Throughout New York State, we are starting to notice the Law Judges becoming extremely strict on the content placed on the carrier’s Pre-Hearing Conference Statements which accompany claim denials. Where Law Judges used to be lenient, they are now requiring more detailed information regarding the denial and the employer witnesses who will be called to testify — and in some cases precluding witnesses due to lack of necessity or vagueness on the PH-16.2 forms.
The procedure for denying claims has not changed. The carrier is still required to complete the FROI-00 form and file it with the Board, specifically giving background information on the file, including when notice was given and when the employer had knowledge. A SROI-04 should then be filed listing all appropriate defense codes and along with a supplemental discussion of codes in the narrative field. Alternatively, both items can be completed in a FROI-04. Thereafter, your legal representative will file the Pre-Hearing Conference Statement within 10 days of the Pre-Hearing Conference.
It was common practice to fill out the PH-16.2 and attend the Pre-Hearing Conference on the carrier’s behalf without necessarily speaking with the witnesses beforehand. However now, with the Law Judges’ crackdown, it has become imperative that the carrier and/or third party administrator give the legal representative as much information as possible regarding the employer witnesses who will be listed on the PH-16.2, including what exactly the witness will testify to at a hearing. We have seen Law Judges preclude witnesses listed on Pre-Hearing Conference Statements due to the fact that there is no description of what the witness will testify to on the form.
Therefore, in an effort to rigorously defend claims, all witness information must be obtained prior to the Pre-Hearing Conference and filing of the PH-16.2. This will help your legal representative defend the claim from its infancy and prevent any possibility of witness preclusion.