Date: May 31, 2013
On April 16, 2013, the New York State Workers' Compensation Board (Board) announced 'New Printable eClaims Transaction Reports Available for Mailing to Parties' in furtherance of the Board's rollout of eClaims in spring 2013. The Board has developed new printable transaction reports to allow claim administrators to notify parties by mail, as required by law. FROI-04 and SROI-04 denial transactions will replace Form C-7, Notice of Controversy. This notice must be filed with the Chair, by the carrier or employer, on or before the 18th day after disability or within 10 days after the employer first had knowledge of the alleged injury, whichever period is greater. In the event that the Board sends a notice of indexing, the employer or carrier must file a controversy within 25 days, or risk a waiver of pleading certain defenses to the claim. FROI-04 and SROI-04 denial transactions do not enable electronic certification. Therefore, the Board will permit a FROI/SROI Notice of Controversy to be certified at the pre-hearing conference using revised Form OC-400.5, Attorney/Representative's Certification of Form C-3 or Notice of Controversy. The OC-400.5 revisions enable FROI/SROI denial certifications at the pre-hearing conference. A pending regulatory change to Rule 300.38 will incorporate this procedure for eClaims cases. Individual carriers and employers should follow the current procedure of paper certification, as set forth in the current Rule 300.38, until going live with eClaims. The form will also continue to serve as the method for the claimant's legal representative to certify a previously filed Form C-3.
Board Rule 12 NYCRR §300.37 provides, in part:
(d) (1) If the claimant has retained a legal representative at the time the Employee Claim form is filed with the Board, the legal representative shall file with the Employee Claim form:
Board Rule 12 NYCRR §300.38 provides, in part:
(d) Subsequent retention of legal representative. If a claimant retains a legal representative after a claim is indexed or after the carrier files a form to controvert the claim when the claim is not indexed, the legal representative shall, within five days thereof, file with the Board and serve on all other parties a notice of retainer on the form prescribed by the Chair together with:
Amended Board Rule 12 NYCRR §300.38 provides, in part:
(a) Notice of controversy:
An insurance carrier who controverts a claim shall file with the Board and serve upon all other parties a notice of controversy on the form prescribed by the Chair in accordance with Workers' Compensation Law section 25(2)(a) or (b) or section 300.22(d)(3) of this Part. The notice of controversy shall comply with the following:
As the Board publishes more information, it will be posted on the eClaims Overview portion of the Board's website.
For more information on the IAIABC Claims EDI Release 3.0 standard, please visit the EDI Implementation Guide section of the IAIABC website at: www.iaiabc.org. Questions related to this announcement can be directed to: eClaims@wcb.ny.gov. New York specific requirements, implementation schedule, and resources can be found at the Board's website: www.wcb.ny.gov.
Robert E. Beloten