Report the type of injury code as defined under provisions of the New York State Workers’ Compensation Law corresponding to the carrier’s estimate, as of the valuation date, of the ultimate injury type of the claim. The injury type does not have to correspond to the type of benefit being paid as of the valuation date; e.g., if temporary total payments are being made on a claim that is reserved as a permanent partial case, report the claim as a permanent partial injury type.

1. Death – Code 01

   Report each death claim unless it has been established that the carrier has incurred no liability.

   The amount reported as incurred indemnity must include all paid and outstanding benefits, including compensation paid to the deceased prior to death, burial expenses and payments to the state.

   If there is compensation paid prior to the death of a claimant and there is later found to be no liability on the death claim, the loss is to be reported on the basis of the injury for which payments have previously been made.

   Refer to Section (h) below for rules concerning the computation of death claim loss amounts that are payable to the Aggregate Trust Fund.

2. Permanent Total Disability – Code 02

   Report as permanent total disability each claim that constitutes permanent total disability under the New York State Workers’ Compensation Law, or that, in the judgment of the carrier, will result in permanent total disability.

   Refer to Section (h) below for rules concerning the computation of permanent total claim loss amounts that are payable to the Aggregate Trust Fund.

3. Permanent Partial Disability – Scheduled Loss of Use – Code 10

   A Scheduled Loss of Use permanent partial loss is defined as any permanent injury that does not involve permanent total disability and has been classified, or is expected to be classified, by the New York State Workers’ Compensation Board as a Scheduled Loss of Use, in accordance with Section 15, Paragraph 3 Items (a) through (v) of the New York State Workers’ Compensation Law, or if a claim has settled prior to such classification but was expected to be classified as such. Refer to this link for more information: Schedule Loss of Use Award.

   The amount entered as incurred indemnity must include specific benefits and compensation for temporary disability, as well as scheduled loss of use award.

   Note: For Permanent Partial claims that include or are expected to include both a Scheduled Loss of Use award and a Non-Scheduled award, report the injury type that generated the higher incurred indemnity loss amount.

4. Permanent Partial Disability – Non-Scheduled – Code 11

   A non-scheduled permanent partial loss is defined as any permanent injury that does not involve permanent total disability and has been classified, or is expected to be classified, by the New York State Workers’ Compensation Board as a non-scheduled permanent partial disability claim, in accordance with Section 15, Paragraph 3 Item (w) of the New York State Workers’ Compensation Law, or if a claim has settled prior to such classification but was expected to be classified as such. Refer to this link for more information: Schedule Loss of Use Award.

   The amount entered as incurred indemnity must include specific benefits and compensation for temporary disability, as well as loss of earning capacity.

   Refer to Section (h) below for rules concerning the computation of permanent partial claim loss amounts that are payable to the Aggregate Trust Fund.

   Note: For Permanent Partial claims that include or are expected to include both a Scheduled Loss of Use award and a Non-Scheduled award, report the injury type that generated the higher incurred indemnity loss amount.

5. Temporary Injury – Code 05

   Report as temporary every case that involves, or is expected to involve, indemnity benefits, but does not constitute a death case, permanent total disability or any permanent partial disability as defined above.

6. Medical Only – Code 06

   Report as medical-only claims that involve medical costs only and for which no indemnity costs have been incurred or are expected to be incurred as of the valuation date.

   When reporting claims involving medical-only losses, incurred and paid indemnity loss amounts must be $0.

   Incurred medical losses from claims not required to be reported to the New York State Workers’ Compensation Board, as defined in Section 110 of the New York State Workers’ Compensation Law, provided that the employer pays the claim in the first instance or immediately reimburses the carrier for the treatment rendered to the employee, should not be reported to the Rating Board.

   Note: An employer is not required to file a claim notice with the New York State Workers’ Compensation Board if the accident or illness requires ordinary first aid or causes loss of time from work of only one day beyond the working day or shift on which the accident or illness occurred.

7. Contract Medical – Code 07

   In conjunction with managed care or preferred provider organization programs in New York, medical costs incurred under a contract for medical services that cannot be allocated to individual claims must be reported in the aggregate as incurred medical and must be assigned to the governing classification. Contract medical costs, or medical costs incurred outside of the contractual arrangement, that are allocated to individual claims must be reported in connection with these claims and must not be included in the amount otherwise reported as contract medical.

