Timeline for Denying a Claim in New York

The insurer begins the payment of benefits if lost time exceeds seven days. If the claim is being disputed, the insurer must inform the Workers’ Compensation Board (and the claimant and his/her representative, if any) by filing Form C-7 “Notice that Right to Compensation is Controverted.” If the claim is not disputed, but payment is not being made for specific reasons stated on the notice, (e.g. that there is no lost time or that the duration of the disability is less than the 7-day waiting period), the insurer must also notify all the parties.

The insurer files Form C-669 (“Notice to Chair fo Carrier’s Action on Benefits”) or Form C-7 with the Board indicating either that payment has begun or the reasons why payments are not being made. A copy of the Form C-669 or Form C-7 must be transmitted to the claimant and his/her attorney/licensed representative, if any, simultaneously with the filing with the Board. If the employee does not notify the employer timely, this notice may be filed within 10 days after the employer learns of the accident.

Now is the time to controvert!
A case may be disputed because:

  • The employer alleges that proper notice was not timely given; or

  • The claim was not properly filed; or

  • A lack of causal connection is alleged between the alleged injury and the accident; or

  • The employer-employee relationship is denied; or

  • The accident is alleged not to have occurred at work; or

  • Any other reason for denying the claim.

A dispute will create an adversarial proceeding. The forum will be the WCB, and a Workers’ Compensation law Judge will hear the dispute.

Within 25 days of the notice of indexing:
After the Board notifies the employer (or its insurance carrier) that a workers’ compensation case has been indexed against the employer, the employer may file a notice of controversy (Form C-7) within 25 days from the date of mailing of the notice of indexing. Failure to file the notice of controversy within the prescribed 25 day time limit could bar the employer and its carrier from pleading certain defenses to the claim.

Where the employer is not controverting (challenging) the claim – If payment has not begun because no compensation is presently due, Form C-669 must be filed with the Board within 25 days after the Board has transmitted a notice of indexing.

Greg Lois is the managing partner of LOIS LLC and dedicates his practice to defending employers and carriers in New York and New Jersey workers' compensation claims. Greg is the author of a popular series of "Handbooks" on workers' compensation, and is the co-author of the 2016 & 2017 Lexis-Nexis New Jersey Workers' Compensation Practice Guide. Greg can be reached at 201-880-7213 or glois@loisllc.com