The PEF Membership Benefits Program (PEF MBP) insures PEF members for the trauma associated with an assault or hostage situation while performing their job duties.
Since its introduction in early October 1989, PEF members have shown considerable interest in the Assault Trauma and Captivity coverage (ATAC). What follows are some of the most frequently asked questions about the ATAC benefit.
A. All active, dues-paying members (not retirees), and staff of the Public Employees Federation.
A. There is a claim form to be filled out by the member. This can be obtained by calling PEF MBP. All active, dues-paying members of PEF are automatically covered by the policy. There is no direct payment made by the member. The premium for the policy is paid by PEF MBP using administrative fees received from endorsed vendors and interest received on various reserve accounts. No membership dues are used to finance this program. Claims must be submitted within two (2) years of the date of the incident. Any claim older than two (2) years will be rejected.
A. ATAC is unique in that it has defined trauma as an insurable item. The policy insures the trauma associated with a criminal assault, as defined by the New York State Penal Code, or a captive situation, while the member is pursuing his or her occupational duties. It also pays benefits for dismemberment, permanent disability, and death resulting from a criminal assault or captive situation. Briefly, criminal assault occurs when someone other than the victim causes physical impairment or substantial pain.
A. The payments depend on the type of claim. For criminal assault while in the pursuit of the member’s occupational duties, the benefit is $2,500 for fractures, rapes, or assaults that require two (2) consecutive nights of hospitalization, $2,000 for the flinging of human waste or bites, and $1,000 for all other injuries.
A. The assault or captivity must occur while the claimant is on the job. The state Worker’s Compensation Law, along with its rules and regulations, is used to define when a member is “in pursuit” of these duties.
A. Essentially, no. But this has to be qualified. The Worker’s Compensation Board’s general rule is: travel to and from the place of employment is not covered activity under the Worker’s Compensation Law. Such travel is generally necessary regardless of what occupation an employee chooses. Thus, any risks inherent in the occupation, but in life generally.
It is their employment which exposes them to travel risks over and above the normal risks incurred in getting to and from the place of employment. If a PEF member is criminally assaulted or taken hostage under these circumstances, he or she would be covered under ATAC.
A. PEF MBP must receive written notice of the claim at their office within 20 days after any covered loss occurs or begins. If notice cannot be given within that time, it must be given as soon as reasonably possible. Thereafter, send copies of:
PEF Membership Benefits Program
10 Airline Drive
Albany, NY 12205
Please note: Claims must be submitted within two (2) years of the date of the incident. Any claim older than two (2) years will be rejected.
A. PEF MBP verifies the claimant is an active, dues-paying member of PEF. PEF MBP then checks to see if the police report defines the incident as a criminal matter and if the medical statement indicates treatment was given for a physical injury. If this does not adequately verify the validity of the claim, a letter is sent to the claimant stating what documentation is needed. When the claim is sustained, it is forwarded to the insurance broker for final approval and payment.
A. If all or part of your claim is denied, you will receive written notice of the denial, including the specific reason for the denial. You may request, in writing, a review of the denial within 180 days after receiving notice of denial. You may submit written comments, documents, records, or other information relating to your claim for benefits. Appeal requests will be submitted to the PEF MBP Trustees at the next regularly scheduled meeting. You will be notified of their decision within 15 business days of that decision being made.
A. Call the PEF Membership Benefits Program at (800) 342-4306, ext. 243, option 2.