How to report “No Lost Time” or “Medical Onlys”
The Board is now instructing carriers that when lost time does not exceed seven days, the claim administrator should file the FROI accepting liability for the medical portion of the claim. Why seven days? That is the “waiting period” for indemnity benefits in New York. Although the Board initially instructed carriers that the FROI-PD form was accepted (for a “partial denial” medical-only filing) the Board rescinded this guidance and now states that a FROI-00 should be filed; the claim administrator may later file a denial if lost time is claimed (SROI-04). This can also be used when there is no evidence regarding the claim.
Reporting Lost time with No Medical.
In an abrupt change from prior practice where no lost time benefits were issued until medical showed a causally-related disability, the Board is now instructing carriers to begin issuing lost time benefits at the minimum rate once lost time is alleged by the claimant despite the lack of any correlating medical narrative. (Source: “Proper eClaims Filing,” slide 4 of 25, WCB training webinar, September 8, 2015. Link here: http://www.wcb.ny.gov/content/main/Monitoring/Controversy.pptx
A medical only filing is not appropriate when the employer reports that there is compensable lost time. For example, a worker was injured at work, went to the doctor, and called the employer to say that the doctor told him to come back in ten days with no work until then. In that example, an Initial Payment (SROI-Initial Payment) indicating payment to the injured worker should be filed as described in the next paragraph.
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