WORKERS COMP QUESTIONS |&
ANSWERS(GRADED A+)
15-8 Cases - ANSWER§15-8 is a section of the NYS WC law relating to disability
following previous permanent physical impairment. §15-8 no longer applies for loss
dates after June 30, 2007.
25-A Cases - ANSWER§25-A is a section of the NYS WC law that applies to cases
closed (NFA), in which the date of accident is more than seven (7) years ago, and in
which the date of the last indemnity payment is more than three (3) years ago. If the
WCB establishes 25-A, then medical and indemnity payments will be made by
Special Funds Conservation Committee, and not the employer or insurance carrier.
A-Rate - ANSWERAn "A-Rated Classification" is a classification with no predefined
manual rate shown in the rate pages of the NYCIRB Manual.
Accident Notice and Causal Relationship (ANCR) - ANSWERThe finding made by
WCLJ that the claimant sustained an accidental injury arising out of and in the
course of employment; that timely notice was given to the employer; and that the
disability is causally related to the accidental injury. (WC law § 2, Sub. 7; § 18)
Actuary - ANSWERA person who calculates insurance and annuity premiums,
reserves and dividends.
Adjourn (a hearing) - ANSWERThe Workers' Compensation Board WCLJ can put off
or suspend until a future time, without making any findings.
Adjusted manual rate premium - ANSWERA premium level charged a risk under a
NYSIF workers' compensation policy, produced by applying an experience
modification to the manual rate premium on either a deposit premium bill or an audit
bill.
ADL - ANSWERActivities of Daily Living.
Administrative Decision (AD) - ANSWERIn an effort to reserve the hearing calendar
process for more complex cases, the WCB can make determinations on cases
outside of the regular hearing process by administrative decisions.
Admiralty Law - ANSWERThe Merchant Marine Act of 1920 also known as the
Jones Act(46 U.S. Code, § 688). This federal law, which is part of Admiralty Law,
provides that masters and members of crews of vessels have the right to sue their
employers for damages in Admiralty Courts for injuries sustained in the course of
employment.
,Advocate for Business - ANSWERThe New York State Workers' Compensation
Board Advocate for Business assists employers by resolving problems and
answering questions about the New York State workers' compensation system.
Advocate for Injured Workers - ANSWERThe New York State Workers'
Compensation Board Advocate for Injured Workers accepts complaints related to
workers' compensation, and investigates and attempts to resolve them. In addition,
the Advocate provides information to injured workers to enable them to protect their
rights in the workers' compensation system.
Affidavit - ANSWERA written statement under oath or affirmation made or taken
before an officer having authority to administer such oath.
Aggregate Trust Fund (ATF) - ANSWERA trust fund established in 1935, under NYS
WC law § 27, entrusting NYSIF as the administrator for the Trust to assure payment
of workers' compensation in claims involving permanent partial disability, permanent
total disability, the loss of major members (limbs or eyes) and fatal injuries.
Anniversary Date - ANSWERThe date each year upon which the policy is renewed;
usually based on the original inception date.
Appeal (Workers' Compensation) - ANSWERA legal action taken by one of the
parties to reverse or amend a decision or direction made by a WCLJ, WCB board
panel or the WCB Chair.
Applicant - ANSWERThe person or entity requesting insurance.
Apportionment - ANSWERA proportionate division of all or part of the liability in a
case between two or more sources of disability for the same claimant.
Apportionment can involve another NYSIF case, another carrier's case, or a prior
existing medical condition of the claimant.
Arising Out of and in the Course of Employment - ANSWERTwo necessary
conditions that must be met to establish a work-connected accidental injury. (WC law
§ 2, Subd. 7)
Assignment of Interest - ANSWERThe transfer of an insurance policy from one
person or entity to another.
Authorized Chiropractor - ANSWERNew York State licensed chiropractor authorized
by the WCB Chair to render chiropractic care under the WC law within the limits
prescribed by the Education Law.
Average Weekly Wage (AWW) - ANSWERA calculation that reflects the employees'
average pay rate used as a basis for determining benefits in workers' compensation
insurance. (WC law § 14)
Binder - ANSWERAn agreement to furnish protection until an insurance policy can
be issued. NYSIF does not use binders for workers' compensation coverage.
