PEF ASSAULT INSURANCE PROGRAM FACT SHEET

WHO'S COVERED:

All regular dues-paying members and staff of the New York State Public Employees Federation (about 56,000 people), provided they have been employed in an eligible position for 6 months prior to the incident.

WHAT'S COVERED:

 

	Assaults while in pursuit of his/her occupational duties.  Benefit:  $2,500 for fractures, rapes or assaults that require two consecutive nights of  hospitalizations due to injuries occurring while on the job.  $1,000 for all other injuries as a result of an assault while on the job.  $2,000 for an assault that involves the flinging of human waste materials.
	Accidental death, dismemberment or permanent total disability during or resulting from assault or captivity.   Benefit:  up to $10,000 per person to a maximum of $300,000 per incident for all covered members involved.
	Captivity for more than 8 hours while in the pursuit of his/her occupational duties.    Benefit: up to $500 per calendar day during captivity, up to an annual maximum total liability of $300,000 for all occurrences in any fiscal year.

BENEFICIARY:

In the event of the death of an insured person occurring under the terms of this policy, the death benefit shall be paid in the following order:

	To spouse, if living.
	If no spouse, in equal shares to the children
	If no children, in equal shares to the parents
	If no parents, in equal shares to siblings
	If no siblings, to the estate.

If the beneficiaries are minors, or cannot give a valid release, payment will be provided to the duly appointed guardian or committee.

CONDITIONS:

 

	An assault will be deemed to have occurred when such action would be a violation of the state penal code dealing with assault and results in the insured person being disabled from their usual occupation for a period of 5 consecutive working days or more. This means 5 working days of absence from profession which must be authenticated by certifications by a medical doctor starting on date of incident and supportive documentation of time off (copies of time sheets).
	Evidence of assault to be a police report charging the person with assault and are willing to press charges and physician's statement
	Captivity exists when an employee is held against his/her will and has been refused release, in excess of 8 hours;
	For each loss event, benefit shall be payable under one item of coverage;
	The plan will use the NYS Penal Law definition of "assault" as the guideline for all claims; (Criminal Assault occurs when the actor causes physical injury to the victim. N.Y.S. Penal Law, Article 120. Physical injury means impairment of physical condition or substantial pain. Whether pain is suffered and the degree of pain suffered may vary among individuals but, at a minimum, excludes such things as "petty slaps, shoves, kicks and the like.")

ANSWERING MEMBERS' QUESTIONS ON ATAC

The PEF Membership Benefits Program has insured 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 Attack Coverage. The following are answers to some of the most frequently asked questions about ATAC:

Q. Who is covered?
A. All regular members (not retirees or associate members) of the Public Employees Federation.

Q. Does a member have to fill out an application form to be covered, and what is the cost to the individual member?
A. There is a claim form to be filled out by the member, this can be obtained by calling Membership Benefits.  All regular members of PEF are automatically covered by the policy.  There is no direct payment made by the member.  The premiums for the policy are paid by the PEF Membership Benefits Program using administrative fees received from endorsed vendors and interest it receives on various reserve accounts.  No membership dues or agency fees are used to finance this program.

Q. What is covered?
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.

Q. What payment does ATAC make to the victim?
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 2 consecutive nights of hospitalization, $2,000 for the flinging of human waste and $1,000 for all other injuries.

For accidental death, dismemberment or permanent total disability resulting from assault, the benefit is $10,000 per member to a maximum of $300,000 per incident for all covered members involved.

For captivity of more than 8 hours while in the pursuit of occupational duties, the benefit is up to $500 per calendar day during captivity, up to an annual maximum total liability of $300,000 for all occurrences in any fiscal year.

For accidental death, dismemberment or permanent total disability during captivity while in the pursuit of occupational duties, the benefit is up to $10,000 to a maximum of $300,000 per incident for all covered members involved.

Q. What is meant by "in pursuit of occupational duties?"
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.

Q. Are members covered while traveling to and from their worksites?
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 a covered activity under the Worker's Compensation Law.  Such travel is generally necessary to matter what occupation an employee chooses.  Thus, any risks inherent in such travel are not risks inherent in the occupation, but in life generally.

However, where travel is necessary or mandated by the particular type of employment that one engages in, such travel is a covered activity.

Thus, "outside" workers, "inside" workers on special errands, and workers who must travel between separate premises of the employer will generally be compensated for any injuries which they sustain during travel.

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.

Q. How do you file a claim?
A. We must receive written notice of claim at our 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.  As soon as possible thereafter, send copies of the filed police or peace officer’s report, charging assault, a medical statement from the attending physician dated the day of the incident, and documentation that the injury resulted in the claimant being disabled for a period of 5 consecutive working days or more (along with copies of times sheets documenting time off), along with a signed cover letter describing the incident, to:

PEF Membership Benefits Program
P.O. Box 12414
Albany, NY 12212-2414

Q. How does the program verify a claim?
A. The Membership Benefits Program verifies the claimant is a regular member of PEF.  Then it 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 substantiated, it is forwarded to the insurance broker for final approval and payment.

Q. How do I get additional information on ATAC?
A. Call Membership Benefits at 1-800-342-4306  Ext. 243