RFA Process Updates

The Workers’ Compensation Board (Board) is working to streamline the request for further action (RFA) process, so that the Board can properly process requests and resolve matters for injured workers as quickly as possible.

Situations where no action will be taken

The Board has identified specific circumstances in which a party of interest’s (POI’s) submission of a Request for Further Action by Legal Counsel (Form RFA-1LC) or Request for Further Action by Carrier/Employer (Form RFA-2) to the Board is either incomplete, inappropriate, or unnecessary. When an RFA form is submitted in any of these situations, the Board will issue a response letter (Acknowledgement of Receipt of Request for Further Action to Claimant [Form ERFA-1.1] or Acknowledgement of Receipt of Request for Further Action to Carrier [ERFA 2.1]), explaining why no action will be taken at that time.

These situations include:

• Request to schedule a hearing when the claim administrator is properly paying per Workers’ Compensation Law Section 21-a at the appropriate rate and providing medical benefits;
• Request to issue an Order of the Chair for no carrier response to a prior authorization request (PAR) before the time window for response by the claim administrator has closed;
• Request to schedule a hearing on a controverted case when required documentation (e.g., Report of Accident or Police Report of Accident [Form MV-104], etc.) has been directed by the Board, but is not yet present in the case folder;
• Request to schedule a hearing after a Workers’ Compensation Law Judge (WCLJ) has given the claim administrator time to arrange an independent medical examination and that time has not yet elapsed (e.g., claim administrator has 60 days, but a hearing request is submitted after just 15 or 30 days);
• Request to schedule a hearing regarding a Schedule Loss of Use or initiating the Notice Regarding Possible Award for Permanent Injury (Form EC-81.7) process when there is no medical report (e.g., Doctor’s Report of MMI/Permanent Impairment [Form C-4.3]) in the case folder showing permanency or while the case is still in the controverted process;
• Incomplete form certification;
• Request for desk review of Special Funds Group decision does not contain the relevant documents outlined in Subject Number 046-1063R Procedural Updates on Special Funds Group Reimbursement and Establishment of Section 15(8) Claims.

Clarification on certifications for certain RFA forms

There are some requests and other items, listed below, that do not always require the submission of an RFA-1LC or RFA-2 form. However, if one of these items is submitted, the Board will not require the submitting party to discuss the matter with opposing parties first. Instead, in the certification, the second check box should be checked, and in the “I attempted to contact” field the phrase “Not Applicable” should be entered, and the date field in that section should indicate “n/a”. The certification is still required, and the opposing party still must be served with the RFA form per the certification.  If the certification is blank or does not say “Not Applicable” as described herein, the Board will inform the submitting party that no action will be taken, if appropriate.  Please be aware that if a submitting party inappropriately indicates “Not Applicable” for any items outside of this list, the party may be subject to a penalty.

• Address changes;
• Request to index a case;
• Matters related to issuance of a Schedule Loss of Use/EC-81.7 form;
• As directed to be submitted by a WCLJ;
• Request for the Board to take an action when no First Report of Injury or Subsequent Report of Injury is on file;
• Request for release of an attorney’s fee when an Application for a Fee by Claimant’s Attorney or Licensed Representative (Form OC-400.1) is in the file;
• Request to approve a Stipulation (Form C-300.5) or Agreed Upon Findings and Awards for Proposed Decision (Form C-312.5) and/or request to schedule a hearing for a Section 32 Waiver Agreement.

Using appropriate check box

Lastly, if the RFA-1LC or RFA-2 form includes a check box for a specific issue, the attorney should always utilize the appropriate check box for that issue, instead of the “Other” check box.

More information

For questions regarding the RFA-1LC and RFA-2 forms, email Claims@wcb.ny.gov.