On November 16 , 2021 the NYS Workers’ Compensation Board issued a bulletin outlining a variety of procedural updates regarding Special Funds and reimbursement.The main points of the Board’s announcement are as follows:
- As of 12/1/21, the following forms are to be used for WCL 15-8 and WCL 14-6 reimbursement requests:
- C-251N – Insurer’s Notification of Initial Request for Reimbursement
- C-251.1-Insurer’s Request for Reimbursement of Medical Payments under 15-8
- C-251.6- Insurer’s Request for Reconsideration of Reduction under 14-6 or 15-8
- When it comes to seeking reimbursement under either statute, the Board advises that a response to the reimbursement request will be sent via email to the insured with an explanation of reductions. If the insurer wishes to dispute any reduction in reimbursement, they must email a C-251.6 form to specialfunds@wcb.ny.gov within 60 calendar days of the date marked on the C-251.Thereafter, a reconsideration will be emailed to the insurer. If, at that point, the insurer still disputes the reconsideration of reimbursement, the insurer may request a desk review by a Law Judge within 30 days by way of RFA-2.
- The Board also issued guidance in regards to establishing any pending 15-8 claims. Once a case is close to a finding of permanency (on a case with a date of accident pre-dating 7/1/07); the Board advised that the insurer is to submit a one-page document to Special Funds Group at SFGmail@wcb.ny.gov. This one page document must list all documents filed in the Board’s electronic case folder that support establishment of 15-8, along with a one-sentence description as to the “material and substantial” nature of the claimant’s prior condition. Thereafter, the Special Funds will either voluntarily accept 15-8 or they will schedule a hearing on the issue.
As always, the attorneys of Jones Jones LLC are ready to assist you and your team in navigating Workers’ Compensation Board procedural updates. Please connect with us today at clientservices@jonesjonesllc.com should you wish to schedule time with a partner to discuss this, or any topic of your choosing.