Compensation Benefits - NYSIF

There is a statutory waiting period of seven calendar days for workers' compensation benefits. NYSIF must begin payments within 18 days after the onset of disability. Subsequent benefits are paid bi-weekly.

Compensation is not payable if an injured worker's lost time is equal to or less than one week. Benefits are payable from the date of disability if an injured worker’s lost time exceeds two weeks.

Compensation Rates

Compensation is based on earnings determined by payroll records for the 52 weeks prior to the date of accident. The case manager may establish a temporary rate until the employer completes and submits Form C-240, "Employer's Statement of Wage Earnings Preceding Date of Accident" to the case manager. The temporary rate is then adjusted retroactively.

An injured employee is entitled to a compensation rate equal to two-thirds of the average weekly wage (AWW) in New York State for the 52-week period immediately prior to the date of accident. The rate is subject to prescribed maximums and degree of disability.

Why Benefits May Not Be Paid

If lost time does not exceed 14 days, the first week is not payable. Compensation may be withheld when lost time exceeds seven days, if:

• NYSIF received no medical evidence of a causally-related disability beyond seven days
• The employer is paying full wages
• In death cases, NYSIF is waiting for evidence of dependents who are entitled to benefits
• NYSIF is disputing the claim on behalf of the policyholder

Forward all medical information from claimants to the case manager for consideration of benefits. Contact the case manager with questions regarding compensation payments.

Hearings and Contested Claims

If you believe a claim is questionable, notify NYSIF immediately. If NYSIF contests the claim, it must controvert the claim as follows:

• On or before the 18th day of disability event, or
• Within 10 days after the employer learns of the alleged accident, or
• Within 10 days after the carrier receives notice, whichever period is greater.

Filing of the notice of controversy within 25 days of the notice of indexing will only preserve our right to raise issues of accident, accident arising out of and in the course of employment and employer-employee relationship.

While a claim is controverted, a claimant may be eligible for benefits.

Appearances at Hearings

It is critical for the employer to appear at a hearing if requested by NYSIF. The employer must appear at a hearing if directed to testify by a judge.

Why a Claim May Be Controverted

Course of Employment - Accident or occupational disease did not arise out of and in the course of employment Notice - The claimant did not report the accident to the employer within 30 days Causal Relationship - The injury sustained was not caused by the accident Coverage - NYSIF did not provide coverage to employer at the time of the accident Employer - Employee relationship: The claimant is not an employee of the employer, is an independent contractor, or never worked for the employer Timely Filing - The claimant did not file a report of injury or illness within two years of the accident Jurisdiction - The injury or illness did not come under the jurisdiction of New York State Prima facie Evidence - The claimant has not provided medical evidence that establishes causal relationship.

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