8. Aggregate Trust Fund

   All death cases and designated permanent total and permanent partial disability cases are payable to the Aggregate Trust Fund as set forth in the New York State Workers’ Compensation Law. In determining the present value of the incurred loss amounts on these claims, the tables published in Bulletin 222C by the New York State Workers’ Compensation Board must be used. Refer to the New York State Workers’ Compensation Board for this Bulletin.

   When an award directing such payment has been made, include in the indemnity loss amount the fee charged by the Aggregate Trust Fund for the handling of such cases. This fee must not be included in the calculation of the present value of any case in which the final award has not yet been made.

   For all permanent total and permanent partial disability cases for which a life award is being made, but for which payments have not been designated for placement into the Aggregate Trust Fund, the tables shown below must be used in determining the present value for reporting under this Plan. For claims on policies effective prior to January 1, 2015, use Table-I. For claims on policies effective on or after January 1, 2015, Table I-M must be used for male claimants and Table I-F must be used for female claimants.

1999 United States Life Tables (U.S. Department of HHS) 3.5% Annual Rate of Interest

2007 United States Life Tables (U.S. Department of HHS) 3.5% Annual Rate of Interest

2007 United States Life Tables (U.S. Department of HHS)3.5% Annual Rate of Interest

1. Explanation

   The New York Construction Classification Premium Adjustment Program provides a premium credit, for up to one year, for a policy which is experience rated, satisfies the hourly wage requirement, and contains one or more construction classifications.

   An employer must submit a separate application for each of their policies that contains an eligible construction classification. An application including all the employer’s policies (e.g. Owner Controlled Insurance Program (OCIP’s), Contractors Controlled Insurance Program (CCIP’s), Wrap-Ups) will not be accepted as any credits will be calculated on a per policy basis only.  A combination of policies and applications is not permitted. Any policies of an employer that do not contain an eligible code will not be eligible for a credit.

   Construction classifications are those classifications subject to the following codes:

   0042	5102	5402	5506	5701	6233	7601
   3365	5160	5403	5507	5703	6235	7855
   3724	5183	5428	5508	5709	6251	8227
   3726	5184	5429	5536	6003	6252	9526
   3737	5188	5443	5538	6005		9527
   5000	5190	5445	5545	6017	6306	9534
   5022	5193	5462	5547	6018	6319	9539
   5037	5213	5473	5606	6045	6325	9545
   5040	5221	5474	5610	6204	6400	9549
   5057	5222	5479	5645	6216	6701	9553
   5059	5223	5480	5648	6217	7536
   	5348	5491	5651	6229	7538

2. Application

   The application for credit on a renewal policy must be received by the Rating Board three (3) months prior to the policy renewal effective date. The Rating Board will accept and process an application if it is received between the renewal policy effective and expiration date, however, it must be accompanied with an explanation from the employer stating the reason for the delay.

   Under no circumstances will an original application be accepted for any policy if it is received after the expiration date of the policy to which the credit would have applied, nor will a revised application be accepted if it is received later than one (1) year from the expiration date of the policy to which the credit would have applied.

3. Payroll and Credit Determination
   1. Payroll Determination

      The basis for determining the credit is the limited payroll of each employee for the number of hours worked (excluding overtime premium pay) for each construction classification (other than employees engaged in the construction of one or two-family residential housing).  For policies with effective dates between January 1 and March 31, the payroll submitted is for the third quarter, as reported to taxing authorities, for the second calendar year preceding the policy effective date.  For policies with effective dates between April 1 and December 31, the payroll submitted is for the third quarter, as reported to taxing authorities, for the calendar year preceding the policy effective date.  Total payroll (and not limited payroll) is to be reported for employees engaged in the construction of one or two-family residential housing.

      If the employer did not engage in operations for the complete quarter, then the last complete quarter prior to policy year inception is used or, if there was no complete quarter of operations prior to the policy inception, then the first complete quarter after policy inception is used.

      Note: Limited payroll is used in the determination of the Credit.  Limited Payroll for commercial work means the weekly maximum (refer to Rule V of this Manual) for work on structures other than one or two-family residential housing in accordance with the Payroll Limitation Law. If commercial work is performed under any eligible code(s), each employee’s weekly payroll and total hours worked is used. If an employee’s weekly payroll exceeds the maximum, the weekly maximum amount is used.