, Board Panel Review - ANSWERWhere a WCLJ's decision is disputed, the aggrieved
party may file an application for a review. (WC Law § 23, §224 and Board Rule 13)
C-105 - ANSWERWCB prescribed form "Notice of Compliance, WC Law" informs
employees at their place of employment of their rights under the WC law. Employers
must obtain this form from their insurance carrier or licensed agent.
C-107 - ANSWERWCB prescribed form "Employer's Request for Reimbursement"
C-11 - ANSWERWCB prescribed form "Employer's Report of Injured Employee's
Change in Employment Status resulting From Injury"
C-2 - ANSWERWCB prescribed form "Employers' Report of Work-Related
Injury/Illness" filed by employers within 10 days after an accident occurs, as required
by WC law § 110.
C-240 - ANSWERWCB prescribed form "Employer's Statement of Wage Earnings
(Preceding Date of Accident)" used to determine the claimant's average weekly
wage.
C-250 - ANSWERWCB prescribed form "Notice of Claim for Reimbursement Out of
Special Disability Fund Under WC law §15-8." A carrier cannot file a C-250 on cases
with accident dates after June 30, 2007.
C-27 - ANSWERWCB prescribed form "Medical Proof of Change in Condition in
Support of Application for Reopening," filed in a closed case to show change in
medical condition supporting the reopening of a claim.
C-3 - ANSWERWCB prescribed form "Employee Claim" completed by the injured
worker to apply for workers' compensation benefits because of a work injury or work-
related illness. It must be submitted to the WCB within two years of the accident or
onset date. The C-3 form contains much of the same information as the C-2.
C-3.3 - ANSWERWCB prescribed form "Limited Release of Health Information
(HIPAA)" for the injured worker. This form is completed by claimants who have had a
previous injury to the same body part or a previous similar illness.
C-32 - ANSWERWCB prescribed form "Settlement Agreement for WC law §32"
C-4 - ANSWERWCB prescribed form "Doctor's Initial Report" is to be completed the
first time a provider treats a claimant for a particular workers' compensation claim.
Please note the request for medical authorhttp://dsdomination.com/membersization
is not included in the new C-4 form; instead new Form C-4AUTH should be used to
request authorization.
C-4.2 - ANSWERWCB prescribed form "Doctor's Progress Report" is a new, shorter
version of Form C-4, which is to be used for all subsequent visits to report continuing
services.
ANSWERS(GRADED A+)
15-8 Cases - ANSWER§15-8 is a section of the NYS WC law relating to disability
following previous permanent physical impairment. §15-8 no longer applies for loss
dates after June 30, 2007.
25-A Cases - ANSWER§25-A is a section of the NYS WC law that applies to cases
closed (NFA), in which the date of accident is more than seven (7) years ago, and in
which the date of the last indemnity payment is more than three (3) years ago. If the
WCB establishes 25-A, then medical and indemnity payments will be made by
Special Funds Conservation Committee, and not the employer or insurance carrier.
A-Rate - ANSWERAn "A-Rated Classification" is a classification with no predefined
manual rate shown in the rate pages of the NYCIRB Manual.
Accident Notice and Causal Relationship (ANCR) - ANSWERThe finding made by
WCLJ that the claimant sustained an accidental injury arising out of and in the
course of employment; that timely notice was given to the employer; and that the
disability is causally related to the accidental injury. (WC law § 2, Sub. 7; § 18)
Actuary - ANSWERA person who calculates insurance and annuity premiums,
reserves and dividends.
Adjourn (a hearing) - ANSWERThe Workers' Compensation Board WCLJ can put off
or suspend until a future time, without making any findings.
Adjusted manual rate premium - ANSWERA premium level charged a risk under a
NYSIF workers' compensation policy, produced by applying an experience
modification to the manual rate premium on either a deposit premium bill or an audit
bill.
ADL - ANSWERActivities of Daily Living.
Administrative Decision (AD) - ANSWERIn an effort to reserve the hearing calendar
process for more complex cases, the WCB can make determinations on cases
outside of the regular hearing process by administrative decisions.
Admiralty Law - ANSWERThe Merchant Marine Act of 1920 also known as the
Jones Act(46 U.S. Code, § 688). This federal law, which is part of Admiralty Law,
provides that masters and members of crews of vessels have the right to sue their
employers for damages in Admiralty Courts for injuries sustained in the course of
employment.
,Advocate for Business - ANSWERThe New York State Workers' Compensation
Board Advocate for Business assists employers by resolving problems and
answering questions about the New York State workers' compensation system.
