New York’s economy is sustained by millions of workers. Unfortunately, accidents happen, and they’re a reality in all kinds of workplaces. When accidents lead to a worker’s injury, the next steps are determined by the New York Workers’ Compensation system.
What Is Workers’ Compensation and How Does It Work?
Workers’ compensation is a state-mandated insurance program designed to provide medical treatment, wage replacement, and other benefits to employees who suffer job-related injuries or illnesses. It is often the sole remedy for workers who have been injured on the job since injured workers cannot file lawsuits against their employer for job-related injuries or illnesses. Fortunately, workers’ compensation is a no-fault system, meaning benefits are not restricted based on the injured worker’s accidental “fault” in their injury.
Key Components of Workers’ Compensation
Coverage
Almost all New York State employers are required to carry workers’ compensation insurance, regardless of the size of their workforce. This coverage extends to full-time, part-time, and even seasonal employees. Length of employment does not matter; employees are fully covered from the moment they start work.
Eligibility
To qualify for benefits, an injury, illness, or death must be work-related, meaning it occurred while performing job duties or was directly caused by workplace conditions. Pre-existing conditions exacerbated by work may also be covered under certain circumstances.
Benefits
New York State workers’ compensation benefits typically include medical expenses, wage replacement (usually two-thirds of the injured workers’ average weekly wages), and certain other related benefits. Additionally, death benefits may be provided to the dependents of workers who died as a result of a work-related injury or illness. Other benefits include mileage to and from medical appointments, prescription drug coverage, and reimbursement for out-of-pocket expenses directly related to medical care. However, workers’ compensation does not provide any “pain and suffering” or “punitive” benefits or payments.
The Workers’ Compensation Board
The Board is a state agency that maintains and arbitrates workers’ compensation cases using hearings and other processes. Injured workers have the right to legal representation in all matters before the Board. Employers and insurance companies can and do hire attorneys to represent their interests as well.
The Workers’ Compensation Process
Notify the Employer
If you are injured on the job, you must notify your employer, in writing, within 30 days of the injury. If you develop an occupational disease, you must also let your employer know in writing within two years of the date you became disabled or aware of the disease.
File a Claim
The Workers’ Compensation Board Form C-3 should be used to make sure the Board properly records your case. The C-3 asks several questions about your job, your injury, and the circumstances leading you to file a claim.
Get Medical Treatment
A workers’ compensation claim rests on the opinion of a medical provider confirming that you have a medical condition and that the condition was in some way caused by your accident or employment. Without good medical reports making that connection, you will not have a viable workers’ compensation case.
Payments
Payments for lost time from work should begin very soon after the employer and insurance carrier know that a person is losing time. The payments are based on the worker’s average weekly wage, as well as the percentage of disability determined by your medical provider.
Job Status and Attachment
If your doctors say you are in any way able to work, you need to try to return to your employer or seek other employment. Otherwise, the insurance carrier can suspend payments.
Permanency
When your doctors have done all they can to treat you, the Board may litigate your permanent injury. In some cases, a permanent injury may entitle you to ongoing payments.
Settlement
In some circumstances, injured workers can waive their right to future payments and/or medical care, in exchange for a lump sum of money negotiated with the insurance company.
When to Get an Attorney
There are many steps and possible outcomes in a workers’ compensation case. Your case might not require an attorney’s help. There are some circumstances, however, where an attorney can make a significant difference in the outcome of your case:
- If there is a chance you missed a deadline for filing or reporting your claim
- If the insurance company stops payments or pays you the wrong amount
- If you are told your claim is “controverted” or “denied”
- If a doctor says you have a permanent injury
- If the Board issues a written decision or schedules a hearing
An attorney handling your workers’ compensation case does not get a fee unless they help you obtain money.
Navigating the complexities of New York workers’ compensation can be daunting, but an attorney can help streamline those complexities and make sure you have the best chance of receiving all the benefits to which you are entitled.
