When a carrier is unsure of its liability with respect to a workers' compensation claim, the carrier may use Workers' Compensation Law (WCL) §21-a to extend its time to investigate the claim. WCL-§21-a permits a carrier to take up to a year (365 days) to determine whether it will accept or deny the claim when:
Use of the §21-a option has increased. In addition, on or after January 1, 2019, carriers will be required to indicate whether benefits are being paid with liability (L) and the claim is accepted or paid without liability (W) under WCL §21-a. These Agreement to Compensate Codes replace the former Claim Type Codes. When a carrier selects an Agreement to Compensate Code of L on a First Report of Injury (FROI) and/or an L or W code on a Subsequent Report of Injury (SROI), the carrier is accepting the case or paying without prejudice pursuant to WCL §21-a. Accordingly, the Board has developed a process and timelines incorporating WCL §21-a rules and the eClaims protocol.
In general, whenever the first indemnity payment of compensation has been made on a claim, the carrier must indicate on its first SROI filing, that the payment is made with (L) or without (W) liability. When a SROI is filed with a W, the servable form of the SROIs listed below will contain the required notice from the Board to the claimant. The case will be identified as subject to WCL §21-a and no further notice will be sent by the Board. The table below lists the SROIs that must indicate W or L when filed and those that should not have this indicator:
| FROI/SROI type | W or L required |
|---|---|
| SROI-IP | Yes |
| SROI-EP | Yes* |
| SROI-PY | Yes* |
| SROI-AP | Yes* |
| SROI-PD | No |
| SROI-SA | No |
| SROI-04 | No |
* Required after February 22, 2019
IMPORTANT: The L Agreement to Compensate Code indicates acceptance of the claim. When a SROI is filed with an L, the Board will mark this case as accepted for the body part(s) identified in the SROI.
To invoke WCL §21-a, the carrier must use the W code on the first SROI that is filed.
There are three ways to properly end a case's WCL §21-a status:
If any of the following occur, the carrier may lose their rights to continue payments per §21-a, as the case may be established:
For cases with a date of accident on or after 1/1/19, the acceptance of a claim on the FROI will change from the Claim Type Code to the Agreement to Compensate Code (this is a new field for the FROI). There are two ways a claim may be accepted: L - With Liability or W- Without Liability.
For dates of accident prior to 1/1/19, the acceptance of a claim will remain to be based on the Claim Type Code.
Additionally, two new Claim Type Codes were added as of 1/1/2019:
The current Claim Type Code descriptions were updated as of 1/1/2019:
Benefits paid under the Volunteer Firefighter's Benefits Law (VBFL) or the Volunteer Ambulance Workers Benefits Law (VAWBL) may not be made without liability pursuant to Workers' Compensation Law (WCL) section 21-a.
When a payment is made pursuant to Section 50 of either the VBFL or VAWBL, the payer is conceding that the benefits are due. The controversy in these Section 50 cases is between potential liable parties. Payments made pursuant to VBFL or VAWBL Section 50 do not extend the payer's time to controvert the claim. The proper filing of a SROI using the Agreement to Compensate Code of "W" without liability, represents the payer is raising Section 50 on a volunteer claim.
