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Which Proof of Coverage (POC) transactions will the Board penalize?
The law (WCL § 54[5-a] permits the Board to issue penalties for every failure to timely file with the Board proof of a policy issuance, amendment, endorsement, reinstatement, non- renewal or cancellation. However, the untimely filings that will be initially penalized, as referenced in Subject Number 046-304, and WCIC 2010 # 1 are as follows:
Type IAIABC Transaction Code Binder 000501 Binder 000580 New Policy 001001 New Policy 001080 Renewal 002001 Renewal 002080 Cancelled by Insurer-Non Payment 004159 Cancelled by Insurer-Underwriting Reason 004164 Cancelled by Insurer-Revocation of Voluntary Market Acceptance 004166 Cancelled by Insurer-Failure to pay deductible 004169 Cancelled by Insurer-Misrepresentation on Application 004170 Non-renew by insurer 006064 Cancelled by WCB- expired term 0041CE This change results in removing transactions that were included in the performance standard but not directly penalizable, and also removes the penalizable reinstatement transactions.
All other untimely transactions will not be penalized at the current time. For a complete listing of all transactions New York State accepts, please review the International Association of Industrial Accident Boards and Commissions (IAIABC) Event Table.
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Will insurance carriers be penalized for the late filing of an endorsement transaction i.e. adding an additional insured to a policy/add location transaction?
Not at the current time. However, transactions that are not currently penalized will be monitored to determine if they should be included as penalties at a later date.
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Will insurance carriers be penalized for late filing of a cancellation when the cancellation was at the request of the policyholder?
Not at the current time. However, transactions that are not currently penalized will be monitored to determine if they should be included as penalties at a later date.
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On a multi-state policy, will insurance carriers be penalized if New York is not timely added as a jurisdiction on the policy?
Not at the current time. However, transactions that are not currently penalized will be monitored to determine if they should be included as penalties at a later date.
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On a multi-state policy where New York is on the policy, will insurance carriers be penalized for a late renewal transaction if the renewal cannot be issued because of a problem with one of the other states?
Yes, you will receive a penalty if the renewal transaction is not filed within the required number of days.
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Will insurance carriers be penalized if the insured does not notify us until 30 days after the policy was issued that the name/FEIN (Federal Employer Identification Number) is incorrect or needs to be added to the policy?
Not at the current time. However, transactions that are not currently penalized will be monitored to determine if they should be included as penalties at a later date.
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How much is the penalty?
The penalty amount for workers' compensation carriers is $50 for each 10 day period that a transaction is late, which is ten percent of the maximum $500 penalty authorized by the Legislature.
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When will we receive our penalty notice?
Penalty notices are issued shortly after the end of each calendar quarter.
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Is the penalty calculated based on business days or calendar days?
The penalty is calculated based on calendar days.
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When is the start date of the penalty period?
The start date of the penalty period for workers' compensation carriers will be the effective date of the transaction or the effective date of the legislation (October 19, 2008), whichever is later.
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What if the carrier wants to file an appeal?
Within thirty days of the date of the notice of penalty, submit requests for re-determination review along with an explanation of any relevant facts and circumstances. Appeals should be submitted to pocpenalty@wcb.ny.gov via hard copy or on line using the IC Inquiry application. Appeal instructions are included with the penalty letters.
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How will insurance carriers file an appeal when the automated process for penalties is implemented?
Carriers must be registered for Insurance Compliance Inquiry in order to obtain a detailed transaction report, summary report and to file their appeal on line.
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When will the Board assess penalties for policy changes not addressed in Subject Number 046-304?
The Board will continue to monitor POC filings (transactions) not listed in the subject number. Carriers will receive notice that additional filings are subject to penalty via a new Subject Number prior to assessment.
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Who can I contact if I have a question?
If you have any questions, please contact the Monitoring and Compliance unit at: pocpenalty@wcb.ny.gov