Injured workers call us with a version of the same sentence: nothing is happening on my case. No hearing, no decision, no money, no answer. They assume the insurance company is behind it, and sometimes it is.
Often it is not. Often the claim is stalled because a piece of paper that should be in the file is not in the file, and until it is, nobody — not the judge, not the Board, not your own attorney — can move the case forward.
In a New York comp claim, the file is the case
Every claim has an electronic case folder, eCase. It holds the forms, the decisions, the carrier’s filings and, critically, the medical reports. If something is not in eCase, then as far as the system is concerned it does not exist. Your doctor knowing you cannot lift your arm is not evidence. Your doctor’s report, filed with the Board and served on the carrier, is evidence.
Your treating provider is required to file reports with the Board and with the insurer when you are out of work, and to keep filing — at least every 90 days — for you to stay eligible for lost-wage benefits. Where a claim is disputed, the Board needs a medical report before it can begin resolving anything at all.
The wall nobody warns you about
Here is the part that costs people months, and it is the reason we wrote this page.
When treatment is denied, or benefits stop, or the claim needs to get in front of a judge, your attorney files a Request for Further Action — the RFA-1LC. It is submitted electronically through eCase. The form is not a blank letter; it is a guided form that opens required sections depending on what you are asking for, and it will not submit until those sections are complete.
In practice, that means the request has to point at something already in the file. If the medical report that supports what you are asking for was never filed into eCase, the form cannot be completed. And a form that cannot be completed is a hearing that never gets scheduled.
Think about what that means from where you are sitting. Your surgeon has told you the surgery is necessary. The carrier has said no. You have a lawyer. And the reason your case is not on a calendar is not that anyone disagrees with you — it is that the report proving the point is sitting in a folder at the doctor’s office instead of in your Board file. The carrier does not have to do a thing. Silence works in its favor.
The reports that carry weight
- The initial report. Establishes the injury, the body parts and the causal connection to work. A body part your doctor does not write down is a body part that is not in your claim, and later treatment for it will not be covered.
- Progress reports. These carry your degree of disability — the percentage that drives what you are paid — and they are what keep lost-wage benefits flowing. Let them lapse and the checks can stop for that reason alone.
- The permanency report, Form C-4.3. Nothing about permanency happens until a provider files one finding you at maximum medical improvement with a percentage. No C-4.3, no schedule loss of use award, no classification. This is the single most common way a permanent award is never made at all — not denied, never reached.
- Prior authorization requests. Treatment that needs approval is requested by the provider through OnBoard, the Board’s medical portal. Attorneys are not users of it, which is why only the provider can escalate a denial.
What this looks like in a real file
What follows is a composite, drawn from the kind of record we read every week. Nothing in it identifies anyone. It is here because the pattern is so ordinary that it is worth seeing laid out end to end.
An injured worker has a shoulder and a wrist established in his claim. A lower back problem is disputed and has never been added to it. He is not being paid, and he cannot understand why no judge will start his benefits. Over four months his file collects seven medical reports:
- Treating orthopedist — “currently working.”
- Second physician — “20 percent disability,” for the lower back.
- Third physician — “not recommended to return to work.” No percentage.
- Fourth physician — examined him, gave no percentage at all.
- Treating orthopedist — “currently working.”
- Treating orthopedist — “out of work.”
- Third physician — form submitted blank but for the demographics.
Seven reports. Now count the disability ratings for the body parts that are actually in his claim. There are none.
Three of those entries are employment status, not medical opinion. “Currently working” and “out of work” describe whether he had a job that week. The last one is the one that should worry you. He is a groundskeeper and his hours stop in winter. “Out of work” on that form meant the season ended. It says nothing whatever about his shoulder — but sitting in a compensation file it reads like lost time, and a carrier will happily argue that the lost time has nothing to do with the injury. On that report, it would be right.
One report gives a real number, and it is for the body part that is not in the claim. Until the back is established, nothing can be paid on that 20 percent. Two more say he should not return to work without saying how disabled he is, which is an opinion no judge can convert into a weekly rate. And one is blank.
So no benefits are directed. Not because anybody disbelieved this man, and not because the carrier outfought him. Because across seven encounters with four doctors, not one report stated a degree of disability attributable to an established body part over a defined period. That single omission is the entire reason he is not being paid.
The fix is unglamorous. One treating provider, naming the established body parts, giving the degree of disability, covering the specific periods, filed with the Board. That is all anyone was ever waiting for — and it is why the difference between a work-status box and a disability rating is worth understanding before you are four months into a file like this one.
How a report goes missing
Rarely through anything dramatic. A busy practice, a form that earns the office nothing, a staff member who left, a report written but never transmitted, a report sent to the carrier but not to the Board, a body part discussed in the room but not typed into the narrative. Sometimes the doctor is not Board-authorized and so cannot file at all — which is worth checking before the first visit, not after the tenth.
None of it is malicious. All of it lands on you.
