Your injury is the same. You are going to your appointments. Your doctor is still treating you, still telling you that you cannot go back to work. And then the checks stop.
The natural assumption is that the insurance carrier did something — cut you off, decided you were better, found a reason to stop paying. Sometimes that is exactly what happened. But there is a quieter explanation that catches a lot of people in New York, and almost nobody is warned about it: your benefits did not stop because of your condition. They stopped because of what is, and is not, in your file at the Workers’ Compensation Board.
New York does not assume you are still disabled
This is the part that surprises people, and it is the root of everything below.
If you have not been classified as permanently disabled, there is no presumption that your disability continues. Being hurt last month does not carry forward into this month on its own. Every period you are paid for has to be supported by current medical evidence in the record — and the burden of putting it there falls on your treating provider.
The Third Department applied that rule in Matter of Virtuoso v Glen Campbell Chevrolet, Inc., 66 AD3d 1141 (3d Dept 2009), where progress reports were required precisely because the claimant had not been found to be permanently disabled and the presumption of continuing disability did not arise. The Board’s denial of benefits for the periods with nothing in the file — one of several grounds in that case — was upheld.
For this purpose, your disability is not what is happening in your body. It is what is in the file.
The 90-day rule
The reporting obligation is set out in the Board’s regulations at 12 NYCRR 325-1.3. A treating provider must file medical reports with the Chair and with the employer or carrier — an initial report after first treating you, and then, during continuing treatment and without anyone having to ask, a progress report for each follow-up visit. Follow-up visits are to be scheduled when medically necessary, except that the intervals between follow-up visits shall be no more than 90 days.
That 90-day figure is a ceiling, not a target. And when the reports stop arriving, the consequence at a hearing is blunt: there is nothing in the file to support awards for that stretch, and the judge may decline to make any. That is not the regulation punishing you. It is that the burden of proving disability for each period sits with you, and the proof is the reports. No award, not because anyone decided you had recovered — because nobody proved you had not.
You will usually have no idea this is happening. Nothing is mailed to you. You are still being seen, still being treated, still being told to stay out of work. The failure is entirely on the paperwork side of a door you never walk through.
Why a doctor stops filing
It is worth being fair about this, because it is rarely indifference and it is almost never aimed at you.
Treating a workers’ compensation patient in New York carries administrative weight that treating the same patient under private health insurance does not. Since July 2022 medical billing runs on the CMS-1500 form, which replaced twelve Board-specific forms, and since August 2025 every provider in the system must submit it electronically — regardless of practice size — through a Board-approved submission partner. The bill is not a valid submission unless a medical narrative goes with it. Treatment has to track the Medical Treatment Guidelines, and anything that varies from them needs a prior authorization request through the Board’s OnBoard system before it happens, as do non-formulary medications and treatment for which no Guideline exists — in that last category a request is required whether the cost is above or below $1,000. Payment disputes have their own process. And at the end of all of it, the provider may be deposed by the carrier’s attorney.
Set that against a private health plan that pays without any of it. A small practice — a podiatrist, an orthopedist, a pain management office — may look at one comp patient and decide the infrastructure is not worth building. Some stop accepting workers’ compensation entirely. Others do something less visible: they keep treating you, and bill your health insurance instead.
Here is where it can turn from an administrative problem into a legal one. Billing a health plan for treatment of a work injury generally requires the chart to reflect that the work injury is no longer the reason for the care. So a note can appear with a date on it — the work injury has resolved, this is now a separate problem — at a point when your condition has not meaningfully changed. We are not suggesting that is usually what has happened. A provider may reach that conclusion for sound clinical reasons, and often does.
But the note has the same effect on your claim either way. It does not stay in the chart; it goes into the record, where the carrier’s attorney will find it. When your own treating physician has put a date on the end of your work-related disability, that becomes the carrier’s best evidence — better than anything it could have obtained on its own.
This is more likely if you live outside New York
If you were hurt at work in New York but live in New Jersey, Connecticut or Pennsylvania, this risk is materially higher for you, and it has nothing to do with the quality of your care.
An out-of-state provider is not required to be authorized by the New York Board in order to treat you. But two things follow from that, and neither is obvious. The Guidelines and the prior authorization requirements still apply to your treatment even though the provider is not authorized here. And a provider who is not Board-authorized is reimbursed at their own state’s fee schedule rather than New York’s, which changes the arithmetic on their end in ways you never see.
This section is written for workers who live outside New York and commute in. The related but different situation — you were living here when you were hurt and you move away while the claim is still open — has its own set of traps, and those are covered on our page about moving out of state while your claim is open.
Meanwhile, an office in Bergen County or Fairfield County has no existing workflow for any of the New York filing requirements. They may treat one New York comp patient a year. An out-of-state practice can register with the Board’s medical portal to get access to the filing systems, and it is a fair question to ask whether yours has.
Staten Island sits next door to New Jersey, and a very large number of people cross a bridge in one direction or the other to go to work. If that is you, assume this risk is live on your claim and check on it early.
Why they were allowed to stop
Everything above explains how the medical side of a claim goes quiet. There is a second reason benefits stop, and it catches people harder because nothing about it is improper.
If your payments started without a hearing, no one ever ordered the carrier to pay you. It was paying voluntarily, and the law does not require it to keep going.
