Over the years, we’ve received many questions about workers’ compensation in New York. It could be daunting, there is a lot of information to know about filing a workers’ comp claim and the process that follows.
We’ve put together this simple, easy-to-follow guide of frequently asked questions about New York workers’ compensation law so that you can be armed with the information you need to file a claim and get the benefits you deserve.
Keep reading, as we answer your questions about workers’ compensation laws in New York. Whether you suffered a construction accident, a slip and fall, or a work-related motor vehicle accident – read on and get the benefits you deserve.
What Is Workers’ Compensation?
Workers’ compensation is a form of benefits injured employees receive after a workplace injury or illness.
Employees have the right to receive these benefits by law and cannot be fired for being injured or filing a claim.
A workers’ compensation claim also lets the employer off the hook for any negligence-based claims in court, as receiving workers’ comp benefits as part of a claim means you give up the right to sue your employer for any negligence on their part.
Most employers carry workers’ compensation insurance that provides coverage after a claim is filed with the insurance company.
Some businesses provide self-insurance. Even those employers who defy the law by not having this type of coverage are required to pay these benefits out.
How To Get Workers’ Comp?
New York law makes it mandatory for employers to provide workers’ compensation coverage for all employees. This means all employees, part-time or full-time, are entitled to file a workers’ compensation claim after an injury related to work.
There is also no waiting period for the coverage to start. From the first day you are employed, you will be qualified to receive workers’ compensation in the event of a job-related accident or illness.
What to Do After a Work Injury?
If you have been injured in an accident at work or have suffered a condition from your job, you should immediately inform your employer.
If your injuries are severe enough to warrant medical attention on-site, allow paramedics or someone else to transport you to a hospital for observation and medical care.
As soon as you can, schedule an appointment with a physician to examine you and make a note of any symptoms you have and how they will limit you.
Also, you will need to fill out some paperwork in order to file a workers’ comp claim.
What Injuries Are Covered By Workers’ Compensation?
Workers’ compensation covers all kinds of work-related injuries and illnesses.
Any type of injury or illness you get from work makes you eligible to file a workers’ comp claim.
Some of the types of injuries that are the subject of workers’ comp claims are:
- Broken bones
- Neck Injuries / Whiplash
- Low back pain
- Bulging and herniated disc
- Shoulder Injury
- Knee Injury
- Sprains and Strains
- Hearing loss
- Injuries by equipment
- Head injuries
- Spine injuries
- Psychological Injury
Almost any injury you could think of can qualify you for coverage under workers’ compensation, no matter how minor or severe or whether caused by a one-time accident or developed over time due to working conditions.
How To File a Workers’ Comp Claim?
After an injury, it is important to start the claims process as quickly as possible. After notifying your employer, he or she will likely notify their insurance company. However, you still need to file a claim with the Workers’ Compensation Board.
The best option when filing a claim is to have an attorney help you out to avoid any mistakes.
However, if you choose to do the paperwork on your own, you can file an Employee Claim (C-3) form with the Workers’ Compensation Board either online in paper form by mail or in person.
If the case is for a deceased worker, the family members will need to fill out a Claim for Compensation in Death Case (C-62 Form) and provide documentation about the death.
When To File Workers’ Comp?
Ideally, you should file a workers’ comp claim immediately after an accident or injury.
The sooner you inform your employer and file a claim, the better for your case, and the more quickly you will receive benefits.
Many times, insurance companies and attorneys will use any delay in filing a workers’ compensation claim against you to argue that your injuries are not that bad or that you are only trying to get money.
What Is a Workers’ Comp Filing Deadline?
Usually, the time limit for filing a claim for workers’ compensation is two years after you had an accident, or you became aware of your injury.
Although you should notify your employer, you should still pursue the claims process diligently to avoid missing the filing deadline.
If the deadline has passed, an attorney will be able to go over your options with you.
How Much Does Workers Comp Pay?
One of the most common questions we get from our readers is “How much does workers’ comp pay?”
