WC & EL / PART ONE / RULE II:

1. Description of Coverage
   Workers’ Compensation Insurance provides coverage for the statutory obligation of an employer to provide benefits for employees as required by:
   1. Workers’ Compensation Law or Occupational Disease Law of any state or territory of the United States of America, including the District of Columbia; and:
   2. United States Longshore and Harbor Workers’ Compensation Act.:
2. Statutory Coverage
   New York Workers’ Compensation Insurance may be provided only by the Standard Policy.
3. Longshore Coverage
   U.S. Longshore and Harbor Workers’ Compensation Act insurance may be provided only by attaching the “Longshore and Harbor Workers’ Compensation Act Coverage Endorsement” (WC 00 01 06 A) to the Standard Policy.  Refer to Rule XI of this Manual.

1. Description of Coverage
   Employers’ Liability insurance provides coverage for liability arising from a workplace injury or death by accident or disease when legal action is brought seeking damages, other than those benefits provided under the workers’ compensation law.  Employers’ liability coverage applies only if the injury or death of an employee arises out of and in the course of employment and is sustained:
   1. In the United States of America, its territories or possessions, or Canada; or
   2. While temporarily outside the United States of America, its territories or possessions, or Canada, if the injured employee is a citizen or resident of the United States of America or Canada; but suits for damages and actions on judgments must be in or from a court of the United States of America, its territories or possessions, or Canada.
2. Employers’ Liability for Diseases
   Employers’ Liability Insurance for diseases not covered by a workers’ compensation law or an occupational disease law is provided by the Standard Policy.
3. Admiralty Law or Federal Employers’ Liability Act
   Employers’ Liability Insurance for liability of an employer under admiralty law or the Federal Employers’ Liability Act is not provided by the Standard Policy.  Refer to Rule XII of this Manual for rules and endorsements to cover or limit this exposure.
4. Employers’ Liability Insurance with Workers’ Compensation Insurance
   Employers’ Liability Insurance written with workers’ compensation insurance is provided by the Standard Policy.
5. Employers’ Liability Insurance Without Workers’ Compensation Insurance
   1. Employers’ liability insurance written without workers’ compensation insurance is provided by attaching, to the Standard Policy, an endorsement which excludes any obligation to pay workers’ compensation benefits. The “Employers’ Liability Coverage Endorsement” (WC 00 03 03 C) is used.  Refer to Rule VII of this Manual for rules on employers’ liability insurance. 
   2. Employers’ liability insurance without workers’ compensation insurance is permissible only:
      1. Where all employees of the employer are excluded from the Workers’ Compensation Law; and
      2. Where there is no law or regulation which makes it illegal to issue such a policy.

1. Description of Coverage
   1. Employers’ liability insurance and, where permitted by law, workers’ compensation insurance are provided in other states not listed in Item 3.A. of the Information Page by listing states where coverage is to be provided in Item 3.C. of the Information Page.
   2. If workers’ compensation insurance does not apply because the employer or carrier is unable to take the necessary action to bring the employer under a workers’ compensation law, the carrier will reimburse the employer for all compensation and other benefits required of the employer under such law.
   3. Part Three - Other States Insurance does not provide U.S. Longshore and Harbor Workers’ Compensation Act coverage. It may be afforded only in accordance with Rule XI of this Manual
2. States Where Not Available
   Other States Coverage is not available in states:
   1. With a monopolistic state fund; or
   2. Where the carrier elects not to write the coverage.
3. Restriction on Use
   Coverage for operations known or expected to be performed in a state not listed in Item 3.A. of the Information Page shall not be provided under Part Three - Other States Insurance.
4. Premium
   Premium developed for operations covered under Part Three - Other States Insurance shall be based on workers’ compensation rules and rates.

1. Description of Coverage
   Voluntary compensation insurance provides workers’ compensation benefits to employees who are not required to be covered under the Workers’ Compensation Law.
   Voluntary compensation insurance shall not provide compensation, medical or other benefits in excess of the statutory requirements in the Workers’ Compensation Law designated in the “Voluntary Compensation and Employers’ Liability Coverage Endorsement” (WC 00 03 11 A).
2. How Provided
   Voluntary compensation insurance is provided by attaching the “Voluntary Compensation and Employers’ Liability Coverage Endorsement” (WC 00 03 11 A) to the Standard Policy.

1. Description of Coverage
   Foreign voluntary compensation and employers’ liability insurance provides benefits similar to or identical to those benefits provided under the statutory workers’ compensation system, repatriation expense and endemic disease coverage to employees temporarily working outside the United States of America, its territories or possessions, or Canada.
2. How Provided
   Foreign voluntary compensation and employers’ liability coverage is provided by attaching the “New York Foreign Voluntary Compensation and Employers’ Liability Coverage Endorsement” (WC 31 06 17 B) to the Standard Policy.  Refer to Rule VII (D) of this Manual for premium determination.

