New York injured worker

NY direct deposit regulation

We are pleased to announce that direct deposit is an available option for the payment of your workers’ compensation indemnity benefit or death benefit.

Per New York regulation, you have the right to have such payments deposited into at least two bank accounts at your request, either as a percentage of the total benefit or a fixed dollar amount for each deposit. If you need a paper copy of the Direct Deposit Authorization form, please contact your Claims Professional. Do not send the form to the Workers’ Compensation Board. There is no minimum deposit amount.

You also have the right to cancel the direct deposit at any time on this website, or by checking the appropriate box on the Direct Deposit Authorization form and forwarding the completed form to the claim administrator responsible for the workers' compensation claim. All requests to cancel the direct deposit will be implemented within 45 days of receipt of notice, and thereafter payment of benefits will be sent by paper check. Direct deposit is only available if your financial institution is part of the New York State Automated Clearinghouse. In addition, the depositor's name MUST appear on the account.

AUTHORIZATIONS & UNDERSTANDINGS:

• I authorize the claim administrator to directly deposit my workers' compensation indemnity benefits or death benefits into the specified bank account(s).
• I authorize the claim administrator to debit the account in order to recover any credits deposited in error. The claim administrator may recover credits deposited in error by any lawful means. IMPORTANT: This consent does not authorize the claim administrator to recover alleged over payments of established and awarded benefits.
• I understand that any change in my employment status may affect my right to receive benefits.
• I understand that any false statement or failure to disclose a material fact in order to obtain or increase my benefits may result in criminal prosecution, disqualification from benefits, and repayment of any funds deposited to my account.
• I understand that the failure to notify the insurance carrier, self-insured employer, or third-party administrator (TPA) (claim administrator) of any change in financial institution or account may delay receipt of my benefits or settlement proceeds.
• I understand that in order to change or cancel the direct deposit for my workers' compensation indemnity benefits or death benefits, I need to submit this form to the claim administrator, or cancel it on their website.
• I understand that I have an obligation to immediately notify the claim administrator if I am no longer entitled to such payments, or of changes in circumstances which affect my entitlement to such payment.
• I understand that the claim administrator may require me to certify annually that I continue to elect the receipt of such benefits by direct deposit, and that if I fail to do so, the claim administrator may discontinue direct deposit and thereafter provide benefits by paper check.

DEPOSITOR/CLAIMANT/JOINT ACCOUNT HOLDER CERTIFICATION: I certify that I am entitled to receive the underlying compensation payments or death benefits and circumstances entitling me to benefits or death benefits have not changed. I understand that the claim administrator may request an annual certification of continued entitlement to such payments or benefits and that such certification must be provided within sixty days in order to continue payments by direct deposit.

¹ 12 NYCRR 300.26 repealed and revised effective July 1, 2021 www.wcb.ny.gov