Cash benefits are only paid for the first seven days if the disability extends past 14 days. For example, if you are out of work for nine days, you will not be entitled to collect cash benefits for the first seven days.
If you were out of work for fifteen (15) days, you would receive cash benefits for the first seven days to be received along with your current benefits.
Your workers’ compensation benefits will be two-thirds your average weekly wage before your disability began multiplied by the percentage level of disability. The amount for weekly benefits cannot exceed $934.11 per week.
In addition, the injured employee is entitled to receive direct medical care for any injuries or illnesses.
My Workers’ Comp Claim Is Denied. Now What?
If your claim is denied, you can file an appeal to the decision. To do so, you can request a Workers’ Comp Hearing to have the decision reviewed. You will then be scheduled for a hearing where you can present your case, along with any evidence of your injury and your inability to work.
If you have a workers’ comp lawyer, it is a good idea to bring him or her along, as the other side will likely have counsel.
In addition, make sure to get any copies of medical records and other types of documentation that would be helpful to your case.
If the judge denies the claim, you may appeal to a panel of the Workers’ Compensation Board for further review.
How to Prepare for My Workers’ Comp Hearing?
If you are set to appear before a Workers’ Comp Judge or before a panel, there are a few things you can do to prepare yourself as best as possible:
- Gather all relevant evidence. What you want to present is evidence that your injury or illness is as bad as you say it is and that you are unable to work in some capacity. Get copies of notes and records from all appointments, any previous communication with the insurance company, and anything else that may seem important.
- Speak to a workers’ comp attorney. If you do not already have one, it may be a good idea to consult with a workers’ comp attorney before a hearing so that you can have an idea of how things will go and how to prepare yourself. The insurance company will surely have lawyers present, so it’s not a bad idea to have an attorney representing you at the hearing.
- Continue following your treatment guidelines. Even after your claim is denied, you should continue to keep up with all treatment plan recommended by your workers’ comp doctor. It is not only an important part of your recovery but could help make your case at a hearing.
Do You Need a Lawyer For Workers’ Comp?
Although the workers’ comp process may seem as simple as filling out some paperwork and getting your benefits, it can quickly become complicated as the process goes on. Insurance companies are often quick to deny or underpay on workers’ comp claims if they find a reason to do so.
Hiring an experienced workers’ comp attorney can make the process a lot smoother and ensure you have an advocate on your side to get you the best outcome you can.
A workers’ comp attorney has the experience with the process to help you through it and can use his or her knowledge of New York workers’ comp law to make sure the insurance company doesn’t step over you.
Can I Get Social Security Benefits or Unemployment While Receiving Workers’ Comp
If you are receiving unemployment or social security benefits, you may still be able to receive those benefits along with workers’ compensation, but your benefits will be limited.
If you are receiving social security benefits and get approved for workers’ compensation benefits, the amount of your total benefit will be capped at the level of your total weekly wage.
For unemployment, if you are able and willing to work, you can still receive unemployment benefits along with workers’ compensation, but your benefits may be reduced to make sure you do not receive more than your weekly wage.
It is important to notify agencies you receive benefits from any workers’ compensation benefits you will be receiving so that proper adjustments can be made, and you will not have to pay back any money later.
An attorney can also help you determine how to proceed and answer any questions about your benefits.
Can I Choose My Own Doctor For Workers’ Comp?
Under a New York law, you are entitled to choose your own workers’ comp doctor to treat your work-related injuries.
However, some insurance companies have Preferred Provider Networks, meaning that payment is only covered for providers who have a contract with the insurance company.
If your employer’s insurance company has a Preferred Provider Network, you must see a doctor within the network within the first 30 days of your treatment. After the 30 days has expired, you are free to switch doctors to one of your choosing.
Many medical professionals specialize in treating injured workers. You can find orthopedic surgeons, neurologists, pain management doctors, physiatrist, chiropractors, psychologists, physical therapists, and more.
