Get Ny Si-4.11 2016-2026

Filling out the NY SI-4.11 form online can seem daunting, but it is essential for reporting outstanding death and disability claims. This guide will provide you with clear, step-by-step instructions to help you navigate the process with confidence.

Follow the steps to complete the form effectively.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred online editor.
2. Begin by entering the outstanding self-insured death claims on Form SI-4 and all outstanding self-insured disability claims on Form SI-4.1. Ensure you value the claims as of September 30, 2016.
3. List the claims in descending order according to the date of accident, organized by accident year from April 1 through March 31. Start with the most recent accident year (April 1, 2015 - March 31, 2016) and follow with earlier years.
4. For all claims before April 1, 2008, create a separate group labeled as ‘all prior years’.
5. If there have been adjustments to reserves made by the Self-Insurance Office, record those claims according to the adjustment reasons provided.
6. Report all workers’ compensation accidents where employees are entitled to compensation benefits. However, do not report cases involving medical treatment only.
7. Include claims that were reported previously and are still open on either Form SI-4 or Form SI-4.1.
8. If a claim has been deemed reimbursable by the Special Fund under WCL Section 15(8) since your last report, attach the necessary documentation showing this acceptance.
9. For claims expected to have recoveries from third-party settlements, ensure they carry a reserve equal to one year of future payments.
10. List closed claims prior to October 1, 2016 at the end of the current report, showing the case number, name of the injured person, date of accident, date closed, and complete closing action.
11. Only complete the affirmation on the top page if multiple pages are used. If claims are handled across various work locations, consolidate the report before filing.
12. Once the form is complete, you have the option to save changes, download it for your records, print a copy, or share it as necessary.

Complete and file your NY SI-4.11 form online to stay compliant with the reporting requirements.