Overview
A wholesale waiver agreement is an agreement between the Board, the Waiver Agreement Management Office (WAMO), the Special Disability Fund and an insurer or self-insured employer pursuant to WCL § 32. In exchange for an agreed upon amount of money, inclusive of reimbursements pending at the time of the valuation of claims, the insurer or self-insured employer agrees to waive its right to seek reimbursement pursuant to WCL §§ 14(6) or 15(8) for all past, present, and future claims.
These agreements benefit all the parties involved. Insurers and self-insured employers will no longer be required to submit reimbursement requests pursuant to WCL §§ 14(6) and 15(8) and will be free to negotiate settlements directly with claimants without WAMO’s approval. Ultimately, New York State workers’ compensation assessments will be reduced, and as a result, the cost of providing workers’ compensation coverage will be reduced.
Wholesale Waiver Agreement vs Individual Waiver Agreement Settlements
Wholesale waiver agreement settlements include all §§ 14(6) and 15(8) claims for a specific insurer or self-insured employer (based on W#) and result in a signed agreement between the insurer or self-insured employer, the Board, WAMO and the Special Disability Fund.
Individual waiver agreement settlements are Section 32 settlements between the insurer or self-insured employer, the claimant and WAMO/Special Funds Group that require the Board’s approval. WAMO will continue to settle individual waiver agreements using the WAMO Individual Waiver Agreement procedure.
Who is Eligible?
Any insurer or self-insured employer that submits reimbursement requests pursuant to §§ 14(6) or 15(8). This includes:
- Self-Insured Individuals (active and inactive)
- Self-Insured Groups (active and inactive, including groups formed pursuant to NY Gen Mun Law Article 5-G)
- Self-Insured Political Subdivisions (active and inactive)
- Insurers (active and defaulted)
- County Plans
- Consortiums
Procedure
All inquiries or requests regarding wholesale waiver agreements should be sent to WholesaleAgreements@wcb.ny.gov.
Templates will be provided for the insurers or self-insured employers to list their §§ 14(6) and 15(8) claims and all outstanding reimbursement requests that have been referred to Special Funds which will be reviewed for accuracy.
Determining the value of the claims
All claims are valued individually. To value indemnity, claims are calculated at 100% of the life expectancy, then discounted by the 20-year Treasury rate, plus 0.5%.
To value medical, the average of the last three years of medical expenses is multiplied by the life expectancy of the claimant, and any anomalies, such as surgeries or procedures that are unlikely to reoccur, are deducted.
Valuations are completed by claim and shared with the insurer or self-insured employer. If there is any issue with the valuation, the insurer or self-insured employer should reach out to WholesaleAgreements@wcb.ny.gov and call will be scheduled to discuss the issues.
Pending reimbursement requests
All outstanding indemnity and medical reimbursement requests that have been submitted to the Special Funds Group for reimbursement will be included in the valuation, but the reimbursement process will be placed on hold pending the finalization of the wholesale agreement.
Timing
Most agreements are finalized within 60 days, but agreements may take longer depending on the volume of requests, the timing of insurers’ or self-insured employers’ responses to questions, and the insurers’ or self-insured employers’ review of the proposal.
Impact to Security Deposit
There is no immediate impact to a self-insured employer’s security deposit, however, claims included in wholesale waiver agreement should be reserved for full value removing any §§ 14(6) and 15(8) offsets. Self-insured employers should notify their actuary of the agreement and they should be able to determine any future impact.