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New York State
Workers' Compensation Board
OFFICE OF THE CHAIR
328 State Street  Schenectady, New York 12305
Governor David A. Paterson


Subject No. 046-254

New Case Assembly, Indexing and Adjudication Processes

Date: October 3, 2008

Background

To support the Workers' Compensation Reform initiative, the Board implemented a new case assembly and indexing process on September 29, 2008. The goal of this process is to dramatically reduce the instances where carriers and self insured employers must file a "protective" C-7 (Notice That Right to Compensation is Controverted). In the past, the Board would assemble a case through its indexing process. Cases were indexed early in the lifecycle of the claim, often before carriers had enough information to determine if they were going to accept or controvert the claim. The Board's indexing process resulted in the dissemination of a Notice of Indexing. The Notice of Indexing is a legal document that requires the carrier to tell the Board, within 25 days, if they are going to accept or controvert the claim. Since carriers often had little information at the time they received the Notice of Indexing, they had no choice but to file a "protective" C-7.

The Board's new processes require more of the information that is necessary to consider a case upfront, before indexing. This will reduce the instances where carriers must file a "protective" C-7 and move true controverted cases more quickly, because the material necessary to decide a case (including a medical report) should now be present before the pre-hearing conference. Delays in the hearing process that today are spent gathering information will be eradicated because hearings will proceed when materials are present.

Case Assembly/Indexing Process

Case Assembly

The Board is introducing a new concept into the process: case assembly. The case assembly process begins with the filing of any form or document that identifies the injured worker, his or her employer, and indicates an injury or illness. For example, filing Form C-4 or C-3 will trigger case assembly. When that occurs, the Board will create a case file and assign a case number. (See Subject Number 046-252 from September 23, 2008, Revised WCB Case Number *Technical Alert*, for more information on the new case number.) All identified parties of interest are advised of the case number, through a Notice of Assembly. The notice will be based on the forms in the case file at the time of case assembly. The Notice of Assembly is NOT a legal document and the carrier is under no obligation to respond to the Board based on that Notice. However, to ensure injured workers receive benefits promptly, parties are expected to begin researching the case and compiling evidence when they receive this Notice.

Carrier Response and Indexing

When the Board has both a medical report (Form C-4) and either an employer (Form C-2) or claimant (Form C-3) statement on file, the case is at a point where a carrier response is necessary. This is an important milestone in the process, because a medical report and an accident statement indicate the claimant is injured and potentially incurring expenses and/or losing wages. A carrier response may have already arrived from the earlier Notice of Assembly. If a carrier response is not in the file, the Board sends all parties a Notice of Indexing, and the 25-day clock for the carrier to either accept or controvert the case begins.

The Notice of Indexing is used to prompt a carrier response. There are instances where the Board will not need to send a Notice of Indexing to move the case forward. For example, if a carrier accepts or disputes a case (by filing Form C-669, C-7 or C-8/8.6) before the Board has received both a medical and injury report, then a Notice of Indexing to ask for a determination is unnecessary, because the carrier has already informed the Board of its intentions and the case is ready to move beyond that point.

In cases where Form C-3 indicates that the claimant suffered an injury or illness to a part of the body that had a prior injury or illness, indexing will occur after the Board receives a signed limited medical release (Form C-3.3).

If a carrier receives a Notice of Indexing or Assembly and does not believe it insures this employer in this case, it should advise the Board immediately.

The Streamlined Adjudication Process

Effective November 3, 2008, if the carrier controverts the case, and the Board has a medical report on file, the claim will move into the new controverted claim process. The Board expects to resolve the issues that created the controversy within 90 days of the notice of controversy, using the new 30/60/90 methodology.

  • A pre-hearing conference will occur within 30 days of receipt of Form C-7, which is the notice of controversy. A Pre-hearing Conference Statement (Form PH-16.2) must be filed with the Board at least 10 days prior to that pre-hearing conference.
  • The first expedited hearing, when the claimant is represented at the pre-hearing conference, will occur within 60 days. If an independent medical examination report is necessary, it must be presented three days prior to that hearing.
  • The second expedited hearing when the claimant is represented at the pre-hearing conference, if needed, will occur within 90 days.

Parties must be prepared as cases will move forward even if they are not, and adjournments are only granted in emergencies. Cases will move more quickly because all parties should begin assembling case materials when they receive the original Notice of Case Assembly.

Implementation

The Board expects all parties to commit to the prompt resolution of issues, in the interest of injured workers. To implement these new processes, the Board has changed its computer applications, rewritten its internal processing procedures, and retrained its staff to ensure a smooth and effective transition.

The Board encourages parties to sign up for eCase to receive instant access to all case information. Visit the Board's website [www.wcb.ny.gov] to register and to also keep current with all Board announcements.

Any questions regarding these matters should be referred to the Office of General Counsel at 518-486-9564.

 

Zachary S. Weiss
Chair