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.
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Who are the Trustees?
The Trustees in each program are member participants of the Trust. 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:
- 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
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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
applicant who may be considering the Trust. Hear from them firsthand about the savings they receive through the program.
Please see the TEAM Transportation
Workers' Comp Trust Trustees page for a list of trustees' names and telephone numbers.
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How
long has the Trust been in existence?
The TEAM Transporation Workers' Comp Trust began operations in
October 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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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 12 years.
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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.
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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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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.
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Do I really
need workers' compensation coverage? What if we only work with
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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Are
my employees covered while working out of state?
Only limited coverage is provided to employees working outside of
New York State. Temporary travel outside New York State will most
likely be covered; however, employees have the option to file a
claim under the jurisdiction they feel is appropriate. If you, as
the employer, maintain a workplace location outside of New York
State you must purchase separate coverage for that state. Also, if
your employee lives and works in a state other than New York, you
should obtain separate coverage for that state. The Trust can only
provide coverage for claims under New York State jurisdiction.
Please consult with your insurance agent or Program Risk Management
if you have questions regarding out of state coverage.
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