Why was my FROI measured when it was received prior to the current quarter being measured?
If an initial FROI is received giving no initial date of disability (no lost time) but FROI/SROI is filed in measurable quarter by same carrier with an initial date of disability present, the initial FROI received becomes measurable for timeliness.
I filed a FROI 00 months ago, and then filed a FROI 02 which updated the insurer FEIN, why is the FROI 02 being measured and not the initial FROI received?
The Board is measuring the filing made by the carrier of record at the end of the quarter. If the FROI 00 contained the wrong insurer FEIN, it is not considered a proper filing with the Board. Therefore, making the FROI 02 the first FROI received by the proper Insurer.
Due to late notice by the employer our FROI was filed late, should I request review?
No, the penalty stands as Section 54(2) of the Workers Compensation Law states notice and knowledge to the employer is notice and knowledge to the carrier. It is in the best interest of the carrier to educate their employers regarding timely notice. The Board regularly speaks with employers and has and will continue to advise them of their obligation to timely notify carriers of an injury.
The Board is tracking both the employer knowledge date along with the claims administrator knowledge date. Initially no penalties will be imposed against the employer. After an initial time period, all penalties available under the law will be considered including when appropriate, WCL 110 (4) against the employer
What if the Payer notices that incorrect data was submitted to the Board after a penalty has been issued that changes the timelines and makes the claim timely?
The Payer should request review of the penalty and send the FROI 02 making the correction. The Request for Review will be processed and the penalty will be withdrawn. The Payer's should send all corrections (FROI 02) prior to the end of the quarter so that the data measured is accurate.
What if the Payer notices that incorrect data was submitted to the Board which would not change the timeliness of the FROI?
The Payer should send the FROI 02 making the correction as soon as possible. The Payer should not request review of the penalty.
I thought Payor Compliance was only measuring lost time claims. Why are you measuring my FROI when the injured worker only lost three days due to this injury?
We are measuring cases that have at least one day of lost time per the definition of disability event.
- "Disability event" means any accident, including death resulting therefrom, occurring in the course of employment or any alleged accident, including death resulting therefrom, that 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 or alleged 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; or any disease or alleged disease, including death resulting therefrom, claimed to have been caused by the nature of the employment and contracted therein.
A First Report of injury is due once an injured worker loses a day beyond the working day or shift or has treatment beyond first aid. Even though your case is a medical only, as long as the claimant loses one day beyond the working day or shift it is a measurable claim, whether the lost time is compensable or not.
Payor Compliance-Administrative Determination (AD-PC-PEN) Penalty FAQ
How often will the AD-PC-PEN penalty be assessed, and how far back will the Board review claims?
These penalties will be assessed quarterly and will begin based upon 2018 first quarter filings. The penalty amounts are $50.00 per §25 (3)(e), $300.00 per §25 (2)(a), and $300.00 plus 20% per §25 (1)(e).
When is it appropriate to file a SROI-PD (various circumstances)?
Please see the Measuring and Monitoring Payer Performance: Timeliness of SROI Webinar Power Point.
Is there a penalty for changing the type of loss?
No, there is no penalty for changing the type of loss; however, if the Type of Loss Code is changed to a Traumatic Injury, all earlier filings are subject to being measured again for timeliness.
How will the AD-PC penalty be distributed to Trading Partners, through Payor Compliance or the Workers' Compensation Board system?
The AD-PC penalty will be sent the same way that Board Notices of Decision are sent.
Will these penalties be applied on a quarterly basis or on an individual basis as they come up?
The penalties will be done on a case-by-case basis.
Is there a character limit on the SROI-PD?
There is a 150-character limit when filing the SROI-PD.
What is the web address to use to request receipt of Notices electronically?
Payers who currently receive other Board notices electronically may contact the Monitoring Unit at email@example.com to start the process of receiving Payor Compliance notices electronically.
Payers who currently do not receive Board notices electronically but are interested in doing so, may find additional information on the Download Claim Notices page.
Is the new WCB form type "AD-PC-PEN" included in the WCB's data file, which includes WCB eCase "Resolution", "Awards" and "Hearings"?
Yes, the AD-PC-PEN form type will be viewable in the Board's eCase file.
Is the AD-PC penalty a new penalty in addition to the normal Payor Compliance penalties, or is the Board issuing the correct Payor Compliance penalties that were missed due to improper filings?
These are penalties that were previously missed due to improper data or no data being submitted.
If you are above the 85% compliance rate, will you be subject to the AD-PC penalty?
These penalties will not be subject to the 85% performance measures.
When is the SROI-PY filing, which shows payment of a penalty payable to the claimant, due?
Pursuant to §300.22 (5), the SROI filing showing payment of a claimant penalty is due within 10 days of making payment.
Suspension Penalty FAQ
When is the suspension due?
A suspension is due within 16 days of ceasing indemnity benefits.
When is the suspension due if paying pursuant to Workers’ Compensation Law (WCL) Section 21.a?
If you are paying pursuant to WCL 21-a (without liability), a suspension is due within 5 days of ceasing indemnity payments.
Has the Board determined if a “grace period” will be allowed as it did with previous measurements?
Yes, a grace period is allowed. The Board began issuing reports to Claim Administrators in October 2020. The education period is intended to be for six months, allowing Claim Administrators an opportunity to review cases that were considered late. During this time, no penalties will be assessed.
Will cases using a non-traumatic type loss code (02-occupational disease or 03-Cumulative Injury) be exempt from measurement as in Phase I?
Cases using a non-traumatic type loss code are not exempt. The Board will be measuring ALL cases when indemnity payments cease, including cases that involved a death.
What type of cases will be exempt from measurement?
Payments made pursuant to a Section 32, Schedule Loss of Use and Facial Disfigurement Awards will be exempt from measurement.
How are the number of days late calculated? Are they business or calendar days?
Calendar days will be used to calculate submissions. Due dates falling on a weekend or Board holiday will be due the next business day.