Instructions for Completing the Section 32 Waiver Agreement
In order to expedite the resolution processing of the Section 32 Waiver Agreement, the parties are requested to follow these instructions. Failure to follow these instructions and to provide the necessary accompanying documents may result in the resolution of the Section 32 Agreement being delayed. The statute and regulation pertaining to Section 32 Waiver Agreements (WCL§ 32 and 12 NYCRR 300.36) is available at www.wcb.ny.gov.
1.Form: Submit a legible Form C-32. The terms of the agreement must be in a single separate attachment. If it becomes necessary to modify the agreement, please submit a new amended agreement incorporating the modifications, rather than an addendum. Any Claim included in a Section 32 Waiver Agreement must be assembled and assigned a Case Number by the Board. A copy of the Section 32 Waiver Agreement must be submitted for each claim included in the agreement.
2.Page Numbers: Number the pages of the document as follows: Page 1 of 4, Page 2 of 4, etc. (Do not include instructions or blank pages in your submission).
3.Signatories: Have all parties in interest, including the guardian for minor claimants if any, sign and date Form C-32 and the final page of the Section
32Waiver Agreement prior to submission. Special Funds or the Waiver Agreement Management Office (WAMO) must also be a signatory and date Form C-32 if WCL §§ 14(6) or 15(8) have been found applicable to the case(s). Special Funds must sign and date Form C-32 if 25-a has been found applicable to the case(s). If a disability benefits lien is addressed in the Section 32 Waiver Agreement, then the Disability Benefits Carrier must sign.
4.Necessary Provisions: Address the resolution of these issue(s) if any have been raised or are still pending before the Board at the time of the agreement:
• disputed medical bills (Form C-8.1B) |
• wage expectancy of a minor |
• |
tentative rates |
• outstanding requests for attorney's fees (OC-400.1's) |
• periods held in abeyance |
• |
responsibility for future medical treatment |
• |
WHEN continuing payments will stop |
• |
disability benefits lien |
5.Language to Avoid: Do not include references to:
•a claim(s) being “disallowed” or “disallowed” by stipulation
•an unassembled claim(s) that has (have) not been assigned a Case Number by the Board
•a waiver of the ten day withdrawal period
•identifiable confidential information pertaining to an individual not a party to the agreement
•when the agreement becomes binding
The Board will not approve any agreement which provides that a claim is "disallowed" by stipulation of the parties because such language implies a finding by the Board, which is not the case. If a claim has not yet been established, the agreement may indicate that the claim is being "withdrawn" by the claimant.
6.Pending Appeals: If there is a pending Appeal for a case included in a Section 32 Waiver Agreement, the agreement must indicate that the appeal is withdrawn or resolved. The Board will not approve Section 32 Waiver Agreements for claims that have an unresolved pending Appeal.
7.Annuity: If the agreement references future payments based upon the purchase of an annuity contract, provide a summary specifying all of the following: that the annuity be purchased from a life insurance carrier rated “A” or better by A.M. Best or Standard & Poor, the total amount payable pursuant to the annuity, cost [present value] of the annuity, schedule of payments to be made, provision if claimant dies before the final payout, and a statement that to the extent they conflict, the terms of the agreement are controlling over the terms of the annuity contract. It is not necessary to provide the annuity contract.
8.Child Support Lien: If the claimant has an outstanding Child Support Lien, the Section 32 Waiver Agreement must provide for payment in full. Documentation no less than 30 days old from the appropriate Support Collection Agency detailing the current lien amount must be submitted. Prior to approving any Section 32 Agreement, the Board will conduct a search for any outstanding child support obligations.
9.World Trade Center Health Program (WTCHP) Review and Approval of the Section 32 Waiver Agreements: Applies to all parties to any settlement of WTC-related workers' compensation claims that have been accepted into the WTCHP. Settlements falling above $10,000 which do not leave medical open are required to protect the interests of the WTCHP in the settlement and to set aside adequate monies to cover future medical services. The Board will enforce the WTCHP policy by requiring all Section 32 Waiver Agreements which do not leave medical open involving WTCHP recipients to address future payments to the WTCHP. A letter of approval from the Administrator of the WTCHP, the National Institute for Occupational Safety and Health (NIOSH), is required before a Section 32 Waiver Agreement which does not leave medical open will be approved by the Board.
10.Other Necessary Documents: Submit along with Form C-32, the following documents. Be sure to reference on the documents the WCB Case Number for each claim included in the Section 32 Waiver Agreement:
•a signed and notarized Form C-32.1, Claimant Release
•a completed Form OC-400.1 if an attorney fee of over $1000 is requested
•a letter from CMS, if the agreement references CMS's approval of a specified Medicare set-aside
•current evidence that the life insurance carrier providing the annuity is rated A or better by A.M. Best or Standard & Poor, if the agreement references an annuity
•a copy of the guarantee letter from the life insurer backing the assignee, if the agreement references a qualified assignment
•document(s) identifying the proper beneficiaries, if the agreement pertains to benefits payable upon the death of the claimant
•letter of approval from the Administrator of the WTCHP, the National Institute for Occupational Safety and Health (NIOSH), if the agreement is for a claim accepted into the World Trade Center Health Program (WTCHP)
