Workers' Compensation Coverage
Employers' Rights and Responsibilities
- Employers must obtain and keep in effect workers' compensation coverage for their employees (Employees); there must be no lapse in coverage even when switching insurance carriers.
The law requires almost all employers operating in New York State to have workers' compensation coverage for their employees. This requirement can be fulfilled by purchasing insurance coverage through an insurance carrier or by obtaining authorization from the Board to be self-insured.
- According to Section 51 of the Workers' Compensation Law, employers must post a notice of workers' compensation coverage (Form C-105). Most employers obtain this form from their workers' compensation carrier. Employers that are approved by the Board as self-insurers may contact the Self-Insurance Office at 518-402-0247 for copies of this form; while employers that are participating in Group Self-Insurance may contact their Group Administrator.
The Workers' Compensation Board prescribes Form C-105 and requires that the form include the name, address and phone number of the insurer and the policy number of the employer. It must be posted in a conspicuous place in the employer's place of business. Violations of this requirement can result in a fine of up to $250 per violation.
- An employer must provide the Workers' Compensation Board with access to all books, records and payrolls related to employees upon request.
- An employer must keep accurate records of the number of employees, classification, wages and accidents for their business for four years. (WCL §131) Failure to keep adequate and/or accurate records may result in a fine of $1,000 per every 10-day period of noncompliance or two times the cost of compensation. Additionally, the fine for criminal conviction is from $1,000 to $50,000. Examples of misrepresentation include:
Failure to pay appropriate workers' compensation premiums by:
1. Paying workers "off the books",
2. Not reporting wages paid to illegal aliens,
3. Misclassifying employees as "independent contractors," and
4. Misclassifying the work of a business to a classification that is less hazardous (identifying all roofers as secretarial staff), and/or
5. Intentionally, materially misrepresenting or concealing information pertinent to calculation of premium paid.
- An employer may not discriminate against an employee or applicant because he or she has claimed or attempted to claim workers' compensation. (WCL §120)
- An employer must report most injuries and occupational diseases to insurance company within 10 days after an accident. (WCL §110)
- A record must be made and maintained of ANY injury or illness incurred by an employee in the course of employment, even if the extent of the injury does not require that the First Report of Injury be filed with the Board.
A First Report of Injury must be filed with the Board if the accident results in personal injury which has caused or will cause a loss of time from regular duties of one day beyond the working day or shift on which the accident occurred, or which has required or will require medical treatment beyond ordinary first aid or more than two treatments by a person rendering first aid. Failure to file a First Report of Injury or failure to file it timely may result in a penalty of up to $2,500.
Your Responsibilities as an Employer - Reporting Injury and Illness
- A First Report of Injury forms must be maintained by the employer or designated third party for at least 18 years and are subject to review by the Board at any time.
- An employer must report an injured worker's wages or other compensation to the Board on a Employer's Statement of Wage Earnings (Form C-240) [ On-line C-240 ].
- An employer must report any changes in an injured worker's pay or work status to the Board on a Employer's Report of Injured Employee's Change in Employment Status Resulting from Injury (Form C-11) [ On-line C-11 ].
- Certain employers must undergo safety consultations if directed to do so. If an employer has an experience modification factor of greater than 1.2 and a payroll in excess of $800,000, they must participate in a mandatory safety and loss prevention program, as outlined by the New York State Department of Labor. (WCL §134)
- An employer has the right to request that the insurance carrier contest the compensability of a claim.
A claim can be contested for a variety of reasons, including, for example, that the injury was not related to work or that the employee is not injured to the extent he or she is claiming. An employer can request that the insurance carrier contest the claim, but since the carrier has assumed liability for the claim, it is not required to comply with the employer's request. In addition, employers or carriers who engage in dilatory tactics will be penalized.
- An employer has the right to attend any hearings related to a claim filed by one of the employer's workers.
- An employer has the right to electronically access the Board's case file for a claim filed by the employer's worker by visiting one of the Board's customer service centers.
The Board's Electronic Case Folder (eCase) allows parties of interest to view the documents in the claim file electronically. Employers should go to one of the eleven district offices or 30 Customer Service Centers with identification to obtain a password to access the files. Based on the confidentiality of workers' compensation records, please be prepared to offer proof that you are the employer of record in the claim.
- A self-insured employer, or an employer who has failed his or her obligation to secure workers' compensation coverage, has the right to participate in the hearing and present relevant evidence about disputed issues at a hearing.
Employers may request that a hearing be scheduled on a particular issue by writing to the appropriate district office in a timely manner. Corporations must be represented by counsel in proceedings before the Board. Certain defenses will be waived if they are not promptly raised or if the employer or carrier does not timely file a Notice of Controversy.
- An employer has the right to report suspected workers' compensation fraud to the Fraud Inspector General.
Fraud Referral Hotline: 1-888-363-6001.
- An employer has the right seek administrative review and/or appeal to the Appellate Division. If insured, it may request that the insurance carrier seek review on appropriate grounds of a Board decision.
Any party may seek administrative review of a notice of decision within 30 days by writing to the Board and requesting Board review; however, a party filing a frivolous application will be penalized.