As has been widely publicized, in April the New York State Senate passed a $153 billion state budget for 2017-2018 which included numerous reforms and changes to the state’s Workers’ Compensation laws.
New York Workers’ Compensation Law §110 states that an accident must be reported when it:
“will cause a loss of time from regular duties of one day beyond the working day or shift on which the accident occurred, or which has required or will require medical treatment beyond ordinary first aid or more than two treatments by a person rendering first aid.”
In order to be reportable, the injury must:
Cause the worker to lose one day of work in addition to the date of loss; OR
In New York, all employers are required to carry Workers’ Compensation insurance. This includes employers with less than five employees. Workers’ Compensation Law imposes heavy penalties against the employer for failure to obtain insurance as well as for defrauding the insurance carrier. [See WCL Section 52]
Penalties are assessed against the employer for misclassifying and concealing employees. The law specifically includes employer’s actions of intentionally and materially understating or concealing payroll, concealing duties to avoid proper classification or
In a previous post, we discussed the process of Loss Transfer and specifically why it matters to Workers’ Compensation carriers. In connection with the Workers’ Compensation aspect, a workers’ compensation carrier can recover up to $50,000.00 by way of arbitration in a Loss Transfer claim through the Arbitration Forums. However, this does not mean that you can simply assert a right to $50,000.00 against another insurance company and think this is enough. Indeed, when arbitrated, liability still has to be proven as well as damages. Continue reading Limits to Recovery in a New York Loss Transfer Claim.→
The Board’s new initiative to enforce EDI (“eClaims”).
Beginning in 2013, the Board has begun an increased tempo of “monitoring and compliance” initiatives intended to enforce the eClaims guidelines and generate more penalty income for the State. The Board has now established a “Compliance Unit” intended to do the following:
monitor performance standards for timely submission of First Report of Injury,
confirm timely first payment of indemnity benefits,
check for timely submission of Subsequent Report of Injury showing first payment,
monitor timely submission of Controversy; and
track the Percentage of Claims Controverted (how many cases is the carrier denying?).
Timeline of the “Typical” case: Admitted Traumatic Accident with Lost Time.
Initial investigation to confirm loss.
If there is medical and lost time, begin benefits.
File update EDI documents as the case progresses.
The process in detail.
Investigation and Communication.
All accidents should be investigated fully. The employer should contact the insurance carrier and maintain those communications throughout the claim. The investigation’s results should be copied to your defense attorney in the case of a controverted claim.