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Everyone has probably heard the old adage, "The least expensive accident is one that never occurs." But accidents do happen, and employers need to become involved before the first form is filed.
When an employee is injured, they should immediately tell their employer or supervisor when, where and how the injury happened, and get medical treatment. The treating health care provider must be authorized by the Workers' Compensation Board, except in an emergency. In addition, the employee should submit written notice within 30 days to their employer (WCL §18).
As a general rule, employers may not direct their employees to a particular health care provider. Exceptions exist for employers who participate in the Preferred Provider Program or an Alternative Dispute Resolution Program. Employers can still recommend care providing they inform employees of their rights to choose providers of their choice through the Notice of Right to Select a Workers' Compensation Board Authorized Health Care Provider (Form C-3.1) .
Self-insured employers, insurance carriers and the New York State Insurance Fund (NYSIF) are authorized to require employers to obtain diagnostic tests from a provider who is part of a network the employer, insurance carrier or NYSIF has contracted with to provide such services (WCL §13-a(7)(c)).
In addition, employers, insurance carriers, and NYSIF may require employees to obtain prescriptions from a pharmacy with which they contract (WCL §13[i]).
In both situations, notice must be provided to the employee.
All accidents should be investigated fully to ensure that all the facts are gathered. In addition, the employer should contact the insurance carrier and maintain those communications throughout the claim. Any written contact with the injured worker’s health care provider should be copied to the injured worker and their legal representative, if any. Any attempt to influence the health care provider in any way may be considered interference with the injured worker’s treatment, which is a misdemeanor.
The injury is minor if
For minor injuries, the employer may choose to pay for the first aid treatments directly. In this instance, the employer completes the Employer's First Report of Work-Related Injury/Illness (Form C-2F) , but does not send it to the Board or the insurance carrier. Instead, the employer maintains the form in their files for the statutory 18-year period (WCL §110). Form C-2F is available from the insurance carrier, or any Board office.
All injuries other than minor injuries (as described above) must be reported to the Board and insurance carrier within 10 days. Failure to file within 10 days after the accident is a misdemeanor and punishable by a fine. In addition, the Board may impose a penalty of up to $2,500 (WCL §110 and 12 NYCRR §310.1).
When completing Form C-2F, it is important to remember that statements may be legally binding. The employer should note on the form if they believe the claim to be questionable or fraudulent. The insurance carrier can be contacted for assistance with completing the form. Form C-2F can be filed by a third-party designated by the employer, however the employer is ultimately responsible for ensuring it is filed.
Filing Form C-2F is not necessarily an admission that you agree with the facts of a reported accident. It is a statement that an employee reported a work-related injury or illness to the employer.
When an employer continues to pay an employee wages, or advances the employee compensation payments following a work-related injury or illness, the employer may seek reimbursement for those wage payments out of any subsequent compensation awards, so long as the employer has made a claim for reimbursement prior to the award of compensation (WCL §25[4]).
IMPORTANT: An employer will forfeit its right to reimbursement for these advance payments unless the claim for reimbursement is made before the Board makes an award of compensation.
The employer may be entitled to reimbursement whether the payments were made voluntarily or as a negotiated benefit, as might be contained in a collective bargaining agreement.
The claim for reimbursement should be in writing, although it may be made at a Board hearing where a hearing reporter is present to transcribe the proceedings and thus make a record of the request.