Agent/Broker FAQs

If an employee is injured, when am I required to file a Workers' Compensation claim?


In New York State, an employer is required to file a claim with the carrier when there is any lost time from duties beyond the injury date OR medical treatment for the injury results in the generation of a medical bill.




Can I self-pay for the minor medical treatment performed for a work-related injury?


An employer can self-pay for up to two medical bills. If there is any lost time beyond the date of injury, the employer cannot self-pay medical bills.




When does the employer need to file a claim with the carrier?


The employer must file the claim WITHIN 10 DAYS from the date of injury. By law, an injured employee has 30 days to provide notice of sustained injury to his/her employer. Make reporting sustained injuries within your organization a priority!




Where do I file a Workers' Compensation claim for an employee, volunteer firefighter, or volunteer ambulance worker?


Paper claim forms are no longer accepted by NYSIF and the NY Workers’ Compensation Board. All WC claims (including claims for volunteer firefighters and volunteer ambulance workers) are now filed online via NYSIF eFROI. Once the claim is successfully submitted online, a carrier case number will automatically be generated.




I have filed a WC claim for an employee; what should I do next?


Provide the injured employee with a Claimant Information Packet. If the claim resulted in LOST TIME for the employee, the employer should complete and submit to NYSIF the C-11 and C-240 forms. If the employer continued to pay the claimant while out on Workers’ Compensation, then the employer would also need to complete and submit the C-107 form to NYSIF.




I have completed a C-107 form requesting employer reimbursement and have not received the reimbursement. How can I confirm the status of this request?


Has the injured worker returned to work? Has a C-11 form noting the return-to-work date been submitted? If yes, please contact either the assigned NYSIF Case Manager or Fleury Risk Management for a status update. Please note that employer reimbursements must be confirmed by the NY Workers’ Compensation Board before NYSIF can issue a reimbursement.




I have filed a WC claim for a volunteer firefighter/volunteer ambulance worker, what should I do next?


If the injury resulted in LOST TIME from the volunteer’s duties, the fire department/ambulance company must note this when completing the eFROI OR notify the NYSIF Case Manager with specific dates that disability began (and ended). Lost Time Benefits are payable to volunteer firefighters/ambulance workers from day one and would be based on earning capacity and degree of disability and NOT their regular employment wages.




Do I need to provide a Claimant Information Packet to an injured volunteer firefighter/ambulance worker?


No, this packet would NOT apply to a volunteer firefighter and/or volunteer ambulance worker. The injured volunteer is encouraged to complete and submit to NYSIF a VF-3 (volunteer firefighters) or a VAW-3 (volunteer ambulance workers).




How would my injured employee, volunteer firefighter and/or volunteer ambulance worker obtain prescriptions for a work-related injury?


Complete a temporary prescription form and present it at a participating pharmacy. A temporary prescription form can be found on the NYSIF website or within the Claimant Information Packet.




How long does the employer need to keep a record of any sustained injuries?


The employer must keep a record of all sustained injuries for 18 years.




I suspect fraud with a new or existing WC claim. How do I notify the carrier of my concerns?


Contact the assigned NYSIF case manager by phone and notify him or her of SPECIFIC CONCERNS that may be fraudulent. After you speak to the case manager, follow up with a written explanation of your specific concerns. The case manager can then issue a request for surveillance or other necessary measures if they determine there is a potential fraud case.




What resources does NYSIF use to confirm that a Workers' Compensation Insurance claim is valid?


NYSIF does have resources to proactively research a claim to help determine its validity. These include claimant and employer interviews, independent medical exams (IMEs) and/or surveillance, which all have the ability to be presented to the Workers’ Compensation Board (WCB). The WCB does have the final say in determining a claim’s validity and the claimant’s scope of injury.





 

Claims FAQs

If an employee is injured, when am I required to file a Workers' Compensation claim?


In New York State, an employer is required to file a claim with the carrier when there is any lost time from duties beyond the injury date OR medical treatment for the injury results in the generation of a medical bill.




Can I self-pay for the minor medical treatment performed for a work-related injury?


An employer can self-pay for up to two medical bills. If there is any lost time beyond the date of injury, the employer cannot self-pay medical bills.




When does the employer need to file a claim with the carrier?


The employer must file the claim WITHIN 10 DAYS from the date of injury. By law, an injured employee has 30 days to provide notice of sustained injury to his/her employer. Make reporting sustained injuries within your organization a priority!




Where do I file a Workers' Compensation claim for an employee, volunteer firefighter, or volunteer ambulance worker?


Paper claim forms are no longer accepted by NYSIF and the NY Workers’ Compensation Board. All WC claims (including claims for volunteer firefighters and volunteer ambulance workers) are now filed online via NYSIF eFROI. Once the claim is successfully submitted online, a carrier case number will automatically be generated.




I have filed a WC claim for an employee; what should I do next?


Provide the injured employee with a Claimant Information Packet. If the claim resulted in LOST TIME for the employee, the employer should complete and submit to NYSIF the C-11 and C-240 forms. If the employer continued to pay the claimant while out on Workers’ Compensation, then the employer would also need to complete and submit the C-107 form to NYSIF.




I have completed a C-107 form requesting employer reimbursement and have not received the reimbursement. How can I confirm the status of this request?


Has the injured worker returned to work? Has a C-11 form noting the return-to-work date been submitted? If yes, please contact either the assigned NYSIF Case Manager or Fleury Risk Management for a status update. Please note that employer reimbursements must be confirmed by the NY Workers’ Compensation Board before NYSIF can issue a reimbursement.




I have filed a WC claim for a volunteer firefighter/volunteer ambulance worker, what should I do next?


If the injury resulted in LOST TIME from the volunteer’s duties, the fire department/ambulance company must note this when completing the eFROI OR notify the NYSIF Case Manager with specific dates that disability began (and ended). Lost Time Benefits are payable to volunteer firefighters/ambulance workers from day one and would be based on earning capacity and degree of disability and NOT their regular employment wages.




Do I need to provide a Claimant Information Packet to an injured volunteer firefighter/ambulance worker?


No, this packet would NOT apply to a volunteer firefighter and/or volunteer ambulance worker. The injured volunteer is encouraged to complete and submit to NYSIF a VF-3 (volunteer firefighters) or a VAW-3 (volunteer ambulance workers).




How would my injured employee, volunteer firefighter and/or volunteer ambulance worker obtain prescriptions for a work-related injury?


Complete a temporary prescription form and present it at a participating pharmacy. A temporary prescription form can be found on the NYSIF website or within the Claimant Information Packet.




How long does the employer need to keep a record of any sustained injuries?


The employer must keep a record of all sustained injuries for 18 years.




I suspect fraud with a new or existing WC claim. How do I notify the carrier of my concerns?


Contact the assigned NYSIF case manager by phone and notify him or her of SPECIFIC CONCERNS that may be fraudulent. After you speak to the case manager, follow up with a written explanation of your specific concerns. The case manager can then issue a request for surveillance or other necessary measures if they determine there is a potential fraud case.




What resources does NYSIF use to confirm that a Workers' Compensation Insurance claim is valid?


NYSIF does have resources to proactively research a claim to help determine its validity. These include claimant and employer interviews, independent medical exams (IMEs) and/or surveillance, which all have the ability to be presented to the Workers’ Compensation Board (WCB). The WCB does have the final say in determining a claim’s validity and the claimant’s scope of injury.





 

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