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Page R-14NEW YORK WORKERS COMPENSATIONAND EMPLOYERS LIABILITY MANUALIssued October 1, 2008Effective May 1, 2017Original Printing1st ReprintRULE IIIB. NAME, ADDRESS AND OTHER WORKPLACES OF INSURED ITEM 11. Combination of Legal EntitiesSeparate legal entities may be insured in one policy only if the same person, or group of persons,owns the majority interest in such entities.2. Single LocationAll operations of any one employer at a single location shall be insured in one policy.3. Multiple LocationsAll New York locations and operations of an employer are automatically covered by the policy.If a policy is issued to limit coverage only to operations conducted at or from specified location(s), theDesignated Workplaces Exclusion Endorsement (WC 00 03 02) must be attached.When coverage for a location is to be excluded subsequent to the effective date of the policy, theNew York Designated Workplace Cancelation Endorsement and Notice of Partial Cancelation (WC 3103 02) must be attached to the policy. All statutory provisions for cancellation of coverage must befollowed when such partial cancellations are made.C. POLICY PERIOD ITEM 21. Normal Policy PeriodThe normal policy period is one year. A policy may be issued for any period not longer than threeyears. Refer to Section I.H.12 of the Digest of Rulings and Interpretations.2. Policy for One Yeara.The manual rules are based on a policy period of one year.b.A policy issued for a period not longer than one year and 16policy.days is treated as a one year3. Policy Longer Than One YearA policy issued for a period longer than one year and 16 days, other than a three-year fixed ratepolicy, is treated as follows: a.The policy period is divided into consecutive 12 month units.b.If the policy period is not a multiple of 12 months, use the Policy Period Endorsement (WC 0004 05) to specify the first or last unit of less than 12 months as a short-term policy.c.All manual rules and procedures apply to each such unit as if a separate policyhad been issuedfor each unit, including submitting an annual endorsement providing carrier approved rates,payrolls and other premium charges. that may change on each anniversary rating date.

NEW YORK WORKERS COMPENSATIONAND EMPLOYERS LIABILITY MANUALOriginal Printing1st Reprint Issued October 1, 2008Effective May 1, 2017Page R-15RULE III4. Three-Year Fixed Rate Policy OptionA policy may be issued for a period of 3 years using carrier approved rates. Such a policy shallnot be issued if the risk is subject to the Experience Rating Plan on the effective date of thepolicy.A policy issued under this option shall be known as a Three-Year Fixed Rate Policy and shall beso designated on the Information Page. Refer to Rule XI.D. STATE LAWS DESIGNATED IN THE POLICY ITEM 3.A.1. Listing of StatesInsurance for operations conducted in a state is provided by listing the state in Item 3.A. of theInformation Page.2. Longshore ActThe U.S. Longshore and Harbor Workers' Compensation Act shall not be entered in Item 3.A. of theInformation Page. Refer to Rule XII.3. Additional StatesA state may be added after the effective date of thepolicy. For the additionalstate operations, apply: a.Authorized rates in effect on theanniversary rating effective date of the policy to which the statehas been added;b.Any approved rate change which applies to outstanding policiesfor the state being added; andc.Any applicable experience rating modification for the policy to which the state has been added.Refer to the New York Experience Rating Plan Manual.

