Legislation

Search OpenLegislation Statutes

This entry was published on 2017-04-21
The selection dates indicate all change milestones for the entire volume, not just the location being viewed. Specifying a milestone date will retrieve the most recent version of the location before that date.
SECTION 32
Waiver agreements
Workers' Compensation (WKC) CHAPTER 67, ARTICLE 2
§ 32. Waiver agreements. No agreement or release except as otherwise
provided in this chapter by an employee to waive his right to
compensation under this chapter shall be valid.

(a) Whenever a claim has been filed, the claimant or the deceased
claimant's dependents and the employer, its carrier, the special
disability fund as set forth in subdivision (e) of this section, or the
aggregate trust fund, if the board has directed that the present value
of any unpaid compensation be paid into such fund pursuant to section
twenty-seven of this article, may enter into an agreement settling upon
and determining the compensation and other benefits due to the claimant
or his or her dependents. The agreement shall not bind the parties to
it, unless it is approved by the board. Such agreements, when so
approved, notwithstanding any other provisions, shall be final and
conclusive upon the claimant, the claimant's dependents, the employer,
its insurance carrier, the aggregate trust fund and the special
disability fund. Every insurance carrier as defined in subdivision
twelve of section two of this chapter shall offer each claimant the
opportunity to enter into an agreement settling upon and determining the
compensation and other benefits due, in the case of disability, within
two years after the date the claim was indexed by the board or six
months after the claimant is classified with a permanent disability,
whichever is later, and in the case of death, within six months after
entitlement to benefits is established for all beneficiaries. The offer
made by the insurance carrier shall clearly state what portion of the
offer is (i) for compensation as defined in subdivision six of section
two of this chapter, if any; (ii) for medical benefits, including
prescription medicine, if any; and (iii) for the fee of the attorney or
licensed representative, if any. If a claimant is represented by an
attorney or licensed representative, the insurance carrier shall present
such offer to such legal representative. If a claimant is not
represented by an attorney or a licensed representative, the insurance
carrier shall, in addition to the offer to enter into a settlement
agreement, provide the claimant with a statement of his or her rights,
obligations and potential liability if the offer is accepted.

(b) The agreement shall be approved by the board in a decision duly
filed and served unless:

(1) the board finds the proposed agreement unfair, unconscionable, or
improper as a matter of law;

(2) the board finds that the proposed agreement is the result of an
intentional misrepresentation of material fact; or,

(3) within ten days of submitting the agreement one of the interested
parties requests that the board disapprove the agreement.

(c) A decision duly filed and served approving an agreement submitted
to the board shall not be subject to review pursuant to section
twenty-three of this article. However, a decision duly filed and served
disapproving an agreement submitted to the board is subject to review
pursuant to section twenty-three of this article. If the board
disapproves of an agreement it shall duly file and serve a notice of
decision setting aside the proposed agreement.

(d) An agreement for compensation and other benefits covered by this
chapter may be modified at anytime by agreement of all interested
parties provided it is approved by the board.

(e) The chair shall establish an office under his or her supervision
to be known as the "waiver agreement management office," to negotiate
and seek board approval for waiver agreements on behalf of the special
disability fund. The office shall operate in accordance with guidelines
or directives that the chair may issue, as approved by the special
disability fund advisory committee, or in the absence of such guidelines
or directives, using such discounting factors as the office determines
are in the financial interest of the special disability fund. The waiver
agreement management office on behalf of the special disability fund may
enter into a waiver agreement with a claimant only when the special
disability fund has been found liable by the board to reimburse the
claimant's employer, insurance carrier or the state insurance fund.
Notwithstanding any other provisions of law, no consultation or approval
of any employer, insurance carrier, self-insurer or the state insurance
fund shall be required before such office may enter into any waiver
agreement, or before the board may approve such waiver agreement. The
chair may, in his or her discretion, and as approved by the special
disability fund advisory committee, terminate the operation of the
waiver agreement management office, if he or she believes it no longer
serves the interest of the special disability fund.

(f) A claimant's executed waiver agreement with the waiver agreement
management office shall be final and conclusive upon the claimant, the
claimant's dependents, and any employer, self-insurer, insurance
carrier, the state insurance fund and the special disability fund as to
all claims by the claimant, and as to any claim or request for
reimbursement from the special disability fund for payments not yet
made. The waiver agreement management office shall give written notice
to any employer, insurance carrier or the state insurance fund entitled
to receive reimbursement from the special disability fund in regard to
any claimant, of any waiver agreement signed by the office with such
claimant within fourteen days of submitting the waiver agreement to the
board for approval.

(g) Nothing in this section shall prohibit any insurance carrier,
employer, the state insurance fund, or the waiver agreement management
office on behalf of the special disability fund from jointly entering
into a waiver agreement with a claimant, by which the joint signatories
may apportion responsibility for making any payments required under the
agreement. The agreement shall set forth the obligations of the
signatories to make such payments, and shall identify, as to each
obligation thereunder: (1) the signatory that has the legal obligation
to carry out that provision, or (2) that all signatories are jointly and
severally liable under the provision.

(h) Neither the establishment of the waiver agreement management
office, nor any action taken by that office, shall serve as grounds for
the board's disapproval of any waiver agreement to which the office is
not a party, or otherwise permit any party to withdraw from such a
waiver agreement.

(i) (1) The waiver agreement management office may contract with an
insurance carrier, self-insured employer, state insurance fund or any
third party to assume liability for, manage, administer, or settle
claims on its behalf, so long as (A) such contract is approved by the
special disability fund advisory committee and (B) such party shall
agree to be subject to any guidelines or directives as the chair may
issue.