      Refer to the “Miscellaneous Values” pages in Part Three - Loss Costs of this Manual for the current weekly maximum amounts.

   2. Credit Determination
      1. A credit may be determined for each construction classification by dividing the total payroll (excluding overtime premium pay) by the number of hours worked to arrive at the average hourly wage for the classification.
      2. In the absence of specific records for salaried employees, it will be assumed each such individual worked forty (40) hours per week.
      3. The factors for each hourly wage range shown below are used in the calculation of the employer’s final credit:

         Average Hourly Wage	Factor	Average Hourly Wage	Factor
         Under $23.25	.00	$38.25 - $39.74	.21
         $23.25 - $24.74	.05	$39.75 - $41.24	.22
         $24.75 - $26.24	.06	$41.25 - $42.74	.23
         $26.25 - $27.74	.07	$42.75 - $44.24	.24
         $27.75 - $29.24	.08	$44.25 - $45.74	.25
         $29.25 - $29.99	.09	$45.75 - $47.24	.26
         $30.00 - $30.74	.10	$47.25 - $48.74	.27
         $30.75 - $31.49	.11	$48.75 - $50.24	.28
         $31.50 - $32.24	.12	$50.25 - $51.74	.29
         $32.25 - $32.99	.13	$51.75 - $53.24	.30
         $33.00 - $33.74	.14	$53.25 - $54.74	.31
         $33.75 - $34.49	.15	$54.75 - $56.24	.32
         $34.50 - $35.24	.16	$56.25 - $57.74	.33
         $35.25 - $35.99	.17	$57.75 - $59.24	.34
         $36.00 - $36.74	.18	$59.25 and over	.35
         $36.75 - $37.49	.19
         $37.50 - $38.24	.20

      4. The total construction classification credit amount, in dollars, must be calculated and then divided by the total policy premium including construction and non-construction classification(s). The result will be the average credit percentage which is then used to calculate the final credit to be applied to the policy.

         When calculating the final policy credit, the percentage is rounded to the nearest whole number with .5 being rounded upward (as an example, 5.4 rounded to 5% and 5.5 rounded to 6%).

4. Experience Modification

   The policy to which the credit would apply must be experience rated to be eligible for this program and the experience modification must be available before the credit can be calculated.

5. Audit
   1. The carrier shall, upon audit, verify the information that was submitted by the employer and used in the calculation of the credit. If the carrier discovers an error in the original request for policy credit, the revised information must be submitted to the Rating Board for recalculation.
   2. If the employer does not furnish records to verify the payrolls and hours worked originally submitted and used in the calculation of the credit, no credit shall be applied to the policy.
6. Information Page

   The credit authorized by the Rating Board must be reported on Item 4. of the Information Page using Statistical Code 9046 “Premium Adjustment Credit Factor.”

7. Form of Endorsement

   The “New York Construction Classification Premium Adjustment Program Explanatory Endorsement” (WC 31 03 19 N) must be attached to each policy.

8. Notification to Employer

   Carriers that elect to notify their employers that have one or more construction classifications on their policy that may be eligible for a premium adjustment credit, are required to use a standardized letter.  A copy of such standardized letter must be submitted to the Audit Division of the Rating Board for approval prior to its use.

Standard Policy means the standard provisions of the “Workers’ Compensation and Employers’ Liability Insurance Policy” (WC 00 00 00 C) and the “Information Page” (WC 00 00 01 A) approved by the New York State Department of Financial Services. Every policy affording coverage under the New York State Workers’ Compensation Law must include the following endorsements and premium elements.

MANDATORY ENDORSEMENTS

*These endorsements are not mandatory for the Volunteer Firefighters’ Benefit Law Policy and the Volunteer Ambulance Workers’ Benefit Law Policy.

Exception: Policies covering employees subject to the New York Volunteer Firefighters’ Benefit Law or the New York Volunteer Ambulance Workers’ Benefit Law must be written only by means of a “Volunteer Firefighters’ Benefit Law Policy” (WC 31 00 00 B) or a “Volunteer Ambulance Workers’ Benefit Law Policy” (WC 31 00 02 B), respectively.

MANDATORY PREMIUM ELEMENTS

Note: The Mandatory Premium Elements also apply to the “Volunteer Firefighters’ Benefit Law Policy” (WC 31 00 00 B) and the “Volunteer Ambulance Workers’ Benefit Law Policy” (WC 31 00 02 B).