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Efficiency Enhancements, Issue 11: RFA-1LC Request Reasons
The NYS Workers’ Compensation Board has received inquiries concerning the Request for Further Action by Legal Counsel (Form RFA-1LC) with respect to certain claim issues. Below is guidance on how to request action on these issues using the RFA-1LC eForm.
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How to address in the current eForm
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Case was marked No Further Action (NFA) pending [xyz], and now we have [xyz].
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If the issue that is ready to move forward is available on the RFA-1LC form, select the appropriate request reason and include the update in the narrative text field. Issues not on the eForm can be submitted using the online Claims Inquiry at wcb.ny.gov/contactclaims or by writing to wcbclaimsfiling@wcb.ny.gov.
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Place another carrier on notice/case and request to travel with another case.
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Select the request reason: Request to Update Employer, Insurer, TPA information, and/or Date of Injury. In the narrative text field, include a request for cases to travel together, if applicable.
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Request that carrier be penalized citing the applicable regulation/statute (e.g., installment payment, failure to make payment within 10 days after decision, etc.).
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When the timeframe to file an appeal or objection to the decision has elapsed, select request reason: Claimant, Attorney, or Licensed Representative has not been paid per decision or was paid late. In the narrative text field, include the request for penalty citing an applicable regulation/statute.
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FROI/SROI not up to date or properly completed by carrier (to determine benefits paid to date).
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If there is a dispute for an award period, select request reason: Claimant has not been paid properly for lost time (current or past payments) and upload/reference supporting medical documentation.
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PAR granted without prejudice to unestablished body part.
Request claim be established to PAR body part.
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Select request reason: Claimant has raised body part(s)/condition(s) that are (a) in dispute, or (b) not reported on a First Report of Injury (FROI), or (c) that should be added to an established case. When the treatment is for a site not accepted yet and the carrier hasn’t disputed the treatment, use the sub-checkbox: Case is not established, and the body part(s)/condition(s) has not been accepted on a FROI filed by the Insurer. A request to accept the body part(s)/condition(s) was sent to the claim administrator and at least 7 days have passed with no response.
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When to use the online Claims Inquiry form
Requests that result in an automated Board action, such as Stipulations, Section 32 waiver agreements, and Extreme Hardship Redetermination Request (Form C-35), do not require an RFA-1LC eForm. If timely action has not been taken on these documents already in the case file, follow up by submitting an online Claims inquiry at https://www.wcb.ny.gov/contactclaims/.
The online Claims inquiry form may also be used when:
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The carrier has not produced an Employer's Statement of Wage Earnings Preceding Date of Accident (Form C-240), Employer's Report of Injured Employee's Change in Status or Return to Work (Form C-11) and/or Employer's Request for Reimbursement (NYSIF) (Form C-107),
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The Workers’ Compensation Law Judge continued the case and no hearing has been scheduled yet, or
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The case is ready for a Reserved Decision to be issued.
More information
For more information and best practices on using the RFA-1LC eForm, please see:
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