Two questions come up more than almost any others, usually in the same breath: why does this take so long, and does the insurance company ever pay a price for dragging it out?
The answer to the second is yes. There are real deadlines and real penalties, several of them payable directly to you. The answer is also more complicated than that, because the penalties are mostly small and the things that actually speed a case up are not penalties at all.
The deadlines the carrier is working against
The first one comes early. The employer or carrier must begin paying compensation on or before the eighteenth day after your disability, or within ten days after the employer first has knowledge of the accident, whichever period is greater. If it is not going to pay, it has to say so in that same window by filing a notice that compensation is not being paid.
Doing neither — not paying, not objecting — is the situation this post is really about. A claim can sit in that condition for months while nobody explains why.
The penalty that actually has teeth: 20%
Once compensation is due, if the carrier fails to pay an installment within twenty-five days after it becomes due, the statute adds twenty percent of the compensation then due. That money does not go to the state. It “shall accrue for the benefit of the injured worker” and is paid to you along with the compensation.
On a meaningful stretch of unpaid benefits, that is the one penalty large enough to change behavior. It is not automatic in every case — the Board can excuse a delay caused by conditions outside the carrier’s control — but it is the provision worth knowing by name.
The $300 penalties
Several smaller penalties are written to be paid to the claimant rather than the state. Each is $300, and they stack with everything else:
- Failing to file a notice of controversy or begin paying within the required period. The statute says this penalty is “in addition to all other penalties.”
- Failing to notify the Board that payments have stopped within sixteen days of the last payment. If your checks simply ended, this is worth asking about — see why workers’ comp payments stop.
- Objecting to an award without just cause, where the Board holds a hearing and makes that finding.
There is also a $500 fine when a carrier fails to pay under a conciliation decision within ten days of it becoming final. That one splits: $300 to you, $200 to the Board. Our post on the proposed conciliation decision explains where that fits.
The penalty you do not collect
Where the Board or a court finds that proceedings were instituted or continued without reasonable ground, it can assess the cost of those proceedings against the offending party, and attorneys’ fees against a representative who did it.
This provision gets cited often, and it does bite — in one recent case a carrier that ignored several hearings was assessed $10,000 under it. But read the statute carefully and you find those assessments are payable to the Board for administrative expenses, not to the injured worker. It is a sanction on conduct, not compensation to you.
Worth knowing, so that nobody promises you a windfall that the statute does not provide.
What actually moves a stalled case
Here is the part that matters more than the penalty schedule.
You can force a hearing. Where the employer has notice of the injury, you are disabled and not working, you are otherwise entitled to compensation, the employer is not paying, has not controverted the claim, and efforts to resolve it with the carrier have failed — you may request a hearing, and the statute directs that it be held within forty-five days of the Board’s receipt of the request. That is the single most useful tool against a silent carrier.
Carriers arguing with each other is not your problem. Where compensation is being withheld solely because there is a dispute over which carrier, fund or employer is responsible, the Board may direct that one of them pay compensation and medical bills immediately, pending resolution of the fight. You should not be financing an insurance coverage dispute.
Not showing up has consequences beyond money. A carrier that fails to appear at hearings can be precluded from producing witnesses and from obtaining an independent medical examination. Losing the right to its own IME is a far heavier blow to a carrier than a penalty, because it takes away the evidence it planned to defend with.
Controverted cases have their own clock. When a claim is controverted, the Board is directed to schedule a pre-hearing conference as soon as practicable and not more than forty-five days after it receives the notice of controversy and a medical report. That last part matters: no medical report in the file, no clock. See what happens at your hearing.
Why cases take long even when nobody is stalling
It would be misleading to blame every delay on the carrier.
Much of the time in a comp case is medical development that cannot be rushed: waiting for a condition to stabilize, scheduling an independent medical examination, exchanging reports, deposing doctors whose opinions conflict. Some is structural — hearing calendars, adjournments, appeals. A case that takes a year is not necessarily a case anyone mishandled.
The distinction worth drawing is between a case that is moving slowly and a case that is not moving. The second one has remedies. The first mostly needs the next medical report.
If nothing is happening on your claim
- Find out whether the claim was controverted. Not paying and formally objecting are different postures with different remedies. If it was denied, see denied claims and appeals.
- Check that a medical report is actually in the file. Cases stall on a missing report more often than on bad faith.
- Write down the dates. When you stopped working, when the employer learned of the injury, when each payment arrived and stopped. Penalties are computed from dates.
- Ask for the hearing rather than waiting for one to be scheduled.
- Raise penalties at the hearing. They are generally not applied on their own; someone has to ask.
Talk to a Staten Island workers’ comp attorney
Most people wait far too long before asking whether the silence on their claim is normal. It often is. When it is not, the remedies exist and they are time-sensitive.
Call (718) 701-2776. The consultation costs nothing, and you will speak with me.
Workers’ Compensation Law §§ 25(2), 25(2-a), 25(3), 114-a(3).
Nothing on this page is legal advice about your own claim. Whether a penalty applies depends on the dates and the findings in the individual case.