Some good things to look for while choosing the right workers’ comp doctor to treat you:
- Experience treating workers’ comp patients.
- Good patient reviews.
- Recommendations from people you know.
- Length of time practicing medicine.
- Authorized by the NYS Workers’ Compensation Board (WCB-Authorized Medical Provider)
Will There Be a Workers’ Comp Drug Test?
You may be subject to a workers’ comp drug test at your doctor’s appointments, especially if there is a suspicion of drugs or alcohol playing a role in an accident.
A positive test for any controlled substances taken without a valid prescription can prevent you from getting benefits and even result in termination.
If you think you may be subjected to a drug test that will come back positive, speak to a workers’ compensation attorney to discuss your options.
My Employer Has No Workers’ Comp Insurance. What Do I Do?
If your employer does not have workers’ comp insurance, they are still required by law to provide benefits.
Without insurance, you may have to file a personal injury suit against your employer in court.
A workers’ comp attorney can help you determine how to proceed if your employer does not carry workers’ comp insurance.
After an accident, follow the same steps you would if your employer had workers’ compensation. Those steps will be equally as important to your personal injury suit as it would be to a workers’ compensation claim.
What Injuries Are Not Covered by Workers’ Compensation?
While many types of injuries at work are covered by workers’ compensation, there are some that are not.
Notably, if the employee hurt himself because of intentional conduct, such as getting into an altercation with a coworker, that incident would not be covered.
In addition, if an employee was under the influence at the time of his or her accident, this could be a bar to recovery.
There are many categories of workers that are not subject to workers’ compensation coverage. These include volunteers, priests, athletes, sole proprietors, and police officers in New York City.
For a full list of those excluded from the workers’ compensation coverage, visit here.
Do I Have To Go to An Independent Medical Exam (IME)?
Most insurance companies will request a workers’ compensation claimant to attend an Independent Medical Examination (IME).
These appointments are conducted by a physician of the insurance company’s choosing and intended to provide a second opinion on your injuries.
Many people debate skipping these, as they are generally intended to hurt a claimant’s case and provide a basis to deny coverage. However, failure to attend these appointments is usually grounds for the denial or termination of workers’ comp benefits.
Plan on attending your appointment. Take detailed notes and ask for copies of any records generated from the visit. You may also consider taking someone along with you to the appointment to serve as a witness.
If the IME doctor disagrees with your doctor, your attorney can help you by initiating proceedings to certify the credibility of your physician over the IME physician.
What If an Insurance Adjuster Wants Me to Give a Recorded Statement or Sign a Medical Release?
If you’ve ever been involved with a car insurance claim, you likely have a good idea of all of the contact you had with insurance companies. A workers’ comp claim functions very much like that.
Your employer’s insurance company is trying to minimize harm to their insured and to their finances. If they can find ways to get less money out of you by finding things to use against you or barring you from filing future claims, they will do it.
If you receive any calls or anything in the mail from the insurance company, do not do anything until you speak to an attorney.
Most workers’ comp lawyers will advise you against signing any medical release form, and they may not advise you to give a recorded statement under the circumstances either.
Forward any communication you receive to your attorney and do not do anything until he or she gets a chance to speak with you about it.
Can I Lose My Job After Filing a Workers’ Comp Claim?
Under New York law, you cannot be fired solely for filing a workers’ compensation claim. However, because employment in New York is “at will,” meaning employers reserve the right to terminate you at any time, an employer can fire you for being unable to work and hire a replacement.
If you believe you have been wrongfully fired for filing a workers’ comp claim, an attorney can tell you whether you have a case to fight it or not.
Will a Pre-existing Condition Bar Me from Recovering Under Workers’ Comp?
Many people believe a pre-existing condition will prevent them from getting workers’ comp. Because of this, many think of withholding information from their workers’ comp doctors, trying not to hurt their case when they are doing significant damage.
The “eggshell skull” doctrine in the law states that you take your victim (or, in this case, injured employee) as he or she comes.
