Controverting A Claim

The C-7, "Notice That the Right to Compensation is Controverted", is the form that notifies all parties of NYSIF’s specific reasons for controverting a claim. This action will result in a hearing. If a claim is questionable, NYSIF must file Form C-7 on or before the 18th day of disability, within 10 days after the employer learns of the alleged accident, or within 25 days after notice of indexing by the WCB. While a claim is contested, a claimant may be eligible for benefits.

What are the reasons a claim may be controverted?

How is the controversy resolved?

What benefits does the claimant receive during the time a claim is contested?

 

Reasons a Claim May be Controverted

• Accident or occupational disease did not arise out of and in the course of employment;
• Notice - Claimant did not report the accident to the employer within 30 days;
• Causal relationship - 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 - Claimant is not an employee of the employer, is an independent contractor, or never worked for the employer;
• Timely filing - Claimant did not file a report of injury or illness within two years of the accident;
• Jurisdiction - Claimant did not have the accident under the jurisdiction of New York State WCL;
• Prima facie evidence - Claimant has not provided medical evidence that establishes causal relationship.

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 How is the Controversy Resolved?

Contested claims are resolved at a WCB hearing.

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 What Benefits Does the Claimant Receive During the Time a Claim Is Contested?

During the time a claim is contested, claimants may be eligible for New York State disability benefits.

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