Advocate for Injured Workers - ANSWERThe New York State Workers'
Compensation Board Advocate for Injured Workers accepts complaints related to
workers' compensation, and investigates and attempts to resolve them. In addition,
the Advocate provides information to injured workers to enable them to protect their
rights in the workers' compensation system.
Affidavit - ANSWERA written statement under oath or affirmation made or taken
before an officer having authority to administer such oath.
Aggregate Trust Fund (ATF) - ANSWERA trust fund established in 1935, under NYS
WC law § 27, entrusting NYSIF as the administrator for the Trust to assure payment
of workers' compensation in claims involving permanent partial disability, permanent
total disability, the loss of major members (limbs or eyes) and fatal injuries.
Anniversary Date - ANSWERThe date each year upon which the policy is renewed;
usually based on the original inception date.
Appeal (Workers' Compensation) - ANSWERA legal action taken by one of the
parties to reverse or amend a decision or direction made by a WCLJ, WCB board
panel or the WCB Chair.
Applicant - ANSWERThe person or entity requesting insurance.
Apportionment - ANSWERA proportionate division of all or part of the liability in a
case between two or more sources of disability for the same claimant.
Apportionment can involve another NYSIF case, another carrier's case, or a prior
existing medical condition of the claimant.
Arising Out of and in the Course of Employment - ANSWERTwo necessary
conditions that must be met to establish a work-connected accidental injury. (WC law
§ 2, Subd. 7)
Assignment of Interest - ANSWERThe transfer of an insurance policy from one
person or entity to another.
Authorized Chiropractor - ANSWERNew York State licensed chiropractor authorized
by the WCB Chair to render chiropractic care under the WC law within the limits
prescribed by the Education Law.
Average Weekly Wage (AWW) - ANSWERA calculation that reflects the employees'
average pay rate used as a basis for determining benefits in workers' compensation
insurance. (WC law § 14)
Binder - ANSWERAn agreement to furnish protection until an insurance policy can
be issued. NYSIF does not use binders for workers' compensation coverage.
, Board Panel Review - ANSWERWhere a WCLJ's decision is disputed, the aggrieved
party may file an application for a review. (WC Law § 23, §224 and Board Rule 13)
C-105 - ANSWERWCB prescribed form "Notice of Compliance, WC Law" informs
employees at their place of employment of their rights under the WC law. Employers
must obtain this form from their insurance carrier or licensed agent.
C-107 - ANSWERWCB prescribed form "Employer's Request for Reimbursement"
C-11 - ANSWERWCB prescribed form "Employer's Report of Injured Employee's
Change in Employment Status resulting From Injury"
C-2 - ANSWERWCB prescribed form "Employers' Report of Work-Related
Injury/Illness" filed by employers within 10 days after an accident occurs, as required
by WC law § 110.
C-240 - ANSWERWCB prescribed form "Employer's Statement of Wage Earnings
(Preceding Date of Accident)" used to determine the claimant's average weekly
wage.
C-250 - ANSWERWCB prescribed form "Notice of Claim for Reimbursement Out of
Special Disability Fund Under WC law §15-8." A carrier cannot file a C-250 on cases
with accident dates after June 30, 2007.
C-27 - ANSWERWCB prescribed form "Medical Proof of Change in Condition in
Support of Application for Reopening," filed in a closed case to show change in
medical condition supporting the reopening of a claim.
C-3 - ANSWERWCB prescribed form "Employee Claim" completed by the injured
worker to apply for workers' compensation benefits because of a work injury or work-
related illness. It must be submitted to the WCB within two years of the accident or
onset date. The C-3 form contains much of the same information as the C-2.
C-3.3 - ANSWERWCB prescribed form "Limited Release of Health Information
(HIPAA)" for the injured worker. This form is completed by claimants who have had a
previous injury to the same body part or a previous similar illness.
C-32 - ANSWERWCB prescribed form "Settlement Agreement for WC law §32"
C-4 - ANSWERWCB prescribed form "Doctor's Initial Report" is to be completed the
first time a provider treats a claimant for a particular workers' compensation claim.
Please note the request for medical authorhttp://dsdomination.com/membersization
is not included in the new C-4 form; instead new Form C-4AUTH should be used to
request authorization.
C-4.2 - ANSWERWCB prescribed form "Doctor's Progress Report" is a new, shorter
version of Form C-4, which is to be used for all subsequent visits to report continuing
services.
