Case Indexing

New York State Workers' Compensation Board sent this bulletin at 09/16/2024 09:00 AM EDT

Case Indexing

To promote efficient resolution of workers’ compensation claims, the New York State Workers’ Compensation Board will begin indexing every complete case on Sept. 26, 2024, for cases assembled on or after this date. For information on the announcement, see Subject Number 046-1704.

As a result, the majority of claims assembled that contain a medical report of treatment and either an Employee Claim (Form C-3) or First Report of Injury (FROI) will be indexed by the Board. The only exceptions will be:

  • Claims already controverted (by the filing of a FROI-04 or SROI-04) at the time they became eligible for indexing.
  • Claims already accepted without liability (under the provisions of WCL-§21-a) at the time they became eligible for indexing.
  • Claims without any lost time from work, that have been identified as “Medical Only” claims, where the Agreement to Compensate Code (ATC) has been left blank. Currently, a payer filing a FROI in a medical-only claim is required to include an ATC code of L-With Liability unless the claim is controverted. As part of this initiative, beginning Sept. 26, 2024, payers filing an initial FROI in a medical-only case will not be required to select an ATC code and may leave it blank.
  • Note: If a medical-only claim becomes lost time, it will be indexed. Payers must update their filings if the worker starts losing time related to the previously medical-only claim, including making a decision on accepting liability.

All other standards regarding the provision of notice and the first payment of benefits by payers remain in place.

Therefore, within 25 days of the date when the Board indexes a claim, the payer should:

  • Accept liability for the claim, or
  • Controvert the claim, or
  • Provide notice that it is initiating payment of lost wage benefits or prescribed medicine without accepting liability for the claim under the provisions of WCL §21-a.

Denials of indexed claims must be filed with the Board within 25 days of the indexing date or defenses listed in Workers’ Compensation Law Section 25(2)(b)) may be barred. The Board provided advance notice of this on Dec. 15, 2023, to allow stakeholders sufficient time to facilitate compliance.

Questions?

Email the Office of General Counsel.