Tag Archives: eClaims

Practical Advice on Reporting No Lost Time Claims in New York.

How to report “No Lost Time” or “Medical Onlys”

The Board is now instructing carriers that when lost time does not exceed seven days, the claim administrator should file the FROI accepting liability for the medical portion of the claim. Why seven days? That is the “waiting period” for indemnity benefits in New York. Although the Board initially instructed carriers that the FROI-PD form was accepted (for a “partial denial” medical-only filing) the Board rescinded this guidance and now states that a FROI-00 should be filed; the claim administrator may later file a denial if lost time is claimed (SROI-04). This can also be used when there is no evidence regarding the claim.

Reporting Lost time with No Medical.

In an abrupt change from prior practice where no lost time benefits were issued until medical showed a causally-related disability, the Board is now instructing carriers to begin issuing lost time benefits at the minimum rate once lost time is alleged by the claimant despite the lack of any correlating medical narrative. (Source: “Proper eClaims Filing,” slide 4 of 25, WCB training webinar, September 8, 2015. Link here: http://www.wcb.ny.gov/content/main/Monitoring/Controversy.pptx Continue reading Practical Advice on Reporting No Lost Time Claims in New York.

Timelines in Admitted Traumatic Cases in New York

Greg LoisTimeline of the “Typical” case: Admitted Traumatic Accident with Lost Time.

  1. Initial investigation to confirm loss.
  2. If there is medical and lost time, begin benefits.
  3. File FROI-00 (Electronic Data Interchange, “EDI”).
  4. File update EDI documents as the case progresses.

The Board’s initiative to enforce EDI (“eClaims”).

Beginning in 2013, the Board has begun an increased tempo of “monitoring and compliance” initiatives intended to enforce the eClaims guidelines and generate more penalty income for the State. The Board has now established a “Compliance Unit” intended to do the following:

  • monitor performance standards for timely submission of First Report of Injury,
  • confirm timely first payment of indemnity benefits,
  • check for timely submission of Subsequent Report of Injury showing first payment,
  • monitor timely submission of Controversy; and
  • track the Percentage of Claims Controverted (how many cases is the carrier denying?).

Continue reading Timelines in Admitted Traumatic Cases in New York