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New York Initial Application For License To Appear On Behalf of Or Represent Carriers And-Or Self-Insurers

State:
New York
Control #:
NY-OC-403.1-WC
Format:
PDF
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Description

Initial Application For License To Appear On Behalf of Or Represent Carriers And-Or Self-Insurers

The New York Initial Application For License To Appear On Behalf of Or Represent Carriers And-Or Self-Insurers is an important document that is required for businesses to obtain in order to legally represent or appear on behalf of carriers and/or self-insurers in the state of New York. This application is administered by the New York State Department of Financial Services. It covers areas such as an applicant’s contact information, education and experience, and any other relevant information. The New York Initial Application For License To Appear On Behalf of Or Represent Carriers And-Or Self-Insurers comes in two forms: 1. Individual Attorney License: This is for individual attorneys who wish to represent carriers and/or self-insurers. 2. Corporate Attorney License: This is for corporate entities, such as law firms, that wish to represent carriers and/or self-insurers. Once the application is submitted and approved, the applicant will receive a license number that must be used in all subsequent filings.

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FAQ

Independent contractors You may need insurance even for those receiving 1099s. Workers' compensation insurance protects employers and employees against financial loss in the event of a work-related injury or illness. Employers must continuously carry workers' compensation insurance for their employees.

SI-12 (7/09) Affidavit Certifying That Compensation Has Been Secured. Employers with Board-approved self-insurance for workers' compensation. Filed with the government agency issuing a permit, license or contract. The SI-12 must be completed by the Board's Self-Insurance Office and approved by the Board's Secretary.

Workers' Compensation coverage is not required if the business is a one or two person owned corporation, with those individuals owning all of the stock and holding all offices of the corporation (each individual must hold an office and own at least one share of stock).

Accepted Forms: U26.3 ? Certificate of Workers' Compensation Ins (NYS Insurance Fund only)

If you filed a claim and were assigned a number, you can call (646)264-3000 for information about your claim. If you are a U.S. Department of Labor employee, please call (816)502-0301 for claim status information.

Workers' compensation coverage is required for sole proprietors with employees, including part-time employees, borrowed employees, leased employees, family members, and volunteers (WCL §3 Groups 1-14-a).

More info

To become an unaffiliated insurance agent, an agent must self-appoint as an unaffiliated agent for the corresponding license type(s). Self-insurers must complete an updated application form sixty days prior to the expiration date of the current certificate.The license itself does not create any authority, actual, apparent or inherent, in the holder to represent or commit an insurance carrier. If an applicant qualifies for self-insurance, the chairman will first issue a notice of conditional approval to the applicant. Items 14 - 33 — Providers may use these instructions to complete this form. This term includes self-insurers. HTMLPDF, 296-15-171, Surety for a self insured pension or fatality claim. Carriers must submit an "Original" application if there has been no previous IRP registration in Florida, and provide various forms of proof. Hereafter in this text, "the Board" or "Board" refers to the Georgia State Board of Workers'. Compensation. For full details on the requirements, see Minnesota.

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New York Initial Application For License To Appear On Behalf of Or Represent Carriers And-Or Self-Insurers