Workers' Compensation Coverage
What To Do When An Accident Happens
The First Steps
Everyone has probably heard the old adage "The least expensive accident is one that never occurs." But accidents do happen, and employers need to become involved before the first form is filed.
Obtaining Medical Treatment
The employee should immediately tell his or her employer or supervisor when, where and how they were injured and obtain medical treatment. The treating health care provider must be authorized by the Workers' Compensation Board, except in an emergency situation. Information about authorization can be found in the WCB's website. In addition, the employee should submit written notice within 30 days to his or her employer. (WCL §18)
As a general rule, employers may not direct their employees to a particular health care provider. Exceptions exist for employers who participate in the Preferred Provider Program or an Alternative Dispute Resolution Program. Employers could and still can recommend care providing they inform employees of their rights to choose providers of their choice (Form C-3.1 ). As of March 13, 2007, self-insured employers, insurance carriers and the State Insurance Fund are authorized to require employers to obtain diagnostic tests from a provider who is part of a network the employer, carrier and SIF has contracted with to provide such services (WCL §13-a(7)(c)). In addition, beginning July 11, 2007, employers, carriers, and SIF may require employees to obtain prescriptions from a pharmacy with which they contract (WCL §13[i]). In both situations, notice must be provided to the employee.
Investigation and Communication
All accidents should be investigated fully to ensure that all the facts are gathered. In addition, the employer should contact the insurance carrier and maintain those communications throughout the claim. Any written contact with the claimant's health care provider should be copied to the claimant and the claimant's legal representative, if any. Any attempt to influence the health care provider in any way may be considered interference with the claimant's treatment, which is a misdemeanor.
If the injury is minor, requiring two or fewer treatments by a person rendering first aid, and with lost time of less than one day beyond the end of the working shift on which the accident occurred, the employer may choose to pay for the first aid treatments directly. In this instance, the employer completes a Employer's Report of Work-Related Injury/Illness (Form C-2) [ On-line C-2 ] , but does not send it to the Board or the insurance carrier. Instead, the employer maintains the form in their files for the statutory 18-year period (WCL §110). C-2 forms are available from the insurance carrier, a Board office or online at http://www.wcb.ny.gov.
All other injuries not fitting the above criteria must be reported to the Board and insurance carrier. Failure to file within 10 days after the occurrence of the accident is a misdemeanor and punishable by a fine. In addition, the Board may impose a penalty of up to $2,500 (WCL §110 and 12 NYCRR §310.1).
When completing a C-2 form, it is important to remember that statements may be legally binding. The employer should note on the C-2 if they believe the claim to be questionable or fraudulent. The insurance carrier can also be contacted for assistance with completing the form. The C-2 can be filed by a third party designated by the employer, however the employer is ultimately responsible for ensuring it is filed.
Filing the C-2 form is not necessarily an admission that you agree with the facts of an accident. It is a statement that an employee reported a work-related injury or illness to the employer.
Continued Payment of an Injured Employee's Wages
When an employer continues to pay an employee wages or advances the employee compensation payments following a work related injury or illness, the employer may seek reimbursement for those wage payments out of any subsequent compensation awards so long as the employer has made a claim for reimbursement prior to the award of compensation (WCL §25).
IMPORTANT: An employer will forfeit its right to reimbursement for these advance payments unless the claim for reimbursement is made before the Board makes an award of compensation.
The employer may be entitled to reimbursement whether the payments were made voluntarily or as a negotiated benefit as might be contained in a collective bargaining agreement.
The claim for reimbursement should be in writing, although it may be made at a Board hearing where a hearing reporter is present to transcribe the proceedings and thus make a record of the request.