Page R-46NEW YORK WORKERS COMPENSATIONAND EMPLOYERS LIABILITY MANUALEffective January May 1, 201520172nd 3rd ReprintRULE VIIRULE VII—PREMIUM DISCOUNTItem 4 of the Information Page—continuedA. EXPLANATION Premium discount recognizes that the relative expense of issuing and servicing larger premium policies isless than for smaller premium policies. Premiu m discount is a per policy charge an d is calculated basedupon the carrier’s expense provision as of the effective date of the policy and policy standard premium.regardless of any cha nge in anniversary rating date or a mid-term change in the carrier’s expenseprovision.B. DEFINITIONS1. Standard PremiumStandard premium is the premium before the p remium discount. For t he purposes of this rule, thepremium is determined on the basis of authorized carrier rates, any experience ratin g or merit ratingmodification, credits under the Ne w York Con struction Classification Premium Adjustment Program,surcharges and credits under the Workplace Safety Programs and other programs as shown inAppendix C, non-ratable elements as defined in Rule VI.A.4, premium for increa sed limits of liabilityand carrier minimum premiums. The carrier expense constant, the New York State Assessment, theWorkers’ Compensation Security Fund Surcharge and th e additional charges fo r the catast ropheprovisions as shown in Rule IX.N shall be excluded from determination of the standard premium.2. Total Standard PremiumTotal standard premium means the total premium for all states covered by the policy.3. InsuredInsured means a single entity or two or moreYork Experience Rating Plan Manual.legal entities eligible f or combination under the NewC. RETROSPECTIVE RATINGAny standard premium under a retrospective rating plan is not subject to premium discount.D. DETERMINATION OF PREMIUM DISCOUNTIf a policy develops tot al standard premium in excess of 5,000, the standard p remium is subject t opremium discount as follows:1.Without Retrospective Ratinga. Single State PolicyIf a policy provides coverage only in New York, the carrier shall apply a premium discount asapproved by the Department of Financial Services.

NEW YORK WORKERS COMPENSATIONAND EMPLOYERS LIABILITY MANUALEffective January 1, 2014 May 1, 20176th 7th ReprintPage R-69RULE IXL. NEW YORK STATE ASSESSMENT1.ExplanationThe New York State Assessment is a separate identifiable charge to policyholders for thefunding ofthe various expenses described in Section 151 of the Workers’ Compensation Law.2.General InformationThe New York State Assessment amount must be displayed as a separate identifiablecharge on thepolicy information page. Statistical Code 0932 must be used in conjunction with this charge forpolicy submission use only.The New York State Assessment amount is subject to change at audit.For policies with effective datesprior to January 1, 2014, the New York State Assessment amount ischarged in conjunction with the effective date of the rates used on each policy.Therefore, where theAnniversary Rating Date Endorsement (WC 00 04 02) applies and the ARD is prior to January 1,2014, e.g., when two sets of rates are used and both are effective prior to January 1, 2014 , twoassessment percentages will apply. For policies with effective dates on or after January 1, 2014, and policies effective prior toJanuary1, 2014 with an ARD on orafter January 1, 2014, the New York State Assessment amount is chargedin conjunction with the effective date of the policy. Therefore, a single assessment percentage willapply to each policy, even if the Anniversary Rating Date Endorsement (WC 00 04 02) applies. For all policies effective on or after March 1, 2011 and prior to January 1, 2014, in accordancewith the Fifth Amendment to Regulation No. 119 (11 NYCRR 151-6) standard premium must beused as the basis for calculating the policy charge.3.Premium Base for Calculating the New York State AssessmentFor policies with effective dates prior to January 1, 2014, standard premium is the only premium baseto be used in calculating the New York State Assessment policyholder charge.(i) For purpose of this rule, standard premium is defined as the premium determined on the basisof the insurer’s approved rates, as modified by:(a) any experience modification or merit rating factor;(b) any applicable territory differential premium;(c) the minimum premium;(d) any Construction Classification Premium Adjustment Program credits;(e) any credit from return to work and/or drug and alcohol prevention programs, including creditsunder the Workplace Safety Loss Prevention Incentive Program (WSLPIP);(f) any surcharge or credit from a workplace safety program, including credits under theWorkplace Safety Loss Prevention Incentive Program (WSLPIP);(g) any credit from independently-filed insurer specialty programs (for example, alternativedispute resolution, drug-free workplace, managed care or preferred provider organizationprograms);(h) any charge for the waiver of subrogation;(i) any charge for foreign voluntary coverage; and(j) the additional charge for terrorism, and the charge for natural disasters and catastrophicindustrial accidents.(ii) For purposes of determining standard premium, the insurer’s expense constant, including theexpense constant in the minimum premium, the insurer’s premium discount, and premium credits forparticipation in any deductible program, as well as any premiums providing federal coverage, andcoverage under the volunteer firefighter benefit law and volunteer ambulance workers benefit law,shall be excluded from the premium base.(iii) The insurer shall also use the definition of standard premium set forth in Regulation 119, citedabove, to report standard premium to the New York State Workers’ Compensation Board.For policies effective on or after January 1, 2014, refer to the Workers’ Compensationwww.wcb.ny.gov for procedures to determine the NY State Assessment.Board at

