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Workers' Compensation Board

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New York State
Workers' Compensation Board
OFFICE OF THE CHAIR
328 State Street  Schenectady, New York 12305
Governor Andrew M. Cuomo


Subject No. 046-874

Revised Request for §14(6) and §15(8) Reimbursement Forms
Effective October 1, 2016

Date: August 24, 2016

Earlier this year, the Workers' Compensation Board (Board) announced a joint effort with the Special Funds Conservation Committee (SFCC) to streamline processing of requests for reimbursement for claim expenses that are eligible to be paid from the Special Disability Fund (SDF) under Workers’ Compensation Law (WCL) §§14(6) and 15(8).

In follow up to that announcement and consideration of submissions received during the question and comment period, the Board has made the following forms and instructions available on its website at:

http://www.wcb.ny.gov/content/main/WAMO/WAMO.jsp

The forms include the following:

  • Carrier's Request for Reimbursement of Indemnity Payments Under WCL §15(8) (Form C-251A), which replaces Carrier's Request for Reimbursement of Compensation Payments under Section 15(8) (Form C-251), consolidates reimbursement requests for all claims associated with a W Number onto a single form and is to be completed and submitted electronically via email to SpecialFunds@wcb.ny.gov.
  • Carrier's Request for Reimbursement of Indemnity Payments Under WCL §14(6) (Form C-251.2A), which replaces Carrier's Request for Reimbursement of Compensation Payments Under Section 14(6) (Form C-251.2), consolidates reimbursement requests for all claims associated with a W Number onto a single form and is to be completed and submitted electronically via email to SpecialFunds@wcb.ny.gov.
  • Carrier's Request for Initial Reimbursement of Indemnity Payments Under WCL §15(8) (Form C-251N), which will be required for any initial request for indemnity reimbursement on a claim and should be completed and submitted electronically with Form C-251A via email to SpecialFunds@wcb.ny.gov.

All requests for reimbursement from the SDF must be submitted on the above forms directly to the Board as of October 1, 2016. Requests on the existing Form C-251 should continue to be submitted to SFCC through September 30, 2016.

The Carrier's Request for Reimbursement of Medical Expenses Under Section 15(8) (Form C-251.1) will not change at this time; however, submissions should be directed to the following address beginning October 1, 2016:

NYS Workers’ Compensation Board
Attn. Special Funds Group
328 State St, Room 331
Schenectady, NY 12305-2302

These changes are expected to allow the Board to more actively manage liabilities and expedite the processing of reimbursement requests, thereby ensuring payment is made to the appropriate party in a timely manner.

If you have questions regarding this notice, please feel free to contact the Board's Office of Financial Administration by phone at (855) 430-3602 or by email at SpecialFunds@wcb.ny.gov.

Thank you for your continued cooperation during this transition.

 

Kenneth J. Munnelly
Chair