Temporary Payments of Compensation without Prejudice
Section 300.22 of Title 12 NYCRR is amended to read as follows:
300.22 Procedure when compensation controverted and when no controversy, including
applications by claimants to reopen cases previously established and closed by the Board and
temporary payments of compensation without prejudice
- (a) Notice of controversy required by section 25 of the Workers' Compensation
Law shall be filed with the Chair either on or before the 18th day after disability or within 10
days after the employer has knowledge of the alleged accident, whichever period is the greater, on
prescribed form C-7
. A copy of the form C-7 must be
transmitted to the claimant and his or her attorney or licensed representative, simultaneously with the filing with the Chair. The issues
being controverted must be clearly stated with an explanation of the reasons for the controversy.
The carrier shall indicate on the form C-7 the date on which it received the employer's report of injury.
A self-insured employer shall indicate on the form C-7 the date of its first knowledge of the
injury.
- (b) If the right to compensation is not controverted, the employer or carrier shall, either
on or before the 18th day after disability or within ten days after the employer has knowledge of the
alleged accident, whichever period is the greater, begin paying compensation and shall immediately
transmit prescribed form C-669
notifying
the Chair that payment of compensation has commenced. A copy of the form C-669 shall be transmitted to
the claimant and to his or her attorney or licensed representative, if any, simultaneously with the filing
with the Chair. The carrier shall indicate on the form C-669 the date on which it received
the employer's report of injury. A self-insured employer shall indicate on the form C-669 the
date of its first knowledge of the injury. Where payments are being made at a rate which is below the
statutory maximum in effect on the date of the injury, the basis for payment at such rate shall be
specified.
- (c) If the right to compensation is not controverted but payment has not begun because
no compensation is presently due, prescribed form C-669 shall be filed with the Chair not
later than 25 days after the Board has transmitted a notice of indexing a case to the employer
or its insurance carrier. The reason or reasons for not commencing payment of compensation shall
be clearly stated in the form C-669. A copy of the form C-669 shall be transmitted
to the claimant and his or her attorney or licensed representative, if any, simultaneously with the
filing with the Chair. The carrier shall indicate on the form C-669 the date on which it received
the employer's report of injury. A self-insured employer shall indicate on the form C-669 the
date of its first knowledge of the injury.
- (d) Notwithstanding any other provisions of this section or section 300.23 of this Part, the following procedures shall apply when an employer or carrier is unsure of the extent of its liability for a claim of compensation made under the Workers' Compensation Law:
- If the employer or carrier is unsure of the extent of its liability for a claim of compensation, and elects to make temporary payments of compensation or payment for prescribed medicine pursuant to section 21-a of the Workers' Compensation Law, the employer or carrier may, at any time prior to or after filing of form C-669 or form RFA-2
pursuant to subdivision (a), (b), (c) or (e) of this section, and prior to any decision of the Board establishing or disallowing the claim, begin temporary payments of compensation and/or prescribed medicine and shall immediately transmit form C-669, if a new case or form RFA-2, if a reopened case, notifying the Board that temporary payment of compensation and/or prescribed medicine has commenced. A copy of form C-669, or form RFA-2 in a case which has previously been established and closed, shall be transmitted to the claimant and the claimant's attorney or licensed representative, if any, simultaneously with transmittal to the Board. Payments of temporary compensation and/or prescribed medicine shall be made without prejudice and without admitting liability.
- Upon receipt of form C-669 or form RFA-2, the Board shall notify the employee that it has received a notice of payment of temporary compensation and/or prescribed medicine that payment of such compensation and the employee's acceptance thereof shall neither be an admission of liability by the employer or carrier nor prejudice the claim of the employee, and that payment of temporary compensation and/or prescribed medicine shall terminate upon either the lapse of one year from the date of first payment, or the filing of a notice of controversy, or the cessation of temporary payments by the employer or carrier upon the filing of form C-8/8.6, whichever is first. The Board shall also notify the employee that he or she may be required to enter into a non-prejudicial agreement with the employer or carrier in order to ensure the continued payments of temporary compensation and or prescribed medicine.
- An employer or carrier may cease making temporary payments of compensation and/or prescribed medicine by delivering to the Board and the employee, within five days after the last payment, a notice of termination of payments of temporary compensation on form form C-8/8.6,
.
If the employer or carrier is now accepting liability for the claim, it shall deliver form C-8/8.6 only. If the employer or carrier is now controverting the claim, it shall file form C-7 simultaneously with form C-8/8.6 or within 10 days after delivery of form C-8/8.6. In any case in which temporary payments of compensation and/or prescribed medicine have been made and form C-669 or form RFA-2 has been delivered to the Board advising that temporary payments without prejudice have commenced, form C-7 is not required to be filed within 25 days from the date of transmittal of the notice of indexing provided, however, that if the employer or carrier cease making temporary payments of compensation and/or prescribed medicine, the filing of a C-7 within 25 days of the date of transmittal of notice of indexing as prescribed in subdivision (c) of this section or within 10 days after delivery of notice that temporary payments
of compensation and/or prescribed medicine have terminated, whichever is later, shall be deemed timely for the purposes of paragraph (b) of subdivision 2 of section 25 of the Workers' Compensation Law.
- If the employer or carrier does not deliver a notice of termination on form C-8/8.6 to the Board within one year from the commencement of payment of temporary compensation and/or prescribed medicine, the employer or carrier shall be deemed to have admitted liability for the claim, and a decision shall be issued establishing the claim.
- The information required in forms C-669, RFA-2 and C-8/8.6 shall be typewritten or entered by computer.
- (e) Except as provided in subdivision (d) of this section, the following procedures and forms shall apply when there is an application by a claimant to reopen a case previously established and closed by the Board. Pursuant to section 300.15(b) of this Part, when the claimant makes an application to reopen a case previously established and is represented by an attorney or licensed representative, such attorney or licensed representative shall on the same day transmit a copy of the application to the employer or carrier. When the claimant makes such application and is not represented by an attorney or licensed representative, the Chair, upon receipt of the application, shall transmit a copy of the application to the employer or its carrier. An employer or its carrier shall file prescribed form RFA-2 with the Chair within 25 days after the employer or its carrier receives an application to reopen a case previously established and closed by the Board. The employer or its carrier shall indicate on the form whether payment for compensation and/or medical treatment has commenced, the claim is controverted, or the claim is not controverted but payment has not begun. When a claim is controverted or payment has not begun in an uncontroverted claim, the reason or reasons therefore shall clearly be stated on such form. A copy of the form RFA-2 must be transmitted to the claimant and his or her attorney or licensed representative, if any, simultaneously with the filing with the Chair. An employer or carrier which fails to comply with the requirements of this subdivision shall be subject to penalties pursuant to Section 25 of the Workers' Compensation Law.
- (f) Where any form or other correspondence is required to be filed or delivered, the
date of filing or delivery shall be the date of actual receipt by the intended recipient. Where any
form or other correspondence is required to be transmitted, the date such form or other
correspondence is actually mailed or otherwise transmitted shall be the date of transmittal, regardless of when
received by the intended recipient.