If a previous condition is worsened by a workplace injury and it can be demonstrated that the accident caused that injury to become worse, you are entitled to benefits and treatment not just for your accident symptoms, but for any worsened condition.
It is important, to be honest with your treating doctor about any previous conditions or injuries you have. This will not only help you get the best treatment possible, but it will help your workers’ comp doctor determine whether the accident worsened those injuries in any way.
Can I File a Workers’ Comp Claim and a Lawsuit Against My Employer?
One of the catches to filing a workers’ comp claim is that you give up your right to sue the employer for negligence. However, if there are other claims that are not negligence-based, you may be able to file these claims in court.
In addition, if someone other than your employer or co-worker were at fault for the accident, even partially, you may be able to file a third-party claim against them for their negligence or on other grounds.
Workers’ compensation lawyer can tell you what your options are and discuss the possibilities with you.
What If I Need Medical Care Later?
With many injuries, pain or symptoms may reemerge at a later date, long past the expiration of your benefits.
Fortunately, New York law gives injured employees a broad right to receive help via workers’ comp. This means future medical care related to your injury may be something you can get benefits for.
To preserve this right, however, it is important to carefully review and discuss any forms you receive from the workers’ comp insurance company.
Many times, insurance companies will send a medical release agreement to a claimant in an effort to get them to give up their right to make any future claims for future injuries.
If you receive a medical release from an insurance company, do not sign it and let your attorney know.
How Can I Make Sure That My Workers’ Comp Claim is Successful
- Seek medical care as soon as possible. If you are injured on the scene and need medical attention, have someone drive you to the hospital or go by ambulance. It is important to make an appointment with a workers’ comp doctor as soon as possible to schedule an appointment so that he or she can document your symptoms and condition.
- Notify your employer about any injuries or conditions you have from an accident or other workplace conditions. When an injury happens, or illness develops, it is absolutely crucial to let your employer know right away. Many workers’ compensation insurance companies give only 30 days to report before they will deny coverage. Besides, the faster you notify your employer, the sooner you’ll get the workers’ comp claim process started.
- Consider seeking the help of a workers’ comp attorney. Although it may not seem like you need an attorney for your workers’ comp claim, hiring one can make a huge difference in the success of your claim. Insurance companies are dealing on behalf of their client, and they will try and take any chance to demean or discredit your case. A workers’ comp attorney can help you navigate your dealings with the insurance company and can advise you about your best options.
- Keep detailed records and take notes if possible at all appointments or meetings. During the claims process, any slipup you make, no matter how small, can be used to cast doubt on your credibility. Taking notes when your appointment is fresh in your mind and keeping a file of all your medical paperwork can be helpful. If you’re asked to attend an IME, it is an especially good idea as many IME appointments are set up with the goal of discrediting your symptoms or how injured you are. Taking notes, having a friend accompany you as a witness, or even filming the appointment, if you can, can go a long way in bolstering your claim.
If I Die, Can My Spouse and Child Get Benefits?
If an injured employee dies from work-related illness or injury, his family can receive benefits in his place.
Weekly payments would be made to a deceased employer’s spouse and children if the employee’s death was caused by a workplace accident or injury.
If the employee who died was single with no children, they might receive a payment of $50,000 to be deposited into their estate, plus funeral expenses.
A workers’ compensation attorney can help you determine if you are entitled to benefits after a loved one’s death and help you initiate the process.
New York Workers’ Comp Doctors You Can Depend On
After a workplace accident, medical treatment is one of the most important things to your recovery and settlement.
Our workers’ comp doctors have extensive experience treating injured workers, and we handle your injuries with the utmost care and attention.
These specially-trained physicians will make sure you get the best and proper treatment to address your injuries and symptoms so that you can move forward after an accident.
Call (888) 590-4030 to find the right workers’ comp doctor near you today.
Telemedicine and virtual consults are available in the comfort and safety of your home.
Don’t delay call now and get you the road to recovery.