Workers' Compensation & Disability Solutions
   

Claims Corner

Criteria for Employer Self Payment Of Minor-Injury Claims

We encourage all members of our Trust Funds to pay for their Minor Injury Claims In-House. This is beneficial to the Members because it helps to keep down their individual Experience Modification Factor and keeps claims off their permanent record.

Section 110 of the NYS Workers’ Compensation Law requires an employer to file a claim on Form C-2 when there has been more than one day of lost time and/or more than two medical treatments. This requirement does not prohibit an employer from paying for their minor injuries in-house. The C-2 form should be mailed to FCS Administrators within ten days of the occurrence clearly marked Self-Pay or First Aid Claim. FCS will send the C-2 to the Workers’ Compensation Board but will not input the claim into the computer. These claims will not be charged against the member.

 

Members need to determine how much liability they want to incur, we do not set a limit. If the claim does not meet the above reporting criteria, you do not need to send a C-2 to FCS for submission to the Workers’ Compensation Board. If it does meet the reporting criteria, mark the C-2 clearly that you intend to pay it in-house. We will mail the C-2 to the Workers’ Compensation Board and put in your general file. It will not be made part of your permanent record.

There are claims that you cannot pay in-house. Below is a list of claims that must be submitted to FCS for payment and claim management:

  When there is lost time or light duty beyond seven days.
  When there is an authorization request pending from a medical provider, i.e. physical therapy, MRI, CT Scan, etc.
  When the employee has treated for more than one month.
  When the Workers’ Compensation Board has indexed the claim.

When we receive medical bills for injuries that appear minor in nature we will mail them to the Members for possible self-payment with a form letter. If any Member does not wish to pay for the bills in-house, they must return the bills to us marking the form letter clearly that they want FCS to pay the bills.

If a claim has been indexed by the Workers’ Compensation Board after a Member has paid for medical bills in-house and must be made a part of their permanent record, the Trust Fund will reimburse that member.