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Workers’ Compensation Board

New York State
Workers' Compensation Board
328 State Street  Schenectady, New York 12305
Subject No. 046-105

To:  Insurance Carriers and Self-Insured Employers Providing Benefits Under the Workers' Compensation Law, the Volunteer Firefighters' Benefits Law and the Volunteer Ambulance Workers' Benefit Law

Penalty and Assessment Reference Numbers

Date:  November 1, 2001

In the first quarter of 2002, the New York State Workers' Compensation Board will be expanding the use of computer-generated reference numbers to track certain penalties and assessments levied against insurance carriers, self-insurers and other parties according to provisions of the Workers' Compensation Law. These reference numbers will be placed on certain penalty and assessment notices sent from the Board to an insurance carrier, self-insurer or other party. Each insurance carrier, self-insurer or other party will be required to put the reference number of the penalty or assessment on the check stub for payment. This will help ensure proper credit for the payments of penalties and assessments sent to the Workers' Compensation Board.

Multiple penalties and assessments can be paid on one check as long as each reference number and its related payment is included on the check stub. In addition, the total amount of individual payments listed on the check stub must equal the amount on the check.

Currently there is a reference number, labeled WCB Dispute Number, on notices related to assessment/penalties under WCL Section 13.G.1,4, &6. The additional penalty notices that will have reference numbers placed on them will include penalties related to the following sections of the Workers' Compensation Law:

  • Section 25-3(c) -- causing an unnecessary adjournment;
  • Section 25-3(d) -- frivolous request for an adjournment of a special part for an expedited hearing;
  • Section 25-3(e) -- failure to file a requested or required notice or report;
  • Section 25-3(f) -- failure to pay an award timely;
  • Section 13(g) -- hospital failure to file hospital records;
  • Section 25-2.b -- failure to pay a conciliation award timely;
  • Section 110 -- refusing (or neglecting) to file form C-2, Notice of Injury, or to keep proper records;
  • Section 114-a -- false representation;
  • Section 300.2(f) (WCB rules and regulations) -- employer/carrier failure to file medical reports

In addition, reference numbers will also be placed on certain assessments, including those related to the following sections of the NYS Workers' Compensation Law:

  • Section 142.5 -- Appeal fees
  • Section 60.4.1 -- Volunteer Ambulance Workers review fees
  • Section 60.4.1 -- Volunteer Firefighters review fees

Cooperation of insurance carriers, self-insurers and other parties in putting the reference number of penalties and assessments on checks stubs for payment will save time and money in reconciling penalty and assessment accounts and ensure proper credit for the payments of penalties and assessments. Please contact Charles Altrock at (518) 474-0394 if you have any questions or require further information regarding reference numbers for penalties and assessments.

Thank you for your cooperation.


Robert R. Snashall