Workers’ Compensation Direct Deposit Notice – New York

New York requires the following Notice to claimants regarding payment of workers’ compensation benefits via direct deposit. 

Directions: To begin, change or cancel the transmittal of workers' compensation benefit checks and/or proceeds from a settlement agreement pursuant to WCL § 32 (hereinafter settlement proceeds) directly to a financial institution: contact your Adjuster at (507) 455-8080 to discuss. 

Claimant’s Rights to Direct Deposit 

• You have the right to receive your workers' compensation indemnity benefits or death benefits in the form of direct deposit. You also have the right to receive your workers' compensation indemnity benefits or death benefits by paper check in the mail or other available methods. 
• You have the right to cancel the direct deposit at any time by contacting your Adjuster at (507) 455-8080. The request will be implemented within forty-five days of receipt of notice, and thereafter payment of benefits will be sent by paper check or other available and requested method. 
• Beginning July 1, 2021, 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. The insurance carrier may require a minimum amount of up to $20 into each bank account. 

Authorizations and Understandings 

• I understand that I can authorize the insurance carrier to directly deposit my workers' compensation indemnity benefits or death benefits into the specified bank account(s). 
• By accepting direct deposit or other electronic payment method, I authorize the insurance carrier to debit the account in order to recover any credits deposited in error. The insurance carrier may recover credits deposited in error by any lawful means. IMPORTANT: This consent does not authorize the insurance carrier 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) 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 contact my Adjuster at (507) 455-8080 to discuss 
• I understand that I have an obligation to immediately notify the insurance carrier 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 insurance carrier 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 insurance carrier may discontinue direct deposit and thereafter provide benefits by paper check.