Workers' Compensation Insurance Solutions

Claims FAQs

workers' compensation insurance frequently asked claims questions

The following are commonly asked questions that we receive from safety group members regarding the claims process.


A. In New York State, an employer is required to file a claim with the carrier when there is any lost time from duties beyond the injury date OR medical treatment for the injury results in the generation of a medical bill.

 

A. An employer can self-pay for up to two medical bills. If there is any lost time beyond the date of injury, the employer cannot self-pay medical bills.

 

A. The employer must file the claim WITHIN 10 DAYS from the date of injury. By law, an injured employee has 30 days to provide notice of sustained injury to his/her employer. Make reporting sustained injuries within your organization a priority!

 

A. Paper claim forms are no longer accepted by NYSIF and the NY Workers’ Compensation Board. All WC claims (including claims for volunteer firefighters and volunteer ambulance workers) are now filed online via NYSIF eFROI. Once the claim is successfully submitted online, a carrier case number will automatically be generated.

 

A. Provide the injured employee with a Claimant Information Packet. If the claim resulted in LOST TIME for the employee, the employer should complete and submit to NYSIF the C-11 and C-240 forms. If the employer continued to pay the claimant while out on Workers’ Compensation, then the employer would also need to complete and submit the C-107 form to NYSIF.

 

A. Has the injured worker returned to work? Has a C-11 form noting the return-to-work date been submitted? If yes, please contact either the assigned NYSIF Case Manager or Glatfelter Brokerage Services for a status update. Please note that employer reimbursements must be confirmed by the NY Workers’ Compensation Board before NYSIF can issue a reimbursement.

 

A. If the injury resulted in LOST TIME from the volunteer’s duties, the fire department/ambulance company must note this when completing the eFROI OR notify the NYSIF Case Manager with specific dates that disability began (and ended). Lost Time Benefits are payable to volunteer firefighters/ambulance workers from day one and would be based on earning capacity and degree of disability and NOT their regular employment wages.

 

A. No, this packet would NOT apply to a volunteer firefighter and/or volunteer ambulance worker. The injured volunteer is encouraged to complete and submit to NYSIF a VF-3/VAW-3.

 

A. Complete a temporary prescription form and present it at a participating pharmacy. A temporary prescription form can be found on the NYSIF website or within the Claimant Information Packet.

 

A. The employer must keep a record of all sustained injuries for 18 years.

 

A. Contact the assigned NYSIF case manager by phone and notify him or her of SPECIFIC CONCERNS that may be fraudulent. After you speak to the case manager, follow up with a written explanation of your specific concerns. The case manager can then issue a request for surveillance or other necessary measures if they determine there is a potential fraud case.

 

A. NYSIF does have resources to proactively research a claim to help determine its validity. These include claimant and employer interviews, independent medical exams (IMEs) and/or surveillance, which all have the ability to be presented to the Workers’ Compensation Board (WCB). The WCB does have the final say in determining a claim’s validity and the claimant’s scope of injury.