2. Agenda Introductions/ Welcome Background
Key Performance Indicator (KPI): How We Are Measuring
Timeliness of First Report of Injury (FROI)
Review of First Report of Injury Report
Monitoring Compliance
Registration Process
Questions from Previous Webinar
Timetable
Wrap-Up/ Questions

3. Background eClaims Project –
Started in 5/13 with full participation by 4/14, provides the Board with the data needed to monitor system participant performance within several Workers’ Compensation system key performance measures/indicators.
Mission of the Board’s newly created Monitoring Unit
To promote excellence in claims handling practices and provide system participants and the general public with information as to claims handling performance.
Role of the Boards newly created Monitoring Unit
Educate system participants on performance standard metrics
Monitor the quality and quantity of system participants data submissions.
Monitor and audit filings and payment performance.
Identify system participants who are not complying with performance standards and issue penalties, if appropriate.
Using information captured to educate and train system participants to improve overall performance within the Workers’ Compensation system.

4. How we are Measuring: Timeliness of the First Report of Injury (FROI)

5. KPIs: How We Are Measuring Timeliness of the First Report of Injury Filing
Education on the 18/10 Day Rule defined in NYCRR Section : “On or before the 18th day after the disability event OR within 10 days after the employer has knowledge of the disability event, whichever period is greater, the carrier, Special Fund, self-insured employer or TPA shall file electronically a First Report of Injury (FROI) with the Board.”
"Disability event" means any accident, including death resulting therefrom, occurring in the course of employment or any alleged accident, including death resulting therefrom, that results in personal injury which has caused or will cause a loss of time from regular duties of one day beyond the working day or shift on which the accident or alleged accident occurred, or which has required or will require medical treatment beyond ordinary first aid or more than two treatments by a person rendering first aid; or any disease or alleged disease, including death resulting therefrom, claimed to have been caused by the nature of the employment and contracted therein.
Note: A C-2F Form filed by an employer with the Board does not satisfy the carrier’s requirement to file a FROI.

6. KPIs: How We Are Measuring Timeliness of the First Report of Injury Filing
The Board will begin to measure First Report of Injuries on only lost time claims. Due to this the timeline will be 18 days from Date of Accident, 10 days from Date Employer had Knowledge of Injury, 10 days from Initial Date of Disability, whichever period is greater.
To determine Employer Knowledge Date the Board will use the earliest date of DN0040 Date Employer Had Knowledge of the Injury, DN0281 Date Employer Had Knowledge of Disability, Assembly Notice Date, Indexing Notice Date.
Late Filing of FROI Report Criteria:
Total number of FROI’s with lost time filed by carrier per quarter
Received date of Initial FROI
Date of Accident (18 days)
DN0040 – Date Employer Had Knowledge of the Injury ( 10 days)
DN0281 – Date Employer Had Knowledge of Disability (10 days)
Assembly Notice Date (10 Days)
Indexing Notice Date (10 days)
DN0056 – Initial Date Disability Began (10 days)
(Definition -The first day qualifying as a day of disability in the first period of disability. This will be the first day of the waiting period).

7. First Report of Injury (FROI) Report: Summary and Detail

8. First Report of Injury Summary Report
New York State Workers’ Compensation Board
Monitoring Unit
First Report of Injury Detail Report
First Report of Injury (FROI) Received or Due 01/01/2015 thru 03/31/2015
Run Date: 04/03/2015
Carrier Code: WXXXXXX Carrier Name: XYZ Insurance Co
Carrier Code
Carrier Name
Total during reporting period
Timely
Untimely
Percent Timely
FROI Filing
Average Days Late
WXXXXXX
XYZ Insurance Co 13 8 5
61.5% 25

