Purpose

The objective of our examination was to determine whether claims were appropriate and complied with the New York State Workers’ Compensation Law and mandated fee schedules.

Background

The Board processed claims totaling nearly $720 million for four sole custody funds in 2017 – the Uninsured Employers Fund, the Special Fund for Disability Benefits, the Second Injury Fund and the Fund for Reopened Cases. Board staff enter claims data for all special funds claims into the Board’s automated payment system, where the claims are subjected to various system edits and validation checks, approved by the Board and submitted to our Office for approval prior to payment.

Key Findings

We halted inappropriate claims totaling nearly $520,000 that the Board approved and submitted to our Office.