WHAT PAYERS NEED TO KNOW - ARCHIVED UPDATES
June 5, 2025
Additional form eligible for eCase document upload
The eCase document upload feature allows injured workers, payers, and attorneys to upload documents directly to the case folder to use as evidence at scheduled hearings.
The Employee Claim (Form C-3) is now eligible for eCase document upload for claimants and claimant attorneys. In cases with a notice of controversy, the claimant should file Form C-3 either before or at the Pre-Hearing Conference.
Read more in a notification dated June 3, 2025.
Residents and fellows permitted to treat workers' compensation patients.
As part of Governor Kathy Hochul's Fiscal Year 2026 Budget signed into law on May 9, 2025, effective immediately, physicians who are training in residency and fellowship programs accredited by the Accreditation Council on Graduate Medical Education (ACGME) are permitted to treat injured workers in New York State under the appropriate supervision of faculty physicians (see Workers' Compensation Law Section 13-b[2][b-2]).
Read more in Subject Number 046-1756R.
Important updates to C-300.5 and C-312.5 forms
Effective immediately, the Board has updated Stipulation (Form C-300.5) and Agreed Upon Findings and Awards for Proposed Conciliation Decision (Form C-312.5) .
Both updated forms now include fields to:
- Provide information on claimant representatives, substitutions, and related fee requests/agreements.
- Denote whether the case has a pending appeal.
Read more in a notification dated May 20, 2025.
New maximum weekly benefit rate effective July 1, 2025.
The maximum weekly benefit rate for workers' compensation claimants is two-thirds of the New York State Average Weekly Wage for the previous calendar year, as determined by the New York State Department of Labor (Workers' Compensation Law §§ 2[16] and 15[6]).
Read more in Subject Number 046-1754.
CMS-1500 electronic mandate approaching! Cost offset available to providers now.
The Board encourages health care providers who are still submitting paper CMS-1500 medical bills to move to electronic submission as soon as possible to take advantage of increased accuracy and more timely payment, among other key benefits.
Impt: Providers can offset the cost of electronic transmission using a designated CPT code. Payers who do not properly reimburse for this code may be subject to penalties from the Board.
Read more in a notification dated April 10, 2025.
Reminders
Telehealth is now a permanent option in the workers' compensation system. Read more in Subject Number 046-1613.
The What Payers Need to Know section of the Board's website walks payers through getting started in the workers' compensation system, becoming a trading partner, administering claims, and more.
Use of the CMS-1500 form is mandatory. Visit CMS-1500 initiative for more details and send your questions to CMS1500@wcb.ny.gov.
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The latest versions of several Paid Family Leave presentations are available, including family care, foster care/adoption, military leave, and bonding. Visit the Paid Family Leave website for more information.
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