Tag Archives: WCL § 25(2)(b).

Video: Penalties and No Coverage Exposure in New York

The New York Workers’ Compensation Board collects $3 Million per year in procedural penalties alone. This is a staggering figure – amounting to approximately $300 in penalty for each new case accepted by the WCB. New York is a form-driven jurisdiction, and most common penalties arise from the late filing of required boilerplate forms.

The Workers’ Compensation Law is a minefield of penalties, fines, and criminal complications for the unwary. There are different penalty considerations for employers, claimants, insurers, and even attorneys.

Lois LLC recently presented a webinar designed to help the attendee answer the following questions:

  • “What are the most common reasons employers/carriers are penalized in New York?”
  • “What are the exposures for non-coverage in New York?”
  • What other activity can draw a penalty, such as illegal employment?”
  • “What do I do about a penalty?”

Attorney Greg Lois covers the fundamentals and at the end of the presentation, the attendees will have a basic understanding of New York penalties and exposures in workers’ compensation cases.

Subject: New York, Workers’ Compensation Law, Penalties
Date Presented: March 20, 2017
Presenter(s): Greg Lois, Esq.
Run time: 16:07 Continue reading Video: Penalties and No Coverage Exposure in New York

Denying Claims in New York

Completing the FROI-04 (denying the claim).

To deny a workers’ compensation claim in New York, the carrier/self insured employer must file an electronic denial. The electronic denial form is mandated by the EDI/eClaims process and designated a “FROI-02” (where the denial is the first document filed by the carrier or self-insured employer) or a SROI-04 (where the carrier/self insured employer has already filed an electronic claim form).

Denial Codes.

Greg Lois
Gregory Lois, Esq.

When denying a claim, the carrier/self-insured employer must designate a, EDI denial code (“MTC code”) which is specific to the legal defense raised. For example, the legal defense of “No Accident Arising Out of and In the Course of Employment” is coded as “1A: No Compensable Accident.” It is general practice for the risk professional handling the claim to contact counsel in advance of filing a denial pleading to confirm the legal defenses to be raised and the denial codes to be used.

Timing.

After the Board notifies the employer (or its insurance carrier) that a workers’ compensation case has been indexed against the employer, the employer may file a notice of controversy (FROI-04) within 25 days from the date of mailing of the notice of indexing. Failure to file the notice of controversy within the prescribed 25 day time limit could bar the employer and its carrier from pleading certain defenses to the claim. WCL § 25(2)(b). Continue reading Denying Claims in New York