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Subject Number 046-179 CLAIM FOR REIMBURSEMENT FROM SPECIAL DISABILITY FUND $250 FILING FEE

Board Bulletins and Subject Numbers

Date: March 23, 2007

To: State Insurance Fund, Insurance Carriers, Self-Insured Employers, Third-Party Administrators, Special Funds Conservation Committee

Chapter 6 of the Laws of 2007 (A.6163/S.3322) amended Workers' Compensation Law §15(8) (h) by adding new clause (C) to new subparagraph (2) which states:

(C) All claims for reimbursement from the special disability fund must be accompanied by a filing fee of two hundred fifty dollars, to be deposited in the special disability fund. Upon any final ruling that a claim is eligible for reimbursement from the fund, the fund will return two hundred dollars of this fee to the claimant. [15(8) (h) (2) (C)].

This new provision was effective immediately upon the Governor's signing this act into law on March 13, 2007. Therefore, every claim for reimbursement filed on and after March 13, 2007, must be accompanied by a $250.00 filing fee.

To comply with this new provision, the entity making the claim must submit an original and one copy of Form C-250, Notice of Claim for Reimbursement out of the Special Disability Fund under Section 15, Subd. 8 and a check made payable to "Special Disability Fund" in the amount of $250.00 for each claim to:

WCB Finance Office
20 Park Street, Room 301
Albany, New York 12207
[Effective June 29, 2012 checks should be mailed to:
328 State Street, Schenectady NY 12305-2318]

If multiple claims are filed by the same entity at the same time, the entity may submit one check in an amount equal to the $250.00 filing fee for each claim. However, a spreadsheet must be submitted which includes the claimant name, WCB case number and check number for each claim. Failure to submit the $250.00 filing fee for each claim will result in the return of the Form C-250 to the carrier listed on the form. Payment of the filing fee is a prerequisite to the filing of a claim for reimbursement from the special disability fund on and after March 13, 2007.

Form C-250 (3-07) has been revised to reflect the new filing fee and revised mailing address. It is available on the Board's website (www.wcb.ny.gov) under the heading Common Forms.

Any questions regarding this requirement should be referred to Kathleen Griffin at (518) 474-9380.

Donna Ferrara
Chair