(2) The chair may, with approval of the special disability fund
advisory committee and on such terms as the committee deems appropriate,
procure one or more private entities to assume the liability for and
manage, administer, or settle all or a portion of the claims in the
special disability fund including, without limitation, by obtaining "an
assumption of workers' compensation liability insurance policy" as
defined in subdivision three of section fifty of this chapter. Any such
policy shall expressly provide and, notwithstanding any other provision
of law, operate to release from any further liability (i) the special
disability fund and (ii) the insurance carrier, including as the case
may be the state insurance fund, originally liable for any claim covered
by the assumption of workers' compensation liability insurance policy
securing such further and future contingent liability as may arise from
any such claim, including from prior injuries to employees and be
incurred by reason of any change in the condition of such employees for
payment of additional compensation. Notwithstanding any other provisions
of law, no consultation or approval of any employer, insurance carrier,
self-insurer or the state insurance fund shall be required before such
office may enter into any such policy of waiver agreement, or before the
board may approve such waiver agreement. Any such procurement shall be
conducted in accordance with state finance law, except as otherwise set
forth below. The chair shall not award any contract that has not been
approved by the special disability fund advisory committee.
Notwithstanding the foregoing, the chair of the workers' compensation
board may, if approved by the special disability fund advisory
committee, and on such terms as the committee deems appropriate:

(A) waive any informality in a bid, and either reject all bids and
again advertise for bids, or interview at least two responsible
qualified bidders and negotiate and enter into a contract with one or
more of such bidders; or

(B) group claims to be assigned, in whole or in part, based on the
insurance carrier, self-insured employer or state insurance fund that is
receiving or will receive reimbursement on those claims from the second
disability fund. Such grouping shall be permissible notwithstanding that
any insurance carrier may have greater access to information, or may be
able to provide better terms, in regard to claims so grouped.

(3) Any policy executed by the chair pursuant to this section shall be
in the form of an assumption of workers' compensation liability
insurance policy securing such further and future contingent liability
as may arise from any claim covered by such policy, including prior
injuries to workers and be incurred by reason of any change in the
condition of such workers warranting the board making subsequent awards
for payment of additional compensation. Such policy shall be in a form
approved by the superintendent of financial services and issued by the
state insurance fund or any insurance company licensed to issue this
class of insurance in this state, or deemed acceptable as an issuer upon
application by the chair to the superintendent as specified in
subdivision three of section fifty of this chapter. In the event that
such policy is issued by an insurance company other than the state
insurance fund, then said policy shall be deemed of the kind specified
in paragraph fifteen of subsection (a) of section one thousand one
hundred thirteen of the insurance law and covered by the workers'
compensation security fund as created and governed by article six-a of
this chapter. Such policy shall only be issued for a single complete
premium paid in advance and in an amount deemed acceptable by the chair
and the superintendent of financial services. When issued such policy
shall be noncancellable without recourse for any cause during the
continuance of the liability secured and so covered.

(4) Notwithstanding any other provision of this article, the waiver
agreement management office may request in writing any information
relevant to its entry into or management of waiver agreements from (A)
any insurance carrier, employer, or the state insurance fund, if that
entity has submitted a claim for reimbursement from the special
disability fund as to the claimant to whom the information relates; or
(B) the special funds conservation committee. The party to whom the
request is made shall provide the requested information within fourteen
days of the request, unless before that date it files an objection with
the board to any information which is subject to a recognized privilege
or whose production is otherwise barred by law. The objecting party
shall provide the requested information within five business days of the
board's rejection of its objection.

(5) No carrier, self-insured employer or the state insurance fund
shall assume the liability for, or management, administration or
settlement of any claims under this section on which it holds reserves,
beyond such reserves as are permitted by regulation of the
superintendent of financial services for purposes of this provision. No
carrier may assume liability for any claims in the special disability
fund under this paragraph unless the carrier maintains, on a stand alone
basis, separate from its parent or any affiliated entities, an
interactive financial strength rating from a nationally recognized
statistical rating organization that is considered secure or deemed
acceptable by the special disability fund advisory committee.

(6) The director of the budget shall notify in writing the chairs of
the senate finance committee and the assembly ways and means committee
of any plans to transfer all or a portion of the portfolio of claims
determined to be eligible for reimbursement from the special disability
fund or to enter into an assumption of workers' compensation liability
insurance policy, not less than forty-five days prior to the
commencement of such process. At any time borrowing is anticipated to
settle claims, the chief executive officer of the dormitory authority of
the state of New York and the director of the budget shall provide a
report to the chairs of the senate finance committee and the assembly
ways and means committee on a planned bond sale of the authority and
such report shall include, but not be limited to: (A) the maximum amount
of bonds expected to be sold by the authority in connection with a sale
agreement; (B) the expected maximum interest rate and maturity date of
such bonds; (C) the expected amount of the bonds that will be fixed
and/or variable interest rate; (D) the estimated costs of issuance; (E)
the estimated level or levels of reserve fund or funds, if any; (F) the
estimated cost of bond issuance, if any; (G) the anticipated use or uses
of the proceeds; (H) the maximum expected net proceeds that will be paid
to the state as a result of the issuance of such bonds; and (I) the
process to be used to select parties to the transaction. Any such
expectations and estimates in the report shall not be deemed a
substantive limitation on the authority of the dormitory authority of
the state of New York.