Recently, we posted an article detailing the most common defenses that are used in denied New York Workers’ Compensation claims, that article can be found here.
Controverting a claim in the state of New York also requires that the carrier and/or self-insured and the defense counsel submit very specific forms in a statutorily defined time frame in order to raise and maintain those defenses. In most cases, if these aforementioned forms are not submitted in a timely fashion or are defective, the carrier and/or self-insured may waive all of its defenses and may have to accept the claim as compensable.
Initial Considerations in Controverted Claims
The process to controvert or deny a workers’ compensation claim in the state of New York is initiated when the carrier or self-insured files the electronic First Report of Injury – Denial Type 04 (FROI-04) which can be viewed here or a Subsequent Report of Injury – Denial Type 04 (SROI-04) form which can be viewed here. These forms now replace the Form C-7 or Notice that Right to Compensation is Controverted form, which used to be the forms upon which a claim was controverted. To view the obsolete form you can click here.
The FROI-04 includes a description of the factual and legal defenses raised as well as information about the employee, the employer, and the insurance carrier. According to New York Workers’ Compensation Law § 25(2)(a) the FROI-04 or SROI-04 must be filed by the carrier or self-insured employer within eighteen (18) days of the disability or within ten (10) days after the employer gains knowledge of the disability, whichever is greater. Continue reading How a New York Workers’ Compensation Claim is Controverted – Initial Considerations