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
self-insurance groups:
How
can a 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.
Back to Top
Is
there a sponsoring group or association? Who are the Trustees?
Each of PRM's programs is sponsored by one or more organizations. ESTRA is co-sponsored by the Empire State Towing & Recovery Association and the Automotive Recycling Association of New York. The majority of Trustees in each program are member participants of the Trust. The Officers of each Trust are elected from the Trustees.
Back to Top
What
are the qualifications for participating in the Trust?
To qualify for the Trust, participants must:
- Be a member in good standing of one of the sponsoring associations
- Have been in business for at least three years
- Have the financial strength to meet the minimum standards of the Trust
- Have loss experience for the previous four years within the range established by the Board of Trustees with input from consulting
actuaries
Back to Top
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
applicant who may be considering the Trust. Hear from them firsthand about the savings they receive through the program.
Please see the ESTRA/ARA-NY Trustees page for a list of trustees' names and telephone numbers.
Back to Top
How
long has the Trust been in existence?
The ESTRA/ARA-NY Self-Insurance Trust began operations in May 1995.
Back to Top
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.
Back to Top
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.
Back to Top
What
safeguards are in place to protect the Trust and my organization? 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.
Back to Top
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.
Back to Top
If a claim is
suspected to be fraudulent, what can the Trust do? Can companies 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.
Back to Top
Do I really
need workers' compensation coverage? What if we only work with
independent contractors?
f 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.
Back to Top
|