1. Description of Coverage
   The “Volunteer Firefighters’ Benefit Law Policy” (WC 31 00 00 B) provides coverage for the statutory obligations required under the Volunteer Firefighters’ Benefit Law and must provide employers’ liability coverage comparable to Part Two of the Standard Policy.  In addition, the “Catastrophe (Other Than Certified Acts of Terrorism) Premium Endorsement” (WC 00 04 21 E) and “Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement” (WC 00 04 22 C) must be attached to each Volunteer Firefighters’ Benefit Law policy.   
2. Group Insurance
   The Volunteer Firefighters’ Benefit Law (VFBL) contains provisions that allow for group insurance.  Under Section 32.1 of the VFBL, any town may obtain a single policy covering all fire protection districts and fire alarm districts within the town.  Under Section 32.2, a group policy may be issued to a group of cities, villages, fire districts or town boards located within one county.  Section 32.2 group insurance requires that:
   
   1. the governing board of each member fire district resolves to be insured under the group policy, and that each such resolution shall be filed with the chairman of the county board of supervisors;
   2. the group file with the chairman of the county board of supervisors an agreement executed by each member fire district agreeing to the effective date of the policy and the population of each fire district;
   3. the chairman of the county board of supervisors contract for a policy of insurance covering the group’s members;
   4. the cost of such insurance be apportioned among the group’s members based on population; and
   5. the county treasurer shall pay for the cost of such insurance.
   
   The New York State Insurance Law also contains provisions for group insurance under Section 3435, provided group members are either public entities or Type B not-for-profit Organizations.  The New York State Insurance Law and Regulations require the group to:
   
   1. be homogenous in nature;
   2. be formed for purposes other than obtaining insurance; and
   3. consist of at least ten (10) members; or a smaller group of at least five members provided that each member generates at least $5 million in annual revenue or the annual premiums for all lines of such group exceeds $500,000.
   
   Refer to Section 32 of the Volunteer Firefighters’ Benefit Law, Section 3435 of the New York State Insurance Law and 11 NYCRR 153 of the New York State Insurance Law Regulations for provisions related to group insurance.
3. Premium
   The premium for the Volunteer Firefighters’ Benefit Law Policy is a flat charge which varies, based on the population of the area(s) served when a single policy is issued or when a single policy of group insurance is issued covering all fire protection districts and fire alarm districts within the town.  When a group policy is issued covering a group of cities, villages, fire districts or town boards located within one county, the population of all members of the group may be aggregated to determine the group policy premium.  Refer to the Volunteer Firefighters section shown under “Miscellaneous Values” pages in Part Three – Loss Costs of this Manual for an explanation of procedures and charges for this coverage.

1. Description of Coverage
   The “Volunteer Ambulance Workers’ Benefit Law Policy” (WC 31 00 02 B) provides coverage for the statutory obligations required under the Volunteer Ambulance Workers’ Benefit Law and must provide employers’ liability coverage comparable to Part Two of the Standard Policy.  The “Catastrophe (Other Than Certified Acts of Terrorism) Premium Endorsement” (WC 00 04 21 E), the “Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement” (WC 00 04 22 C) must be attached to each Volunteer Ambulance Workers’ Benefit Law policy.
2. Group Insurance
   The Volunteer Ambulance Workers’ Benefit Law (VAWBL) contains provisions that allow for group insurance.  Under Section 32.1 of the VAWBL, any town may obtain a single policy covering all ambulance districts within the town.  Under Section 32.2, a group policy may be issued to a group of cities, villages, ambulance districts or town boards located within one county.  Section 32.2 group insurance requires that:
   1. the governing board of each member ambulance district resolves to be insured under the group policy, and that each such resolution shall be filed with the chairman of the county board of supervisors;
   2. the group file with the chairman of the county board of supervisors an agreement executed by each member ambulance district agreeing to the effective date of the policy and the population of each ambulance district;
   3. the chairman of the county board of supervisors contract for a policy of insurance covering the group’s members;
   4. the cost of such insurance be apportioned among the group’s members based upon population; and
   5. the county treasurer shall pay for the cost of such insurance.

   The New York State Insurance Law also contains provision for group insurance under Section 3435 provided group members are either public entities or Type B not-for-profit organizations.  The Insurance Law and Regulations require the group:

   1. to be homogeneous in nature;
   2. to be formed for purposes other than obtaining insurance; and
   3. to consist of at least ten (10) members; or a smaller group of at least five members provided that each member generates at least $5 million in annual revenue or the annual premiums for all lines of such group exceeds $500,000.

   Refer to Section 32 of the Volunteer Ambulance Workers’ Benefit Law and Section 3435 of the New York State Insurance Law and 11 NYCRR 153 of the New York State Insurance Law Regulations for provisions related to for group insurance.

