Updated Direct Deposit Authorization Form

New York State Workers' Compensation Board sent this bulletin at 05/21/2021 02:12 PM EDT

Updated Direct Deposit Authorization Form

As previously announced via Subject Number 046-1378, direct deposit is now an available option for the receipt of injured workers’ compensation and death benefits. To comply with the proposed amendment of 12 NYCRR 300.26, the Workers’ Compensation Board (Board) has placed a sample version of the Direct Deposit Authorization (Form DD-1) on our website. Please do not fill out this sample form. The insurer or administrator that pays your benefits will provide its own version of the application form on its website and will make a paper version available if you request it. If you do opt for direct deposit, you will submit the completed application directly to the insurer or administrator. If you have any questions about how to apply, please contact the insurer or administrator.

A few things to note about the new option for direct deposit: 

  • Beginning July 1, 2021, you must be notified by the insurer of your right to have payments deposited into at least two bank accounts at your request, either as a percentage of the total benefit or a fixed dollar amount for each deposit. The insurer may require a minimum amount of up to $20 into each bank account.
  • Completing the direct deposit application form is optional. Injured workers and people entitled to a death benefit have the right to receive workers' compensation indemnity benefits or death benefits through direct deposit or by paper check in the mail; it is your choice. Again, if you choose to receive payments by direct deposit, please do not send the completed form to the Board. Your completed form must go to the insurer.
  • While the Board has made the sample Form DD-1 available as an illustration, the insurer may create their own version or an electronic version of the form. Any insurer version must include all elements required by the regulation and contained in Form DD-1.
  • You have the right to cancel or change the direct deposit at any time by checking the appropriate box on the form and forwarding the completed form to the insurer responsible for your workers' compensation claim. Your request will be implemented within 45 days of receipt of notice.

Questions?

For questions regarding the regulation, email officeofgeneralcounsel@wcb.ny.gov.