This is about to get easier — in 2028
New York is one of only a handful of states that makes a doctor obtain special authorization before treating an injured worker, and the effect is exactly what you would expect. Roughly 24,500 providers are Board-authorized and about 18,000 actively treat comp patients — around 10 percent of those eligible. Injured workers outside the city commonly travel 35 miles to be seen, and up to 40 percent go to another county.
That requirement is being removed. Legislation known as Universal Authorization, enacted in the FY26-27 State Budget, lets any eligible licensed provider in good standing treat workers’ compensation patients, with authorization becoming automatic through their New York State Education Department licensing. It means being able to use your own family doctor and your own specialists. What changes on that date, and what stays exactly as it is, is set out here: can I use my own doctor for workers’ comp in New York.
It takes effect January 1, 2028. Until then the current rule stands, and a provider who is not Board-authorized still cannot file into your claim. Treating with the wrong doctor in 2026 is still a problem in 2026. Participation will also remain optional for providers even after the change, and the Board keeps its oversight and its exclusion list.
What you can actually do
- At every visit, say out loud every body part that hurts, and check the report reflects all of them.
- Ask the office one specific question rather than a general one: has the report been filed with the Workers’ Compensation Board, and on what date? “It’s been sent” can mean sent to the carrier only.
- Ask for a copy for yourself. You are entitled to your own records, and a copy in your hand is the fastest way to prove what was written.
- If you are approaching permanency, ask directly whether a C-4.3 is going in and when.
- Tell your attorney what your doctor said, and when. If it is not in the file, that is a problem your lawyer can chase — but only if they know it exists.
If you treat injured workers in New York
This section is for providers and their office staff, and it is meant plainly rather than as a complaint.
Filing is not administrative overhead on a comp case. It is the mechanism. A report that stays in your system does three things: it leaves your patient without the benefits the report would have supported, it prevents their attorney from filing a request that could resolve the dispute, and it delays your own payment, because the bill follows the established claim.
It is also worth saying that the objections providers have raised about this system for years are being answered. Prior authorization has moved entirely online through OnBoard, which has materially sped requests up. The Board replaced twelve custom billing forms with a single universal one, the CMS-1500. The medical billing dispute backlog has been cleared — disputes are now handled administratively in two to three months and arbitration in three to four. Provider depositions are now taken by phone, with steps taken to increase and speed up payment for testimony. New fee schedule regulations have been proposed to lift Evaluation and Management fees to something competitive with private insurance. And from January 1, 2028, Board authorization disappears altogether.
The points where it matters most:
- Name every affected body part in the narrative, at the first visit. Adding a site later is a fight; including it at the outset is a sentence.
- State causal relationship explicitly. “Consistent with the described injury” does work that “patient reports pain” does not.
- Keep reports inside the 90-day rhythm when the patient is out of work.
- File to the Board, not only to the carrier. They are different destinations and only one of them is the record.
- When a prior authorization request is denied, escalate it. You are the only one who can — the patient’s attorney cannot do it for you.
- When permanency is reached, file the C-4.3 rather than waiting to be asked. Everything downstream is waiting on it.
Frequently asked questions
My doctor says he sent the report. Why is it not in my file?
Usually because it went to the insurance carrier and not to the Board, or because it was prepared but never transmitted. Ask for the filing date specifically. A report the Board does not have cannot be relied on by a judge.
Can my lawyer file the missing report for me?
No. Medical reports are filed by the provider. Your attorney can chase the office, tell them exactly what is needed and why, and use the reports that are in the file — but the filing itself belongs to the doctor.
Why can’t my attorney just request a hearing anyway?
Because the request form has to be completed, and completing it means pointing at what is in the file. If the supporting document is not there, the request cannot be made in the form the Board requires. This is why a missing report does not just weaken a case — it can stop it from being heard.
What if my doctor is not authorized by the Board?
Except in an emergency, treatment for a work injury has to come from a Board-authorized provider, and an unauthorized doctor cannot file into your claim. Ask the office directly whether they are authorized to treat workers’ compensation patients before you build your case on their reports. This requirement goes away on January 1, 2028 under Universal Authorization — but it applies to every claim before then.
I heard the law changed so I can use my own doctor. Can I?
Not yet. Universal Authorization was enacted in the FY26-27 State Budget and it does exactly that — any eligible licensed provider in good standing will be able to treat comp patients, with authorization automatic through their state licensing. But it takes effect January 1, 2028. Until that date the existing authorization rule governs your claim.
I went back to work. Do the reports still matter?
Yes, and this is where people stop paying attention at exactly the wrong moment. Permanency is assessed after you reach maximum medical improvement, whether or not you are working. If no report is filed finding you permanent, no permanent award is made.
Can I get a copy of what my doctor filed?
Yes. Ask the office for copies of everything submitted on your claim. Keeping your own set is the simplest protection there is, and it is free.
If your case has gone quiet
Before assuming the carrier is stonewalling, it is worth finding out what is actually in your file. That is a question with an answer, and it usually takes one look. Call 718.701.2776 or 800.310.5520.
This page describes New York workers’ compensation practice in general terms, including the Board’s medical reporting requirements. It is not legal advice about your claim, and reading it does not make us your attorneys.
