Reaching the settlement stage of your New York workers’ compensation claim can feel like progress. If your Section 32 agreement takes longer than expected, you may wonder what is holding it up.
Several issues can delay review or approval by the New York State Workers’ Compensation Board.
1. The parties have not agreed on all terms
A Section 32 settlement is voluntary. You and the insurance carrier generally need to agree on the settlement terms before submitting the agreement to the board for approval. If negotiations continue over payment amounts or other terms, the process may take longer.
2. Required documents are missing
The board requires specific forms and supporting documents for a Section 32 agreement. Missing information or required attachments can cause the board to return the agreement or delay its review.
3. Medical bill disputes remain unresolved
The parties must resolve certain outstanding medical bill disputes before the board will approve the settlement. These disputes may involve objections over whether the insurer should pay a medical bill or the amount it should pay.
4. Future medical costs need clarification
If your settlement closes future medical benefits, the agreement generally needs to address expected medical expenses. An inadequate allocation for anticipated treatment may prevent approval. However, an allocation may not be necessary if no future treatment is reasonably expected.
If Medicare’s interests are involved, the parties may also need to consider a Workers’ Compensation Medicare Set-Aside. When the parties submit a proposed set-aside to CMS for review, that additional process can affect the settlement timeline.
5. The board requests changes
The board may identify terms that need revision before approving the agreement. If that happens, the parties may need to submit a revised agreement, adding another step to the process.
Even when no issue delays the agreement, either party has 10 calendar days from the date the board considers the agreement submitted to withdraw in writing. The agreement does not become final and binding until that period has passed and the board approves it.
Find out what still needs to be resolved
A settlement delay does not always mean something is wrong with your claim. It may involve unfinished negotiations, missing documents, medical issues or a required step in the board’s review process. Knowing what is holding up the agreement can give you a clearer sense of what happens next. An attorney can review the settlement status, explain any unresolved requirements and help you understand what must occur before the agreement becomes final.