Frequently Asked Questions

We assist insurance companies, self-insured employers, third-party administrators, and legal teams handling New York workers' compensation cases.

We offer specialized, independent analysis and strategy to optimize claim outcomes. Our focus is proactive, not reactive, and is designed to complement — not replace — your existing team.

Our core expertise is in New York workers’ compensation, but we can assist with analysis and consultation for other state programs on a case-by-case basis.

We work collaboratively, providing detailed recommendations, analytics, and support while respecting your team's workflows and authority.

Actuarial services involve the use of statistical, mathematical, and financial modeling techniques to evaluate and predict the costs of workers’ compensation claims. In New York, this includes projecting claim reserves, setting loss development factors, assessing claim trends, and identifying cost- saving opportunities.

Actuarial insights help employers and carriers better understand their exposure, manage reserves accurately, and make data - driven decisions regarding premiums, claims handling, and safety programs. These services can uncover patterns that lead to excessive claim costs and support strategies for reducing future liability.

Not at all.Our actuarial team works collaboratively with your existing partners to provide independent, supplemental analysis.We offer fractional services designed to enhance—not replace—your internal processes and existing vendor relationships.

All types of employers—whether self-insured, participating in group self-insured trusts, or purchasing insurance through carriers—can benefit from actuarial evaluations. This includes construction firms, healthcare providers, manufacturers, and public entities.

Key reports include: Loss development analysis to assess claim trends over time, Reserve adequacy studies to validate or adjust claim reserves, Program cost forecasting for budgeting and strategic planning, Loss stratification to identify high-cost drivers and potential fraud.

By identifying claim outliers, medical cost trends, and reserve anomalies, actuarial insights can flag inefficient practices or excessive costs. This enables proactive steps like early intervention, case management, and vendor oversight—ultimately lowering the total cost of risk.

We provide practical, actionable insights tailored to New York’s legal and regulatory environment. Our actuarial team collaborates with claims professionals, attorneys, and nurse case managers to translate complex data into strategies that work in the real world. Plus, we offer fractional and on-demand services to match your organization’s size and needs.

We perform in-depth reviews of claim files, medical records, legal documents, and surveillance results to identify cost drivers, risk factors, and opportunities for resolution.

Yes. We conduct detailed claim audits and reserve evaluations to help ensure accuracy, consistency, and financial predictability.

We closely review each file for red flags and coordinate appropriate investigative or legal strategies to protect your interests.

The earlier, the better — but we can assist at any stage, from initial filing to long-tail legacy claims. Analysis can save you money and free up resources.

Surveillance is appropriate when there are discrepancies between reported injuries and observed activities or when claim validity is in question.

Our team offers field surveillance, social media monitoring, background investigations, and activity checks, tailored to your case needs.

All surveillance is conducted ethically, professionally, and in strict compliance with New York privacy and investigative laws.

Yes. Investigators we work with provide detailed, court-ready reports and video evidence that can support your case in litigation, settlement discussions, or hearings.

Our investigators operate discreetly and professionally, ensuring minimal disruption and maximum confidentiality.

Nurse case managers coordinate medical care, facilitate communication between providers and claims professionals, and work to ensure appropriate, cost-effective treatment.

Early intervention is key — we recommend assigning a nurse case manager when an injury is complex, high-cost, or requires specialized care.

They act as a liaison, ensuring that treatment plans are aligned with evidence-based guidelines and that communication flows smoothly between all parties and understand NY medical treatment guidelines.

Yes. Studies consistently show that early, proactive nurse involvement leads to faster recoveries and lower overall claim costs.

Yes. Our nurses are well-versed in New York Workers' Compensation Board regulations, including treatment guidelines and reporting standards.

If the claimant has retained counsel, the attorney must consent to the assistance of a nurse case manager.

By identifying risk factors early and implementing tailored solutions, you can prevent injuries, speed return-to-work outcomes, and lower premiums and reserves.

Yes. Our team tailors every risk management assessment to your industry, workforce, and claims history.

At a minimum, annually, but more often if your organization undergoes significant operational changes or if claims trends shift.

Absolutely. Our team can help design, launch, and refine programs to facilitate safe returns to work and reduce future claim exposure.

Diagnostic imaging like early MRIs or X-rays that reveal pre-existing degenerative changes—such as disc desiccation, osteophytes, or multi-level spondylosis—can be critical. Radiologist interpretations that classify these findings as chronic rather than acute are especially persuasive. The absence of signs typical of acute trauma, such as edema or bone bruising, can further weaken the claimant’s causal link.

The C-2F should be treated as a tactical document, not just a formality. Use precise, factual language to describe the accident and note any inconsistencies or ambiguities without speculation. If there are known pre-existing conditions or questionable circumstances, document them. This sets the foundation for potential controversion later on.

Beyond uploading documents, eCase allows real-time monitoring of claimant submissions. This helps you anticipate arguments, identify contradictions in the medical narrative, prepare focused cross-examinations, and track directives or upcoming deadlines issued by the judge.

A treating doctor’s deposition is especially useful when causation is disputed, disability duration is contested, treatment appears excessive, or when the treating opinion conflicts sharply with an IME. It enables direct challenges to subjective reasoning and medical necessity.

Focus on inconsistencies in their account of the accident, daily activities that contradict reported limitations, any omissions in disclosing prior injuries, and their compliance with medical recommendations. Also question the extent and sincerity of job search efforts if disability benefits are being claimed.

Consider whether the medical condition is stable before settling. Ensure Medicare Set-Asides are calculated correctly if applicable. Understand if the claimant is more motivated by indemnity or medical coverage, and evaluate whether the Section 32 can resolve multiple claims. Always be ready to show that the settlement is in the claimant’s best interest to secure board approval.

Proactive RFAs can request judge directives like ordering IMEs or testimony. Pre-hearing conferences can clarify and streamline issues. Timely objections and referrals for vocational assessments can support defenses like partial disability or work capacity.

A persuasive RB-89 identifies specific factual or legal errors in the WCLJ’s decision, such as misinterpreting evidence or ignoring precedent. It should point out procedural violations, argue a lack of substantial evidence, and clearly state the outcome being sought—whether reversal, restoration, or further development.

At the appellate level, the focus shifts to legal errors or a total lack of substantial evidence. The standard of review is stricter, and the court defers to the WCB’s factual findings. Only arguments properly raised and preserved at the board level will be considered.