Goldberg Segalla Can Help
Receive a bulk payout to compensate for past and future WCL
§§ 14(6) and 15(8 ) claims
Settle claims quickly and efficiently
Potentially turn a profit through smart negotiating
What Are WAMO Wholesale Waiver Agreements?
An agreement between the NYS Workers’ Compensation Board, the Waiver Agreement Management Office (WAMO), the Special Disability Fund, and the Carrier/SIE for a one-time payout in exchange for the Carrier waiving the right to any past, present or future reimbursement under WCL §§ 14(6) and 15(8), including reimbursements pending at the time of valuation, for all open claims.
What Are the Benefits?
- The Carrier receives a bulk payout to compensate for all past and future reimbursement claims, which could be sizeable depending on the amount of active claims.
- Compiling a list of active §§ 14(6) and 15(8) claims and valuing them for inclusion as part of the Wholesale Waiver Agreement will give you an opportunity to take stock of all active claims, identify claims where reimbursement has not yet been requested (i.e. periods of tentative rates), and take any action required to maximize reimbursement.
- After the Wholesale Waiver Agreement is finalized, §§ 14(6) and 15(8) claims can be settled without waiting for WAMO approval, which will allow for quicker and more efficient settlement.
- Once the value of an individual claim is determined as part of the Wholesale Waiver Agreement, you can focus on negotiating full and final settlement of the claim for less than the amount paid by WAMO, creating a net profit.
Who Is Eligible?
Any Carrier with open claims subject to full or partial reimbursement from the Special Disability Fund under WCL §§ 14(6) and/or 15(8).
What Are the Requirements?
- All §§ 14(6) and 15(8) claims for the Carrier’s particular W# must be included in the agreement.
- Valuation of each individual claim will be determined using the specific formula set forth by WAMO (provided here).
- Since the Special Funds Group (SFG) will not authorize reimbursement for periods of awards directed at a “tentative” rate, any periods of “TR” awards must be set firm by stipulation or at a hearing in order to include the associated reimbursement in the overall settlement valuation.
- To maximize reimbursement, all outstanding issues, such as C-8.1Bs, must also be resolved, and any associated reimbursement requests filed, prior to submitting for WAMO valuation.
What Are the Steps?
- Request the appropriate template from WAMO (WholesaleAgreements@wcb.ny.gov).
- Identify all open (i.e. not previously settled) claims where WCL §§ 14(6) and/or 15(8) have been found to apply and list them on the provided template.
- Review each claim to determine whether a request for reimbursement has been submitted for all eligible payments made to date and/or whether any outstanding issues are preventing a request for reimbursement that would otherwise be made (i.e. “TR” awards, C-8.1Bs, etc.).
- Remedy any discovered issues by stipulation (preferred) or at a hearing, if appropriate.
- File reimbursement requests for any prior payments that have not yet been claimed. This step is essential because the right to reimbursement for payments made prior to the Wholesale Waiver Agreement is waived as part of the Agreement. WAMO will include all outstanding indemnity and medical reimbursement requests that were submitted to the SFG for reimbursement, but the requests have to be sent to the SFG before the request for valuation is sent to WAMO.
- Send the completed template to WAMO for valuation.
WAMO will value each claim identified in the template, add in any pending reimbursement requests, calculate the overall settlement amount, and share the valuation with you.
- You should also value the individual claims to allow for easy, side-by-side comparison once the valuation is shared in order to ensure that the valuation provided by WAMO is accurate.
Here is the formula WAMO uses to value the claims:
Medical: the average of the last three years of medical expenses is multiplied by the life expectancy of the claimant, with any “anomalies” deducted (e.g. surgeries, expensive procedures or DME that won’t be needed again).
Indemnity: take 100% of the life expectancy of the claimant, then discount it by the 20-year Treasury rate, plus 0.5%.
If the WAMO valuation for any claim is significantly lower than your prediction (using the above formula), or if there are any other issues, you can reach out to the Board/WAMO and a call will be scheduled to discuss the issues.
How Long Will This Take?
- The amount of time that it will take on the front end (before the paperwork is submitted to WAMO) will depend heavily on how many open §§ 14(6) and 15(8) cases you have.
- Once the completed template listing all open claims is submitted to WAMO, most agreements are finalized within 60 days.
How Can Goldberg Segalla Help?
- We can tailor our level of involvement depending on your internal capacity and preference.
- It is recommended that GS attorneys review the individual files that will be included in the Wholesale Waiver Agreement to ensure that there are no issues preventing reimbursement or that would otherwise negatively impact the valuation of the particular claim. GS will also assist with settling the individual claims once the Wholesale Waiver Agreement is finalized.
- Other ways that GS can facilitate the Wholesale Waiver Agreement process include:
- Reviewing the individual files and identifying any claims where a reimbursement request for prior payments is needed;
- Remedying any discovered issues preventing a reimbursement request by stipulation or at a hearing;
- Compiling the necessary information into the template provided by WAMO;
- Calculating the projected valuation for each claim, as well as the overall valuation inclusive of pending reimbursement requests;
- Comparing the valuation provided by WAMO to our internal calculations to ensure accuracy;
- Contacting WAMO to dispute any inaccuracies that may be discovered; and
- Facilitating preparation and execution of the final Wholesale Waiver Agreement.
If you have any questions or would like further information, please contact:
- S. Philip Unwin
- Todd M. Jones
- Kristen Hazlet
- Kristen Romano
- Sean J. McKinley
- Esther F. Omoloyin
- Damon M. Gruber