Page R-70NEW YORK WORKERS COMPENSATIONAND EMPLOYERS LIABILITY MANUAL2nd3rdReprintEffective January 1, 2014 May 1, 2017RULE IX4.Assessment ChargeThe assessment percentages to be applied to each policy can be found in Part Three–Loss Costs,Miscellaneous Values in this manual.Note: For policies effective prior to January 1, 2014, NewYork State Law requires that theassessment amounts collected from policyhol ders be considered as premium for taxpurposes. Assessment charges prior to January 1, 2014 contemplate premiumtax, but notcommission. For policies effective on or after January 1, 2014, assessment amountscollected from policyholders are no longer considered as premium for tax purposes.M. WORKERS COMPENSATION SECURITY FUND SURCHARGE1.ExplanationThe Workers Compensation Security Fund Surcharge is a separate identifiable charge topolicyholders for the funding of the Workers Compensation Security Fundwhich serves as theguaranty fund for fulfilling the obligations of insolvent private carriers writing workers compensation inthe state of New York.Department of Financial Services, as requirednecessary.2.by statute, determines when this surcharge isGeneral InformationWhen applicable, the Workers Compensation Security Fund Surcharge amount must be displayed asa separate identifiable charge on the policy information page. Code 9749 must be used inconjunction with this charge.The Workers Compensation Security Fund Surcharge amount is subject to change at audit and at allsubsequent retrospective rating adjustments.The Workers Compensation Security Fund Surcharge amount is charged in conjunction with theeffective date of the rates used on each policy.Therefore, where the Anniversary Rating DateEndorsement (WC 00 04 02) applies, e.g., when two sets of rates are used, two surchargepercentages will apply. 3.Premium Base for Calculating the Security Fund SurchargeTotal policy premium is the premium base to which the surcharge percentage,shown in Part Three–Loss Costs, Miscellaneous Values section of this manual, applies.

Page D-10NEW YORK RULINGS AND INTERPRETATIONSSECTION IIssued October 1, 2008Effective May 1, 2017Original Printing1st Reprint6.7.8.9.10.11.Rule VI.J .Rule VI.K.Rule IX.A.6Rule IX.B.4Rule IX.C.3.Rule IX.I.312. Rule XII.D.4Premium Determination for Federal and Maritime InsuranceLoss Prevention ProgramsExecutive Officers Premium DeterminationSole Proprietors and Partners Premium DeterminationPremium for Uninsured SubcontractorsNew York Construction Classification Premium Adjustment Program CreditDeterminationNon-Federal "Non-F" Construction ClassificationsFrequently asked questions that better explain the intent of the Program and clarify application of themanual rules are shown below. Following the questions and answers are some examples of premiumcalculations as they pertain to payroll limitation.FREQUENTLY ASKED QUESTIONS Q:What is the Construction Employment Payroll Limitation Law?A:The Payroll Limitation Law was enacted to become effective for policies with anniversary ratingdates on or after October 1, 1999. Beginning May 1, 2017, anniversary rating date is replaced bypolicy effective date. For workers compensation insurance premium determination purposes, theLaw applies a maximum payroll limitation for eligible construction classification codes. The Lawdoes not apply, however, to employments engaged in the construction of one or two-familyresidential housing. Refer to Rule V.G.1.Q:What is the purpose of the Payroll Limitation Law?A:The purpose of the Payroll Limitation Law is to provide a more equitable distribution of premiumbetween high wage paying and low wage paying employers in the construction industry.Q:How does the payroll limitation work?A:A payroll limitation is applied to the actual weekly payroll per employee in each of the eligibleconstruction classification codes. Actual payroll, and not the limited payroll, is used for employmentsengaged in the construction of one or two-family residential housing. Refer to Rule V.G.1-4.Q:Who is eligible for payroll limitation?A:Employers with payroll in the classifications shown in Rule V.G.1 of the Manual.Q:Are any construction employments excluded from the Payroll Limitation Law?A:Yes, any employments engaged in the construction of one or two-family residential housing.Example: The payroll limitation would apply to an employer subject to Code 5183 who performsplumbing work in a commercial or retail building. However, if the same employerperformed plumbing work in one or two-family residential housing, then that payroll wouldnot be subject to payroll limitation. Refer to Rule V.G.1.

