eClaims Reminders for Payers

The Workers' Compensation Board (Board) would like to remind payers that eClaims R3.1 requires payers to use DN0075 (Agreement to Compensate Code) (referred to as “ATC code”) on nearly all filings that are not a First Report of Injury denial (FROI-04) of a claim to indicate whether they are accepting the case with liability or without liability. The following values are used:

• L: Accepting liability for indemnity and accepting liability for medical
• W: Without liability for indemnity and without liability for medical

The legal significance of these filings must be interpreted within the framework of New York’s Workers’ Compensation Law (WCL). Two sections of law in particular must be considered in conjunction with a payer’s eClaims filings: WCL 25(2)(b) states that in the event the Board indexes a claim, the payer will waive most defenses unless it files a denial of the claim within 25 days of indexing; and WCL 21-a states that when payer makes payment of compensation without prejudice to its right to later controvert the claim, the payer must notify the claimant of this reservation of rights.

FROIs: When a payer files a FROI in a claim, and the ATC code value is  ‘L,’ but the case is either not indexed or 25 days have not passed from the date of indexing:

• The payer may file a Subsequent Report of Injury (SROI-04) in the case due to its rights under WCL 25(2)(b).
• The payer may also file a SROI with an ATC code value of ‘W,’ as WCL 21-a is not triggered until the payer begins to make benefit payments to the claimant.

SROIs: When a payer files a SROI indicating payment to the claimant and enters an ATC code value of ‘L,’ the insurer has accepted the case for the body parts listed on the SROI.

Any subsequent SROI-04 or SROI that changes the value from ‘L’ to ‘W’ is of no legal effect. This is due to the application of WCL 21-a, which requires that payments to a claimant where the payer wishes to reserve its rights be made with notice to the claimant. An initial SROI with an ATC code value of ‘L’ indicates that payments are being made without any such reservation.

More information

For more information, please visit Process for Section 21-a and Claims Paid Without Liability

For questions, please email eclaims@wcb.ny.gov.