Uninsured Employers` Fund: Legal Hearings Unit

Uninsured Employers’ Fund

June 21, 2011 Victoria Plotsky, Associate Attorney

Where is UEF?

Legal Hearings Unit’s Many Hats  Represent

UEF in uninsured claims  Represent the World Trade Center Volunteer Fund  Represent the Board for defaulting selfinsured employers  Represent the Board in Stop Work Order, 131.3 & Misclassification Penalty Appeals

Purpose of the UEF  Created

in 1962 to guarantee workers’ compensation benefits to all employees in New York State even if employer did not have compensation coverage.

 Before

1962, if no coverage, no benefits!

The U in UEF UNINSURED Employers’ Fund not UNIDENTIFIED Employers’ Fund and not MISCLASSIFIED Employers’ Fund

The E in UEF Uninsured EMPLOYERS’ Fund

There must be an Employer A LEGAL ENTITY

The F in UEF We are a STATE

FUND

Not a

CARRIER

CARRIER       



Client Application Premium Policy C-7s 25(2)(b) applies Files PHC statements 25(1)(f) applies

UEF        



Restricted by Statute Pay only as WCLJ directs No privity with Employer No knowledge of employer, accident or employee No C-7s 25(2)(b) does not apply PHC not required Adversarial position with Employer 25(1)(f) does not apply

20 UEF Hearing Locations

UEF Attorney Territories George Trimper

Dave Filion

Tanya Lambert-Watkins Ernestine Jenkins Laura Yellon Miggie Warms

Arif Khan

Typical Carrier Claim  

Worker falls & breaks arm at construction site. Worker was hired by “Insured Construction, Inc.”  Worker is paid by “Insured Construction, Inc.”  Worker files an accident report with employer.  Employer tells its carrier about the accident.  Carrier accepts the claim & pays wages and medical.  Claim may come before the Board if carrier disputes the claim or as future issues arise. In a Carrier case, the EMPLOYER is known. The CARRIER is known. Not a lot of issues.

Typical UEF Claim 



 

  

Worker falls & breaks arm moving bricks at construction site. Worker was hired off the street by “Joe”. He knew Joe because he hired workers from the same street corner whenever he needed help. Joe had his own business, “Bricks R Us.” Worker was paid by “Nancy” every Friday in cash from a truck at the construction site. The truck said “Fly-by-Night Construction” Joe told him when to be there and what to do, but also that “Bob” was the big boss. “Bob” supervised all the workers, including Joe and Worker. Bob wore a shirt that said “Insured General Contractor, Inc.”

WHO DOES WORKER WORK FOR? Joe, Nancy or Bob?  Worker files a claim against Joe/Bricks R Us.  A coverage check shows no coverage.

UEF Claim Diagram Comp Carrier

Insured General Contractor, Inc.

Fly by Night – Nancy

Bricks R Us - Joe

Worker

Law Judge Finds:      

Employer-Employee Relationship Accident, Notice & Causal Relationship No Coverage = Violation of WCL § 50, WCL § 26-a penalties & assessments Lost Time & Medical Expenses awarded General Contractor’s carrier pays or if no GC Employer is directed to pay. If Employer does not pay or appeal within 30 days, UEF pays.

UEF Appeals  UEF

appeals about 2 decisions a month out of 420 hearings, .4%  UEF files about 15 rebuttals per month  UEF occasionally appeals to the Appellate Division  Dedicated Senior Attorney to Appeals, Kim Swidler

Third Party Actions Money recovered in 2007

$827,916 2008

Recovered to date 2011

$889,036

$553,170

2009

$1,165,361 2010

$1,392,349

UEF Hearings per Year UEF Hearings 2008-2010 7500 7095 7000 6500

6284

6000 5500

5303

5000 4500 4000

2008

2009 25% drop from 2008 - 1010

2010

Section 50 Findings Newly established UEF cases 600

563 503

505

547 480

500

496 469

434 408

409 369

400 327 300 248 200

110 100

0 1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

32 % drop in established UEF cases 2008-2010

2011

2010 Uninsured Claims by type Construction 42.5% Information 0.3% Accommodations 0.3% Domestic 1.9% Manufacturing 0.3% Arts/Entertainment 0.5% Taxi & Limo 24.4%

Passenger Trans. 1.6% Admin & Support Sv. 1.9% Landscaping 1.6% Healthcare 2.2% Trucking 3.0%

Food Sv. 8.7% Retail/Wholesale 4.3%

Services 6.5%

Uninsured Claims 2009-2010 by Type Classification

2009

2010

change

% change

Construction

176

157

-19

-11%

Taxi & Limo

116

90

-26

-22%

Food Sv.

52

32

-20

-38%

Services

32

24

-8

-25%

Retail/Wholesale

16

16

0

0%

Trucking

25

11

-14

-56%

Healthcare

18

8

-10

-56%

Landscaping

18

6

-12

-67%

Admin & Support Sv.

12

7

-5

-42%

Passenger Trans.

10

6

-4

-40%

Arts/Entertainment

5

2

-3

-60%

Manufacturing

5

1

-4

-80%

Domestic

4

7

3

75%

Accommodations

2

1

-1

-50%

Information

0

1

1

NA

Farming/Agriculture

2

0

-2

-100%

Banking/Real Estate

3

0

-3

-100%

496

369

-127

-26%

total

WHY ARE UEF HEARINGS & CASES DOWN?

Lower Premiums – 20% drop in 2007 The Economy – Construction Greater Compliance & Stop Work Orders ILDBF – Few taxi hearings

UEF : LHU - Summary 

Ensuring prompt benefits to injured workers  

Protecting the assets of the Fund

Helping assess penalties and increase compliance among employers 

Protecting the Board against Fraud