NEW YORK WORKERS COMPENSATIONAND EMPLOYERS LIABILITY MANUAL4th 5th ReprintEffective January May 1, 20152017INDEXALPHABETICAL INDEX OF ENDORSEMENTSSTANDARD AND STATE SPECIAL ENDORSEMENTS APPLICABLE IN NEW YORK Alternate Employer Endorsement. WC 00 03 01 AAnniversary Rating Date Endorsement .WC 00 04 02Catastrophe (Other Than Certified Acts of Terrorism) Premium Endorsement . WC 00 04 21 DDefense Base Act Coverage Endorsement . WC 00 01 01 ADesignated Workplaces Exclusion Endorsement .WC 00 03 02Employers Liability Coverage Endorsement . WC 00 03 03 CExperience Rating Modification Factor Endorsement. WC 00 04 03Federal Employers' Liability Act Coverage Endorsement . WC 00 01 04 A Information Page Notes .WC 00 00 01 CDInsurance Company as Insured Endorsement . WC 00 03 04Joint Venture as Insured Endorsement . WC 00 03 05Longshore and Harbor Workers' Compensation Act Coverage Endorsement . WC 00 01 06 AMaritime Coverage Endorsement . WC 00 02 01 BNew York Ambulance and Fire District Liability ExclusionEndorsement for County or Town Policies . WC 31 06 12New York Ambulance District Liability Exclusion Endorsement for County or Town Policiesfor County or Town Policies . WC 31 06 09New York Benefits Deductible Endorsement . WC 31 03 15 ANew York Construction Classification Premium Adjustment Factor Endorsement . WC 31 04 01New York Construction Classification Premium Adjustment Program ExplanatoryEndorsement . WC 31 03 19 New York Coverage for Elected or Appointed Officers of Municipal Corporationsor Other Political Subdivisions Endorsement . WC 31 03 01New York Designated Workplace Cancelation Endorsement and Noticeof Partial Cancelation . WC 31 03 02New York Domestic Workers Restricted Endorsement . WC 31 06 01New York Excess Medical Coverage Endorsement . WC 31 03 03New York Exclusion For Designated Officers and Employeesof Ambulance Districts Endorsement . WC 31 06 11New York Exclusion For Designated Officers and Employees of Fire DistrictsEndorsement . WC 31 06 02New York Exclusion of Executive Officer Endorsement . WC 31 03 05 BNew York Executive Officers Exclusion Endorsement . WC 31 03 04New York Executive Officers Hold Harmless Endorsement . WC 31 06 03New York Fire District L

NEW YORK WORKERS COMPENSATION Page R-1 AND EMPLOYERS LIABILITY MANUAL 8 th 9 Reprint ( Effective March 1, 2015) Effective January May 1, 2015 2017 RULE I PART ONE—RULES RULE I - GENERAL A. WORKERS COMPENSATION Workers Compensation as used in this manual means workmen's compensation, workers compensation