3. Premium
   The premium for a Volunteer Ambulance Workers’ Benefit Law Policy is a flat charge per ambulance.  The charge is not cumulative in the event of substitution of ambulances during the policy period, but shall be cumulative if more than one ambulance is owned or operated during the same policy period regardless of whether or not coverage is written on a single policy basis or as a group policy subject to the provisions of Section 32.2 of the Volunteer Ambulance Workers’ Benefit Law.  The charge is prorated for ambulances owned or operated for part of the policy period.

   Notes: For purposes of this rule an ambulance shall mean any ambulance or first response vehicle that transports either patients or personnel.

   Antique ambulances or any other ambulance used solely for parade or ceremonial purposes and equipped with vintage or historical license plates are exempt from a premium charge.  A copy of the registration of the vehicle must be submitted to the carrier to be eligible for the premium waiver.

   The premium and losses incurred are reported under Code 7370.  The loss cost per ambulance is shown under "Miscellaneous Values" pages in Part Three - Loss Costs of this Manual.

Note: Carriers have the option of using Sections (H)(2)(b) of this Rule in lieu of Rule specified below.

1. Definitions

   As defined in the New York State Professional Employer Act, Article 31, Section 916 of the New York State Labor Law.

   1. Client

      “Client” means a person who enters into a professional employer agreement with a professional employer organization.

   2. Person

      “Person” means an individual, an association, a company, a firm, a partnership, a corporation, or any form of legally recognized entity.

   3. Professional Employer Agreement

      “Professional Employer Agreement” means a written contract whereby:

      1. A professional employer organization expressly agrees to co-employ all or a majority of the employees providing services for the client;
      2. The contract is intended to be on-going rather than temporary in nature;
      3. Employer responsibilities for worksite employees, including those of hiring, firing and disciplining, are expressly allocated by and between the professional employer organization and the client in the agreement; and
      4. The professional employer organization expressly assumes the rights and responsibilities as required in Section 922 of Article 31 of the New York State Labor Law.
   4. Professional Employer Organization

      "Professional employer organization" means any person whose business is entering into professional employer agreements with clients and is registered to do so by the New York State Department of Labor. In determining whether the professional employer organization employs all or a majority of the employees of a client, any person employed pursuant to the terms of the professional employer agreement after the initial placement of client employees on the payroll of the professional employer organization shall be included. Temporary help firms and employment agencies, as defined in Article 11 of the New York State General Business Law, shall not be deemed to be professional employer organizations for purposes of Article 31 of the New York State Labor Law.

   5. Temporary Help Firm

      "Temporary help firm" means a business which recruits and hires its own employees, and assigns those employees to perform work at or services for other organizations, to support or supplement the other organization’s workforce, or to provide assistance in special work situations such as, but not limited to, employee absences, skill shortages, seasonal workloads, or to perform special assignments or projects. A temporary help firm shall not be deemed to be a professional employer organization for the purposes of Article 31 of the New York State Labor Law.

   6. Worksite Employee

      "Worksite employee" means a person having an employment relationship with both the professional employer organization and the client. Such term may also include the client’s officers, directors, shareholders or partners to the extent such persons act as operational managers or perform services for the client.

2. Registration

   In accordance with the New York Professional Employer Act, Article 31, Section 918 of the New York State Labor Law, professional employer organizations are required to be registered with the New York State Department of Labor.

   The PEO is statutorily required to provide workers’ compensation coverage for its client either in the name of the PEO or the client. Both the PEO and its client are deemed employers for Workers’ Compensation Law purposes and are both immunized from suit under the exclusive remedy provision. In event of a claim by an employee, the New York State Workers’ Compensation Board will determine the percentage of liability attributable to each employer (from 0% to 100%), as the PEO will be considered the general employer, and the client will be considered the special employer.

   Insurance carriers have the option of adopting Section (H)(2)(b) “Professional Employer Organization – Option 2: Leased Employee Only Policy” of this Rule in lieu of Section (H)(2)(a) “Professional Employer Organization – Option 1: Single Client Policy” as specified below:

   1. Professional Employer Organization – Option 1: Single Client Policy
      1. The professional employer organization must secure and provide required workers’ compensation coverage for its worksite employees in the client’s name in accordance with the New York State Labor Law Section 922(3)(c). The policy must cover the client’s leased and non-leased workers. The policy must include the “New York Professional Employer Organization (PEO) Endorsement” (WC 31 03 17 A) in each of its client’s policies naming the professional employer organization as an additional insured employer on such policies.
      2. The professional employer organization must obtain a standard workers’ compensation insurance policy to cover only its non-leased workers and such policy must include the “New York Professional Employer Organization (PEO) Exclusion Endorsement” (WC 31 03 18 A).
   2. Professional Employer Organization – Option 2: Leased Employee Only Policy
      1. Professional Employer Organization /Client Policy

