Controverted Claims

Form C-7, "Notice That the Right to Compensation is Controverted," notifies all parties of NYSIF's specific reasons for controverting a claim. This action will result in a hearing.

If you have reason to believe a claim is questionable, notify NYSIF immediately. 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 controverted, a claimant may be eligible for benefits.

Why 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 claim 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.

Appearances at Hearings for Controverted Cases

If NYSIF requests the employer to appear at a hearing to testify, it is critical for the employer to appear. In controverted cases, or claims with disputed issues, the employer's role is also important in the production of testimony from witnesses and documentary evidence. If the claimant contradicts information provided by the employer, and the judge directs the employer to testify, the employer must appear to testify at the hearing.