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Glossary of WCB Terms

Workers' Compensation Coverage


What To Do When An Accident Happens

The Path of a Claim

Immediate step in claim process
Within 48 hours of the accident
Within 10 days of the accident
Within 14 days of receipt of C-2
10-18 days from date of accident or onset of disability
Within 25 days of notice of indexing
every two weeks
Periodically
Before the employee has lost 12 weeks from work

Immediately:

The worker obtains the necessary medical treatment and notifies his/her supervisor about the accident and how it occurred.

The employee notifies the employer of the accident in writing, as soon as possible, but within 30 days. The Board can excuse the lack of notice if notice couldn't be given, the employer had knowledge, or if the employer is not harmed by lack of notice (WCL §18).

The employee may file a claim with the Board on Employee Claim (C-3)  [ On-line C-3 ]  , by filing the form with the Board. This must be done within two years of the accident, or within two years after the employee knew or should have known, that the injury was related to employment (WCL §28).

Within 48 hours of the accident:

The doctor completes a preliminary medical report on Doctor's Initial Report (C-4) adobe pdf and mails it to the appropriate District Office. Copies must also be sent to the employer or its insurance carrier, the injured worker, and his/her representative, if any (WCL §13-a [4][a]).

Within 10 days of the occurance of the accident:

The employer, or its third party designee, reports the injury to the Board and the insurance company on Employer's Report of Work-Related Injury/Illness (C-2) adobe pdfOn-line C-2 ]  (WCL §110 [2]).

Within 14 days of receipt of Form C-2:

The insurer provides the injured worker with a written statement of his/her rights under the law (Statement of Rights (C-430S) adobe pdf  ). This must be done within 14 days after receipt of the C-2 from the employer or with the first check, whichever is earlier (WCL §110 [2]). If the insurer requires the injured worker to use a provider within a network for diagnostic tests it must provide the injured worker with the name and contact information from the network (WCL §13-a[7][b]).

Within 18 days after the first day of disability or 10 days after the employer first has knowledge of the alleged accident, or within 10 days after the carrier receives the Form C-2, whichever is greater:

The insurer begins the payment of benefits if lost time exceeds seven days. If the claim is being disputed, the insurer must inform the Workers' Compensation Board (and the claimant and his/her representative, if any). If the claim is not disputed, but payment is not being made for specific reasons stated on the notice, (e.g. that there is no lost time or that the duration of the disability is less than the 7-day waiting period), the insurer must also notify all the parties (WCL §25 [1] and 12 NYCRR §300.22) .

The insurer files Notice to Chair of Carrier's Action on Claim for Benefits (C-669) adobe pdf , or Notice That Right to Compensation is Controverted (C-7) adobe pdf with the Board indicating either that payment has begun or the reasons why payments are not being made. A copy of the Form C-669 or Form C-7 must be transmitted to the claimant and his/her attorney/licensed representative, if any, simultaneously with the filing with the Board. If the employee does not notify the employer timely, this notice may be filed within 10 days of learning of the accident.

Within 25 days of the notice of indexing:

Where controverted – When the Board notifies an employer or its insurance carrier that a workers' compensation case has been indexed against the employer, and the employer or insurance carrier decides to controvert the claim, a notice of controversy (Notice That Right to Compensation is Controverted (C-7) ) adobe pdf shall be filed with the Board within 25 days from the date of mailing of the notice of indexing. Failure to file the notice of controversy within the prescribed 25 day time limit could bar the employer and its carrier from pleading certain defenses to the claim (WCL §25[2][b]).

Where not controverted – If the right to compensation is not controverted but payment has not begun because no compensation is presently due, prescribed Notice to Chair of Carrier's Action on Claim for Benefits (C-669) adobe pdf shall be filed with the Board not later than 25 days after the Board has transmitted a notice of indexing a case to the employer or its insurance carrier.

Every 2 weeks:

The insurer continues to make payments of benefits to the injured employee (if the case is not being disputed). The carrier must notify the Board on Notice That Payment of Compensation Has Been Stopped or Modified (C-8/8.6) adobe pdf when compensation is stopped or modified (WCL §25 [1][d]).

Periodically:

The doctor submits progress reports following every treatment on Doctor's Progress Report (C-4.2) adobe pdf to the Board.

Before the employee has lost 12 weeks of time from work (continuous or intermittent):

The insurer considers the necessity of rehabilitation treatment for the injured employee (Carrier's Report on Rehabilitation (R) adobe pdf ).

Hearings:

Notices of hearings will ordinarily be sent by The Board to the carrier for the employer, or directly to the employer if self-insured. An employer having knowledge of a hearing is not obligated to attend unless a hearing notice is sent to the employer, specifically requesting attendance, or unless a representative of insurance carrier requests attendance.