Protect yourself with adequate coverage! If you are considering
self-insurance as an alternative to traditional insurance coverage, you need to
ask questions first!
Here are the answers to some frequently asked questions about the types of coverage you should be carrying for your home-care or community-based organization, and how PRM can save you money on those
coverages.
How
will the self-insurance trust save my organization money?
As a participant in a self-insurance trust specifically designed for the members
it serves, you benefit from the Trust's use of data specific to your
industry/occupation
to determine appropriate rates just for this industry and to assist participants with loss control and risk management based on claims statistics generated from our program.
With data specific to your industry, loss control and claims management become
specialized. This can lead to lower experience modification factors which will
reduce your cost of coverage.
Without the overhead of large, multi-industry/multi-state organizations, the
administrative costs are kept to a minimum. Each program is
operated without the motive to "make a profit". Although each program
is operated with the goal of maximizing savings, this goes hand-in-hand with the
goal of maintaining a responsible surplus.
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Is
there a sponsoring group or association? Who are the Trustees?
Each of PRM's programs is sponsored by one or more
organizations. CRISP is co-sponsored by the Association for
Community Living, the NYS Association of Community Residential
Agencies, the Empire State Association of Adult Homes, and the
Coalition of Voluntary Mental Health Agencies. The majority of
the Trustees in each program are member participants of the Trust,
along with designated representatives of the sponsoring association,
usually the President. The officers of each Trust are elected
from the Trustees.
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What
are the qualifications for participating in the Trust?
To qualify for the Trust, participants must:
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May
I speak with participants in the Trust?
Please speak with any of the participants in the Trust program. All members of the Board of Trustees are open to talking to any provider who may be considering the Trust. Hear from them firsthand about the savings they receive through the program.
Please see the CRISP
Trustees page for a list of trustees' names and telephone numbers.
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How
long has the Trust been in existence? Is this a start-up program or does
it have a long operating history?
CRISP began operations in December 1995.
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How is the contribution determined?
Contributions are calculated using a traditional
rating method. Rates are multiplied per $100 of remuneration and, if eligible,
the experience modification factor is applied.
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Is
the Trust flexible with alternative rating plans? Do these plans adversely
affect the strength of the Trust?
Each Trust can be extremely flexible in accommodating the particular needs for the lowest possible costs. If they qualify, participants can choose from a number of alternatives to save on workers' compensation, including low-cost rating plans, financing options and monthly
payments.
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Who
is the Program Administrator? Does this organization have experience in
New York?
The Program Administrator for the Trust is Program Risk Management, Inc.
(PRM), an experienced company specializing in self-insurance programs in New York State
for more than 10 years.
Find out more About PRM.
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What
safeguards are in place to protect the Trust and my agency? Does the Trust
purchase excess insurance?
By law, the Trust is required to purchase excess insurance.
Claims are covered above the Self-Insured Retention level, up to the Statutory Limits of the Workers' Compensation
Law.
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How
are medical claims handled? What safeguards are in place to assure that a
claim doesn't cost more than is necessary?
The Trust is known for processing claims quickly,
thoroughly, and inexpensively. We offer fast, easy online reporting via our
WebClaim application and the Online C-2 Reporting Form. After registering for
WebClaim, participants can enter their new claim information in a few simple
steps, submit the claim, and receive a copy of the C-2 via e-mail in less than
half the time paper reporting methods take.
The Trust also utilizes nurse care management on claims with more complicated medical issues.
This can facilitate a prompt return to work. Claims are processed efficiently, injured employees are encouraged to see physicians quickly, and the Trust works with participants to ensure employees receive proper treatment
which will enable them to return to work as soon as possible.
In New York State, workers' compensation medical costs must be billed by physicians according to a
statutory fee schedule. The Trust audits medical bills to ensure that no overpayments are made and that cases are settled correctly and fairly. The Trust also works to get injured employees back to work quickly once they've fully recovered or have become well enough to work in a modified position.
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What loss
control services are provided? Are there any additional costs for
individualized attention by risk management experts?
The Trust employs extensive loss control and risk management services. Experienced professionals work with each participant to design and implement proactive loss control programs for individual agencies. These experts work one-on-one with providers in their offices, and with their staffs, to thoroughly explain methods for reducing losses, to demonstrate risk management skills, and to teach claims management techniques to maintain low Experience Modifications and keep workers' compensation rates low.
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If a claim is
suspected to be fraudulent, what can the Trust do? Can providers help
control costs by ensuring that only legitimate claims are paid?
Once participants join the Trust, they become actively involved
in the claim process. Each month participants can access their loss reports
online via WebReports. Participants are provided with written updates and status reports on any claim reserved at
$25,000 or more. Participants are notified of Workers' Compensation Board hearings and are encouraged to send someone from the
organization to attend. If participants suspect fraudulent claims, when
economically feasible the Trust will investigate to the extent required in order to determine legitimacy. The Trust covers any costs incurred for surveillance or investigative activities and, by proactively combating fraud, saves money for individual agencies and for the entire Trust.
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Do I really
need workers' compensation coverage? What if we only use independent contractors?
If your organization utilizes the services of individuals you consider "sub-contractors," the New York State Workers' Compensation Board will require evidence that they are protected by workers' compensation coverage to the same degree that your employees are protected.
Therefore, when working with these individuals, you should obtain proof of workers' compensation coverage from them. If they are injured while working for you and are unable to provide evidence of coverage through another source, they may file a claim for workers' compensation benefits under your coverage.
Unless proof of coverage is provided at the time of your payroll audit, the cost of covering these individuals will be chargeable to your organization.
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