ASSAULT, TRAUMA, & CAPTIVITY FAQs
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.
Q. Who is covered?
A. All active, dues-paying PEF members (PEF retirees are not eligible).
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 form can be downloaded via the button below or it can be obtained by calling PEF MBP. All active, dues-paying PEF members are automatically covered by the policy. There is no direct payment made by the member. The premium for the policy is supported by careful investments and administrative fees. No membership dues are used to finance this program. Claims must be submitted within one (1) year of the date of the incident.ATAC Claim Form
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 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 worksite?
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 regardless of 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 qualify for a claim?
A. PEF MBP must receive copies of the following:
- A claim form must be completed in full by the member.
- Release must be signed (technology signing optional).
- Proof of immediate (within 24 hours) medical attention—ER/urgent care and/or facility physician, including discharge instructions and description of care.
- An Attending Physician Statement (medical statement) must be completed by the treating physician.
- A time sheet showing work on the date of the incident, and time missed immediately after the incident, that has been signed/approved by a supervisor.
- A police report showing assault charges OR agency security report (not just supervisor) with either security or member indicating why police did not respond and/or why police cannot file charges.
PEF Membership Benefits Program
10 Airline Drive, Suite 101
Albany, NY 12205
PLEASE NOTE: Claims must be submitted within one (1) year of the date of the incident.
Q. How does the program verify a claim?
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.
Q. What if my claim is denied?
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.
Q. How do I get additional information on ATAC?
A. Call the PEF Membership Benefits Program at (518) 785-1900, ext. 243, option 2, or (800) 767-1840. You may also email the PEF Membership Benefits Program insurance department.