The safety and well-being of your employees is always your number one priority. But even with all the safety measures you have in place, an accident could still occur. The following can help make sure you stay on track when reporting any injury that might have been sustained as a result of an accident, as well as filing your Workers Compensation Claim. Please keep in mind: the information below applies to New York and New Jersey specifically.
New York Timeline
If an injury that occurs on the job results in more than 1 day of lost time, or 2 first aid treatments, it must be reported to the Board by an Employer within 10 days. After more than 10 days from notice, or 18 days from the accident, the initial First Report of Injury (FROI) is due. Under the Statute of Limitations, the worker is given 2 years from the date of injury to file a Workers Compensation claim. Oral notice of a claim by the employee, is recognized as being sufficient if the facts of the injury are stated within a reasonable certainty and it can be reasonably inferred that a claim for compensation is being made.
In New York, a doctor is able to perform treatment without receiving authorization from the Carrier or Employer, as long as they follow proper protocol. If treatment is completed, it’s billed and covered by the Carrier. It’s also important to mention that, in this state, the Board measures timely filing or denial of a claim from the date the Employer receives knowledge, rather than the Insurance Carrier (which most other states abide by). If claims are reported late, your insurance company may lose valuable rights to investigate/dispute an injury. Ultimately, if a worker doesn’t notify their Employer of an injury within 30 days of the accident, the claim may be barred under WCL Section 18. This defense may be overcome when there is no prejudice to the employer, such as in cases where the employer had actual knowledge that the accident happened.
New Jersey Timeline
First, it’s important to mention that the Court calculates permanency (the degree of disability) based upon medical evaluations throughout the life of the claim, and that the calculation of award percentage comes from charts based on different body parts. When it comes to reporting, the FROI should be filed by the Insurance Carrier or Third Party Administrator (TPA) immediately. If the claim is reported later than 21 days, penalties for late reporting will be incurred, increasing the cost of the claim. Following 26 weeks after the worker reaches Maximum Medical Improvement or returns to work, the Subsequent Report of Injury (SROI) is due. This is the responsibility of the Insurance Carrier or TPA as they are to file the SROI in NJ (copied to worker) which offers explanation of the benefits paid.
Unlike New York where the Claimant chooses their own form of medical assistance after an accident, injured workers MUST treat with the physician chosen by the employer or insurance company. Failure to do so will result in unauthorized treatment and may result in termination of the employee’s benefits. This emphasizes the benefit of Employers notifying their Carriers right away if an accident occurs. Because even if it’s minor, your Carrier could set your Employee up with a doctor of their choosing and ensure the power remains in their (and your) hands.