9. First Report of Injury Reports
New York State Workers’ Compensation Board
Monitoring Unit
First Report of Injury Detail Report
First Report of Injury (FROI) Received or Due 01/01/2015 thru 03/31/2015
Run Date: 04/03/2015
Carrier Code: WXXXXXX Carrier Name: XYZ Insurance Co.
Case Id
Claim Administrator
Sender
FEIN #
FROI#
Carrier Case Id
Injury Date
Date Employer had Knowledge of the Injury
Date Employer had Knowledge of Date of Disability
Assembly or Indexed Notice Date
Initial Date of Disability
Due Date of FROI
Received Date of Froi
Number of Days Late G
XYZ Insurance Co
666666
WC000000
12/14/2014
02/09/2015
12/15/2014
01/02/2015
02/04/2015 33 G
777777
WCS111111
01/09/2015
01/10/2015
02/13/2015
01/27/2015
02/20/2015 24 G
888888 WC
01/17/2015
02/11/2015
01/19/2015
02/06/2015 2 G
999999 WC
01/18/2015
03/30/2015
02/05/2015
03/25/2015 48 G
555555 WC
01/21/2015
03/16/2015
02/08/2015
02/18/2015
03/11/2015 21

10. Monitoring Compliance

11. Monitoring Compliance
The Board expects to use penalties as the last step of the process. Payors will have sufficient time to work with the Board to understand where they are out of compliance and the steps that can be taken to avoid penalties.
Penalty for Late FROI Filings
WCL §25 (3)(e) If the carrier or employer fails to file a notice or report requested or required by the Board or otherwise required within the specified time period or within 10 days if no time period is specified, the Board may impose a $50 penalty.

12. Monitoring Compliance
Performance Standards:
WCL §25 (3)(e) If the carrier or employer fails to file a notice or report requested or required by the Board or otherwise required within the specified time period or within 10 days if no time period is specified, the Board may impose a $50 penalty.
The Board is planning to implement performance standards:
The penalty under §25(3)(e) will not be imposed as long as a carrier meets the below performance standards per category. Your filings will be measured for each category, per quarter, against the performance standard. If the performance standard is met in that category your §25(3)(e) penalty will be waived.
Timely First Report of Injury at TBD
Timely First Payment at TBD
Timely Filing of Notice of Controversy at TBD 8

13. Registration Process

14. Registration Process
All Carriers, Self-Insureds and Municipalities would need E-claims Inquiry access.
In order to get E-claims Inquiry access please register on line at
Payor Compliance Agreement will need to be signed in order to review Payor Compliance Reports.
Payor Compliance Agreement will be an electronic document
A Payor Compliance Agreement will be signed for access per W-code (may list multiple W-Codes on one agreement)
Please send name and address of executive officer for each W-code to in order to receive Payor Compliance Agreement for signature
Once the Payor Compliance agreement is signed and approved by the Board, anyone with e-claims Inquiry Access for that W-code (carrier or TPA) would then be able to see the Payor Compliance Reports. 10

15. Up Coming Measurements
Timeliness of Initial SROI showing Initial Payment
Timeliness of Initial Payment of Compensation
Timeliness of Controversy
Percentage of Claims Controverted

16. Questions Received From Focus Group: In Regards to FROI

17. Questions:
QUESTION:
Why can’t the First Report of Injury penalty be applied against the employer and not the carrier?
ANSWER:
The Board is tracking both the employer knowledge date along with the claims administrator knowledge date. Initially no penalties will be imposed against the employer. After an initial time period, all penalties available under the law will be considered including when appropriate, WCL 110 (4) against the employer.
If the date the form is due falls on a Saturday, Sunday or Holiday will the Board consider it timely on the next business day?
Yes

18. Timetable
Sept Measurement criteria defined/sample reports drafted November 2014 – March, Begin outreach to system participants and dashboard programming January 1, Monitoring Unit develops an Enforcement Plan for Timely First Report of Injury, Timely First Payment and Timely Controversy.
April 2015 – Advise all system participants of new process April September TRIAL PERIOD (6 months)- Reports generated and distributed to all system participants Oct 1, System goes live
January 2016 – th quarter reports and penalties generated and distributed to all system participants.

19. Denise Hughes, Monitoring Program Manager
Wrap-Up/Questions
Share your thoughts, questions and feedback with:
Denise Hughes, Monitoring Program Manager