Workers’ Compensation Law § 25(2)(d) is blunt about what happens next. “Whenever for any reason compensation payments cease,” the carrier has sixteen days afterward to send the Board a notice that payment has been stopped. Afterward. Nothing in the statute requires it to ask permission first, and no judge has to agree beforehand.
The same is true when the carrier does not stop your checks but cuts them, for example from a total to a partial rate after its doctor examines you. See the carrier cut my checks after an IME.
If the carrier misses that sixteen-day deadline, the Board may impose a $300 penalty payable to you. Notice what that penalty is for: failing to tell the Board, not stopping. The heavier twenty percent penalty applies to installments left unpaid twenty-five days after they become due, which is the language of an award. Payments nobody directed in the first place are a different situation.
So a claim can look perfectly healthy for a year, and then the checks stop, and no rule has been broken. That is the part nobody explains at the beginning.
What it takes to start it again
If you already have an attorney on the claim, the work starts the day you call. If you do not, here is the sequence that has to run before any money moves, and it is worth seeing laid out because every step is time you are not being paid.
First you find an attorney, which you are doing while the income is already stopped. Your attorney then files Form OC-400, the Notice of Retainer and Appearance, which the regulations require be filed immediately upon being retained. The Board places that attorney on notice in your claim, which is what unlocks access to your eCase file. Only then can anyone read it — what the carrier actually filed, what your doctors last reported, which body parts are established, what your average weekly wage was set at. And only after reading it can a request for a hearing be filed, which then waits its turn.
Days at each step. Weeks in total, sometimes longer, all of it after the money stopped. An attorney already on notice skips the front half of that entirely and can file the request the week it happens.
None of which means the situation is hopeless if you are starting now — it means the clock is the thing to respect. See how to demand a hearing within 45 days, and, if you are weighing whether this was avoidable, when a claim actually needs a lawyer.
What a gap actually costs you
Three things, in rising order of seriousness.
- Awards stop for the uncovered period. That is money for weeks you were genuinely disabled, and it does not appear later on its own.
- Your file now contains an opinion that your work injury ended. Even if your benefits resume, that opinion sits in the record and will be used — at a permanency hearing, in a settlement negotiation, on an appeal.
- Your medical care ends up billed to the wrong insurer. New York has a process for sorting that out, and it generally runs between the health plan and the compensation carrier rather than through you — a provider treating an established work injury is not permitted to bill you for it. But it is not always that clean. Self-funded employer health plans can have reimbursement terms of their own, and if a claim is ultimately disallowed or withdrawn that protection can fall away.
How to check on your own
You do not need a lawyer to find out whether this is happening to you.
- Register for eCase. eCase is the Board’s electronic case folder, and as a party to your own claim you are entitled to read it. If you have a New York State driver license or non-driver ID, registration is quick. If you do not — which is common for out-of-state claimants — there is a second path: you submit the registration, print the form it generates, sign it in front of a notary, and email or mail it to the Board. That one takes longer, so start it today rather than the week of your hearing. Once you are in, our FAQ page explains what each eCase tab shows, and covers the Board’s phone line and the NYSIF app for claims insured through the State Insurance Fund.
- Find the date of the last medical report filed in your case. Then put it next to the date of your last appointment. If you have been seen since then and nothing was filed, you have a strong indication of the problem and a date you can point to.
- Call the office and ask two direct questions. Are you still billing workers’ compensation for my treatment? Are you still filing reports with the Board? Ask both. The answers are not always the same, and the second one is the one that pays you.
- If the answer is no, do not simply switch doctors and move on. Going forward is only half the problem. The gap that already exists has to be dealt with separately, and it will not fix itself.
A gap is not always permanent
This is the part worth knowing before you give up on the missing weeks.
A different problem, with different remedies: if the gap is not about your medical proof but about a carrier that simply is not paying, see whether the insurance company is ever penalized for delay.
When a judge declines to make awards for a period, that is a decision about the record as it stood on the day of the hearing. It is not a ruling that you were healthy. If evidence for that window exists and can be put in front of the Board, the period can sometimes be revisited.
And evidence sometimes does exist. If another authorized provider was treating you during the gap — a hospital, a wound care center, a specialist you were referred to — those are treating provider reports, and they can speak to the period.
What will not fill the hole is an examination the carrier arranged. Proving continuing disability is your burden, and it runs through your own treating providers. An independent medical examination speaks only as of the day the examiner saw you, and you cannot build your case on evidence the other side controls and may never have produced at all.
None of this is automatic. If a decision has already been filed, there is a thirty-day window to appeal it. After that you are asking the Board to exercise its continuing jurisdiction, which is discretionary and carries outer time limits of its own. A provider filing a report late has to explain in writing why it is late. That does not make a gap unfixable. It does mean the odds are better the sooner somebody looks.
What to do about it
If your payments have stopped and nobody has explained why, do not assume the explanation is medical. Read your own case folder first. A stretch of silence where reports should be is a common reason benefits end in New York, and in our experience one of the more fixable ones — but only while the records still exist and while there is still time to act on the decision that follows.
Those deadlines are short. Thirty days, and they run from the date the decision was filed, not from the day it reached you or the day you understood it. Our page on denied claims and appeals walks through that timetable. For how long benefits are meant to run in the first place, see how long workers’ compensation lasts, and our workers’ compensation FAQs cover the rest of the claim process.
If you are not sure what your file says, we will look at it with you. Consultations are free. If we don’t recover money for you, we don’t get paid.
