make clear on the forms if you were at the WTC site during the disaster time frame to receive these benefits. It must be clearly marked on your application.

Article 8-A. WCL §161 defines a "participant in World Trade Center rescue, recovery or cleanup operations" as any employee or volunteer, who between September 11, 2001 and September 12, 2002:

(i) participated in the rescue, recovery or cleanup operations at the World Trade Center site;

(ii) worked at the Fresh Kills Land Fill in New York City;

(iii) worked at the New York City morgue or the temporary morgue on pier locations on the west side of Manhattan; or

(iv) worked on the barges between the west side of Manhattan and the Fresh Kills Land Fill in New York City.

The term "World Trade Center Site" is defined as "anywhere below a line starting from the Hudson River and Canal Street; east on Canal Street to Pike Street; south on Pike Street to the East River; and extending to the lower tip of Manhattan."

Finally, a "qualifying condition" means "any latent disease or condition resulting from a hazardous exposure during participation in" WTC operations.

This legislation also modifies the employer notice requirements with regard to claims for "qualifying conditions" resulting from participation in WTC operations. Under the Workers' Compensation Law, a claimant is required to provide notice of a work-related injury to his or her employer "within thirty (30) days after the accident causing such injury" WCL §18. However, pursuant to WCL §163, a claimant with a "qualifying condition" will have two years from the date of disablement or the date when he or she knew or should have known that the latent condition was causally related to his/her participation in WTC operations, to provide notice to the employer who employed the participant at the time of his/her participation in the rescue, recovery or cleanup operations. In the case of a volunteer, the volunteer must provide notice to the Board within two (2) years of the date of disablement, or the date when he/she should have known that the latent condition was causally related to his/her participation in WTC operations.

Article 8-A applies to all pending and future claims filed or to be filed by participants in the World Trade Center rescue, recovery and cleanup operations, including those claims already disallowed because timely notice was not given to the employer (WCL §18) or the claim was not timely filed with the Board (WCL §28). WCL §165 expressly provides that claims previously brought by employees and volunteers who participated in WTC operations, which claims were disallowed based on the claimant's failure to provide timely notice to the employer or to file a timely claim for benefits, will be reopened and redetermined in accordance with the provisions of WCL Article 8-A, provided the claimant files a sworn statement with the Board before August 14, 2007.

WCL §166 makes clear that claims brought by employees who participated in WTC operations in the course of their employment will be the liability of the insurance carrier on the risk for the employer on the date that the employee last participated in WTC operations, which is considered the date of accident. With respect to claims by volunteers, WCL §167 provides that benefits will be payable out of federal funds appropriated to the Board for that purpose. However, the uninsured employers' fund shall be deemed to be the employer only for the purposes of administering and paying claims for which it will be reimbursed from federal funds. Benefits to volunteers are payable to the extent that federal funds are appropriated and available for that purpose.

Employees and volunteers who participated in rescue, recovery and/or clean-up operations at the World Trade Center site, the Fresh Kills Landfill, the New York City morgue or temporary morgue or the barges between the west side of Manhattan and the Fresh Kills Landfill between September 11, 2001 and September 12, 2002, who were exposed to hazardous conditions must file the registration statement, Board Form WTC-12, before August 14, 2007, in order for the provisions of Article 8-A to apply. Employees and volunteers who do not file the registration statement before August 14, 2007, will not have the benefit of the statute of limitations and notice provisions in Article 8-A. Instead, such claims will be governed by the provisions of WCL §18 and §28, which require notice to the employer within 30 days of the accident and the filing of a claim within two years.

WCL §21-a allows an employer or its insurance carrier to pay workers' compensation lost wage and medical benefits to an injured employee for up to one year without admitting liability for the claim and without prejudice to its right to controvert the claim. At any time during that one-year period, the employer or carrier may provide notice that it is ceasing temporary payments and may then controvert the claim if its investigation reveals that it should not be liable.

Rather than automatically controverting the claim, self-insured employers and workers' compensation insurance carriers are encouraged to voluntarily pay lost wage and medical benefits pursuant to WCL §21-a in those claims in which liability is uncertain and more time is needed to investigate the claim. Doing so will provide benefits to injured claimants, while preserving the right of an employer or carrier to later controvert a claim based on the results of its investigation. The employer or carrier is required to provide notice to the claimant and the Board that payments without prejudice have begun by filing Form C-669. Termination of temporary payments by the employer or carrier must be in accordance with the five day notice provisions of WCL §21-a (3).

In claims arising out of employee participation in World Trade Center operations which are controverted by the self-insured employer or insurance carrier, the Board, in the interest of justice, has directed the World Trade Center Volunteer Fund to temporarily pay for a claimant's causally related medical treatment, until liability for the claim is ultimately determined. The World Trade Center Volunteer Fund is the money appropriated by the Federal government to the Uninsured Employers' Fund (hereinafter UEF) for claims of volunteers. If claimant's employer or its insurance carrier is ultimately determined to be liable for the claim, the employer or carrier will reimburse the UEF for the cost of medical treatment paid while the claim was being litigated upon demand therefore. Any notice of decision containing a finding that the employer or its carrier is liable to pay the claim will include a direction to the employer or carrier to reimburse the UEF for amounts paid from the World Trade Center Volunteer Fund within thirty (30) days from presentation of a demand by the UEF for reimbursement.

Self-insured employers and insurance carriers who have controverted claims by employees for injuries or illnesses caused by participation in WTC operations, which have not yet been established, are directed to submit to the Board within 15 days of the date of this Announcement, on August 21, 2006 and monthly thereafter, an itemized list of all medical bills to be paid from the World Trade Center Volunteer Fund detailing the date of treatment, name and address of the medical provider, diagnostic codes and the amount of the outstanding medical bill(s). The medical bills and the accompanying medical reports must be attached to the itemized list. Board Form WTC-16 MUST accompany each itemized list with attached medical bills and accompanying medical reports sent to the Board for payment initially and monthly thereafter.

Health providers must still request authorization from the self-insured employer or insurance carrier. The self-insured employers and carriers are directed to timely respond to all requests for authorization for special medical services pursuant to the procedures outlined in WCL 13-a(5) and 12 NYCRR 325-1.4(b).

Health providers must continue to forward medical bills to the insurance carrier of record. Reimbursement for pharmaceutical expenses will be accepted although reimbursement for claimants travel allowances will not be payable from this fund.

Medical providers are required by law to seek prior approval from the employer or its insurance carrier for any procedure costing more than $500. Sometimes the required approval cannot be obtained in a timely fashion. Recognizing this, the Board developed a procedure in 2002 to enable medical providers to request Board intervention whenever an employer or insurance carrier fails to promptly respond to a request for authorization, a procedure commonly referred to as the "MD-1 process". See WCB Subject Number 046-116, issued November 24, 2003.

Employers and insurance carriers are urged in all cases, and particularly in those claims arising out of an employee or volunteer's participation in WTC operations following the September 11, 2001 attacks, to promptly respond to all requests for authorization of medical treatment. Additionally, medical providers are strongly encouraged to take advantage of the Board's MD-1 process when they do not receive a prompt response to a request for medical authorization.