09/15/2025 - DB-PFL Proof of Coverage penalty update

As a reminder, New York State Workers' Compensation Law (WCL) § 226 authorizes the Board to penalize insurance carriers who fail to file proof of coverage (POC) transactions in a timely manner.

The Workers' Compensation Board (Board) will be measuring carrier performance quarterly on the timeliness of Add Policy (new) and Cancelation transactions on disability (DB) and Paid Family Leave (PFL) insurance policies. Upon implementation (exact date to be announced), carriers who do not meet an 85% timely performance rate will be penalized for untimely POC transactions.

Following discussions with DB-PFL carriers, the Board is further clarifying the POC transactions that will or will not be measured:

• Add policy: The Board will not measure the timeliness of an Add Policy filing where the policy has already been reported prior to that transaction date. This will allow for a change to an insured or the addition of another insured to an existing policy.
• Cancellation: The Board will only measure cancelations submitted as non-payment of premium. All statutory reporting rules apply. The Board will not be measuring all other reasons for cancelation such as no employees, out of business, or "other" (which is often used for coverage placed elsewhere).

The definition of "late" depends on the transaction type, which can be determined using the following table:

Next steps

Next month, the Board will provide each insurance carrier with their performance (percentage timely) for all measured transactions for the third quarter of 2025 (July 1 through September 30), including a list of any untimely transactions. This will enable carriers to review their performance and make any necessary adjustments before the Board begins penalizing for late filings.

As we move closer to going live with penalty issuance, the Board will hold a webinar to provide more detailed information, review the process carriers will use to request review of transactions and appeal penalties, and allow time for carriers to ask any questions they may have. While the go-live date has not yet been determined, the Board will schedule the webinar at least three months prior to implementation.

More information

If you have questions or would like more information, please email: [email protected].