         All insurance companies affording workers’ compensation coverage for a professional employer organization must issue a separate policy for each client to cover the client’s leased workers. If the policy is in the PEO’s name, the client is to be named as an additional named insured with respect to employees leased from the professional employer organization. Item 1. of the Information Page must include the name of the professional employer organization as the insured and identify the client as follows:

         ABC Leasing Company P/E/O for XYZ Machine Shop
         (where P/E/O stands for “Professional Employer Organization”)

         Each policy shall expire on the same date. Such policy shall not include coverage for non-leased workers of the client or direct employees of the professional employer organization. Each policy shall include the “New York Optional Professional Employer Organization (PEO) Endorsement” (WC 31 03 20 A).

         Each policy will be sent to the professional employer organization as the named insured.

      2. Separate Policy for Client

         The client is obligated to provide a separate policy for any non-leased workers. Such policy shall include the “New York Optional Client Exclusion Endorsement” (WC 31 03 22 A).

      3. Separate Policy for the Professional Employer Organization

         A separate policy shall be issued in the name of the professional employer organization to provide coverage for their direct employees. The policy shall include the “New York Optional Professional Employer Organization (PEO) Exclusion Endorsement” (WC 31 03 21 A).

   3. Premium for Leased Workers

      1. Professional Employer Organization – Single Client Policy
         1. Client’s Policy

            Premium shall be charged on the client’s policy for the workers that are leased from each professional employer organization and its non-leased workers. 

            The “New York Professional Employer Organization (PEO) Endorsement” (WC 31 03 17 A) is to be attached to the client’s policy.

            The following rules apply to premium:

            1. The client shall provide a complete payroll record of the workers leased to them from the professional employer organization in addition to the payroll record of its non-leased employees.
            2. If the client does not supply the payroll records of the workers leased to them from the professional employer organization, 100% of the full co-employer arrangement price shall be established as the payroll of the workers leased to the client. The premium will be charged at the carrier’s highest rate for the classifications that apply to the client’s operations.
         2. Professional Employer Organization as Policyholder

            Premium shall be charged on the professional employer organization’s policy for its direct employees.

            The “New York Professional Employer Organization (PEO) Exclusion Endorsement” (WC 31 03 18 A) must be attached to the professional employer organization’s policy.

3. Professional Employer Organization – Option 2

   Premium for all policies issued under Section (H)(2)(b)(i), (ii) and (iii) of this Rule, shall be calculated according to Rule VI of this Manual.

4. Policy Filing

   The carrier shall submit separate Information Pages to the Rating Board for each policy providing coverage in accordance with Section (H)(2)(b)(i) of this Rule. The carrier issuing the policy for the client’s leased employees must attach the “New York Optional Client Exclusion Endorsement” (WC 31 03 22 A). The effective date of the policy issued must coincide with endorsement WC 31 03 22 A issued by the carrier of the client’s non-leased employees. 

   Note: Master policies are not acceptable in New York State.

5. Audit

   The carrier shall conduct periodic audits to verify that all Rating Board authorized classifications, rates, experience modification factors and payrolls are appropriate.

6. Statistical Data

   Statistical information shall be filed separately for every policy written pursuant to this Section and in accordance with the rules of the New York Workers’ Compensation Statistical Plan.

7. Experience Rating Factor
   1. Separate factors will be promulgated for each qualifying client and professional employer organization.
   2. The experience rating rating factor, if any, shall apply to any policy issued to a professional employer organization under Section (H)(2)(b)(iii) of this Rule and in accordance with the New York Experience Rating Plan.
   3. The change of ownership rules, as contained under Rule 3 – Ownership Changes and Combination of Entities in the New York Experience Rating Plan Manual, shall be applied to the policies described in Section (H)(2)(a)(i) of this Rule as though the named insured is only that of the client.
8. Premium Discount

   All individual professional employer organization/client policies written in accordance with Section (H)(2)(b)(i) of this Rule by the same carrier, which reference the same professional employer organization, shall be combined for premium discount purposes in accordance with Rule VI of this Manual.

9. Retrospective Rating

   When individual professional employer organization/client policies issued in accordance with Section (H)(2)(b)(i) of this Rule are written by the same carrier, the carrier and the professional employer organization may agree to a retrospective rating program in accordance with the provisions of the New York Retrospective Rating Plan.

10. Cancelations/Non-Renewals by The Carrier

    Where a professional employer organization/client policy written in accordance with Section (H)(2)(b)(i) of this Rule, is canceled, the carrier shall provide individual notices to the professional employer organization and to each of the professional employer organization’s clients.

    Refer to the Cancelation Rules of this Manual.