July 17, 2014
Workers' Compensation Law (WCL) § 21-a allows an employer or its insurance carrier to pay workers' compensation lost wage and appropriate medical benefits to an injured employee for up to one year without admitting liability for the claim and without prejudice to its right to controvert the claim. WCL § 21-a cannot be utilized by an employer or carrier on claims that involve medical only and is an option only when payments for lost wages are due. When an employer or insurance carrier indicates a WCL § 21-a election, indemnity payments must be made to the claimant. At any time during that one-year period, the employer or carrier may provide notice that it is ceasing temporary payments and may then controvert the claim if its investigation reveals that it should not be liable.
Rather than automatically controverting the claim, self-insured employers and workers' compensation insurance carriers are encouraged to voluntarily pay lost wage and appropriate medical benefits pursuant to WCL § 21-a in those claims in which liability is uncertain and more time is needed to investigate the claim. Doing so will provide benefits to injured claimants, while preserving the right of an employer or carrier to later controvert a claim based on the results of its investigation.
When an employer or carrier begins temporary payments of compensation without prejudice and liability under WCL § 21-a, it is required to provide notice to the Board that payments have begun by electronically filing a SROI-IP, which indicates “without liability” in the “Agreement to Compensate” field. In addition to providing notice to the Board via the SROI-IP, the employer or carrier is required to notify the claimant and his or her representative when it begins payment of compensation pursuant to WCL § 21-a. In support of this requirement, the employer or carrier can utilize the printable transaction report of the electronic SROI-IP filing. Information regarding the generation and mailing requirements for servable paper documents can be found in Section 3.6 of the NYS eClaims Implementation Guide on the Board's website. This section of the Implementation Guide includes multiple options for how claim administrators can obtain their FROI/SROI transaction report for each successfully submitted filing.
Questions related to this announcement can be directed to: eClaims@wcb.ny.gov.
Robert E. Beloten