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.
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. 38 | Page
The maximum amount that a multiple-coordinated insureds are required to pay is annual standard premium as shown on the Information Page of its policy adjusted by audit, there is no override for the extra benefits provided under the Program. Assessment (assessments and taxes charged by the State) are paid directly to the State. 24-Hour Program Components The program components include: • Early Intervention, Advocacy, Case Management, Communication and Professionalism • Utilization Review including Pre-certification, Concurrent and Continued Treatment Plan Review • Utilization Review including Concurrent and Continued Hospitalization Stay Review and Discharge Planning • Medical Case Management • Loss Control • Catastrophic Case Management • Vocational Case Management • A Preferred Provider Network including Credentialing, Monitoring and Quality Assurance Review • Bill Review • Audit and Re-pricing • Rehabilitation/Occupational Injury Management • Return to Work and Temporary Alterative Work Programs • Risk Management Steps to Set-Up the 24-Hour Program • Initial Study Including on-Site Surveys. (Survey current situation with management, safety personnel, and claims people; Review manuals and procedures and claims files. Interview project managers, foreman, and workers regarding field operations and current problems.) • Access Current Post-Injury Management Program and Return to Work Policies. • Prepare Comprehensive Business Plan to Create Results Monitoring Program. (The business plan will be for review by senior management regarding findings and steps necessary to reduce costs.) • Receive Commitment from Labor and Management. (Effectiveness depends on current status of policies, procedures and activities, as well as level of commitment to changes). • Begin working out details and assigning procedural responsibilities to supervisors and employees. 39 | Page
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