The Percy Program

It is a fight to level the playing field to be able to compete for jobs and careers on the basis of skills and make available apprentice training to all. In 1973 Al Percy launched a class action lawsuit to give workers like him a chance to better their lot in life. It would also ensure the availability of skilled workers to build the infrastructure of the future. Who is Al Percy? What is the lawsuit?

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Percy Program - Alternative Employment Practice EDNY 20-cv-06131

  • Text
  • Percy
  • Workers
  • Compensation
  • Pageid
  • Apprenticeship
  • Osha
  • Assessment
  • Coverage
  • Items
  • Employment
  • Edny

Case

Case 1:20-cv-06131-CLP Document 22-21 Filed 03/14/21 Page 40 of 64 PageID #: 2772 Total Estimated Policy Premium shall equal Annual premium plus New York Assessment. Final premium will be determined after a policy ends by using the actual payroll to calculate the actual premium owed, not the estimated, based on the proper classifications and rates that lawfully apply to the business and work covered. If the final premium is more than the premium paid, the balance must be paid. If it is less, a refund will be due. All records that relate to the policy shall be subject to audit. These records include ledgers, journals, registers, vouchers, contracts, tax reports, payroll and disbursement records, and programs for storing and retrieving data. The audit shall be conducted during regular business hours during the policy period and within three years after the policy period ends. Information developed by audit will be used to determine final premium. A sliding scale policyholder dividend plan as a means to provide further incentive to enforce the risk management, apprenticeship and other OSHA safety programs The dividend plan is targeted to return, on average, 10.0% of premium. The dividend scale requires a developed loss ratio of under 40.0%. Annual dividends of as high as 40.0% are available to the larger, loss free risks. Policyholder dividends are not guaranteed and are to be payable only from earned surplus upon declaration by the Board of Directors of the Company. 24‐Hour Coverage Program Gaining control of workers' compensation costs is essential. Health care providers under intense pressure from health care programs, find it all too convenient to shift costs to workers' compensation coverage. This can raise the medical cost for any claim by a factor of 100 - 400%. To help alleviate this crushing burden, the Program offers a singularly unique 24-hour protection portfolio jointly administering workers' compensation, health, and disability coverages. Delivery of workers' compensation services and traditional health care reduces costs while providing employees with a simple, state-of-the-art system of health care delivery, combining care for injured and ill workers. Oriska Insurance is the sole provider of a fully insured 24-Hour Coverage Program of employee benefits (the “24-Hour Coverage Program”) offered by Oriska as a domestic New York insurance carrier. The 24-Hour Coverage Program seamlessly provides instant care through a workers’ compensation carrier that is also a licensed health carrier, specializing in workers’ compensation, health and disability. Oriska is so singularly licensed, licensed for health in its PandC licensing, even though health coverage is normally the purview of a life carrier. This gives Oriska the ability to provide immediate care regardless of the injury is work-related or not in a cost-efficient manner. No other U.S. company is so specially licensed. The unusual licensing of Oriska for health, disability and workers’ compensation insurance within the same carrier enables Oriska to provide immediate care under its health coverage, returning 38 | P age

Case 1:20-cv-06131-CLP Document 22-21 Filed 03/14/21 Page 41 of 64 PageID #: 2773 injured employees to work, avoiding long term worker compensation benefit costs. Employees receive the same medical attention whether the injuries are work or non-work related. The necessary licenses for the business of accident and health, disability and workers’ compensation as specified in paragraphs 3 and 15 of Section 1113(a) of the New York Insurance Law, are required for the loss sensitive 24-Hour Coverage Program. These licenses were granted by the State to Oriska in 1993. The licenses required rating and form approvals by the DFS pursuant to Insurance Law §2307 and were first approved by the DFS for Oriska in 1994, and were revised and ratified in 2003, 2005 and 2007. Oriska’s membership in the New York Compensation Insurance Rating Board (“NYCIRB”), credentialed with the New York Workers Compensation Board (“WCB”), recognized by New York State by the issuance of licenses under paragraphs 3 and 15 of Section 1113(a) of the New York Insurance Law, were necessary to legally operate this 24-Hour Coverage Program, intellectual property specifically approved for Oriska’s individual use and identity. This loss sensitive program of 24 hour work-related and non-work related coverage is accomplished by endorsing standard policies to provide coverage offered as a portfolio of coverages with basic required pieces that the insured must agree to take and participate in, a basic program that the insured agrees to by its Adoption Agreement. There are additional coverages that are added to enhance the program as the insured chooses. The basic coverage is workers’ compensation as shown on the Information Page of the Policy. A first aid emergency treatment, well care coverage rider and preventative care is added for claims which are not immediately accepted as work related in order to provide immediate medical care and treatment. If there is a C2 First Report of Claim alleging a work related incident, the Carrier so notifies the Workers Compensation Board but continues to pay as a non-work-related incident until a claim has been established by decision of the Workers Compensation Board. In addition, a rider for Enhanced Statutory Disability shall apply for lost wages as an enhancement to supplementing Statutory Disability overage issued by the Carrier or to enhance Disability coverage provided by another carrier [upon renewal of the Program adopted by the Insured, the Carrier shall provide Statutory Disability Coverage at rates in place with another carrier at the time of the initial adoption of the Program, and thereafter at rates calculated by the Carrier for the experience of the Insured. If upon renewal of the Program the insured opts not to purchase its Statutory Disability Coverage from the Carrier, the Carrier has the option to non-renew the Program in its sole discretion]. The Program includes first aid emergency treatment, well care, safety, risk management, loss control, education and continuing education, and apprenticeship. If an insured fails to participate in these aspects of the Program, the Carrier has the option to nonrenewal in its sole discretion. 39 | P age

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