New York Workers Comp Claims: Eligibility, Filing and Appeals

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If you are injured on the job in New York, or become ill as a result of your employment, you likely will have a compensable workers’ compensation claim. The information below will help you determine if you are eligible for workers’ compensation in New York, and if so, how to go about filing your claim. 

Your employer has workers’ compensation insurance, which pays for injured workers’ medical care and cash benefits to compensate for workplace injuries. If you work in New York, your employer likely is required to provide you with workers’ compensation benefits through their insurance carrier.

Certain workers are not covered under the New York workers’ compensation system, such as clergy members, volunteers, and federal employees.

Eligible Work-Related Injuries

All work injuries that occur during the course of work are covered under New York workers’ compensation law. New York, like most states, also covers occupational diseases, which are illnesses that arise during the course of employment. Typical occupational diseases include asbestosis and hearing loss.

Industrial (work-related) injuries can include bone fractures, sprains, burns, cuts, amputations, and other injuries that cause immediate harm. If your injury requires more than simple first aid, and it occurred in the course of your employment, you likely have a workers’ compensation claim.

Activities that happen outside the scope of your employment, such as commuting to and from work, are not covered. In other words, injuries or diseases arises from these activities do not give rise to a workers’ compensation claim. 

What to Do if You Are Injured at Work

The first thing you should do if you are injured at work is to notify your employer, in writing, as soon as possible. You must report the injury within 30 days of the accident that caused the injury; otherwise, you may lose your right to file a workers’ compensation claim. Alternatively, if you believe you have an occupational disease, you must notify your employer within two years of when you learned the disease was likely related to your workplace.

To report the workers’ compensation claim, your employer should provide you with Form C-3 to complete. Either you or your employer will then need to mail this form to the nearest office of the Workers’ Compensation Board. The C-3 form will begin the process of filing your workers’ compensation claim.

Within 10 days of receiving notification of your injury or occupational disease, your employer will report the workers’ compensation claim on form C-2, and send this to the Workers’ Compensation Board and the employer’s workers’ compensation insurance carrier.

You should also see a doctor as soon as you can, so that the doctor may assess and document your condition. The doctor must be authorized by the Workers’ Compensation Board to treat injured workers, so make sure you find a provider that is so authorized. You can call (800) 781-2362 or visit www.wcb.state.ny.us to find more information about authorized providers in your area.

Additionally, you should talk to your employer about which doctor to use, since your employer may require you to obtain treatment from a health care provider participating in their Preferred Provider Organization (PPO). If your employer participates in a PPO or Alternative Dispute Resolution program, you should receive information regarding these programs from your employer. Your employer may also require you to use certain providers and pharmacies for diagnostic studies and prescription medications.

New York Workers’ Compensation Benefits

If you have an allowed workers’ compensation claim, you will begin receiving workers’ compensation benefits immediately. Your employer’s workers compensation insurance carrier will pay medical bills for treatment related to your industrial injury.

If you are unable to work due to your work-related injury or occupational disease for more than seven days, your employer’s workers’ compensation insurance carrier will begin payment of cash benefits to compensate for your lost wages. These temporary disability benefits equal two-thirds of your average weekly wage, multiplied by the percentage of your disability.

These payments are usually paid every other week. The insurance carrier will continue to make these payments to you until your workers’ compensation claim is closed or you are able to return to work, whichever occurs first.

There are also other benefits for specific situations, such as death benefits for the families of injured workers.

Your Appeal Rights

If you disagree with a decision by your employer or your employer’s workers’ compensation carrier, you may have the right to appeal that decision to the Workers’ Compensation Board. For example, if the workers' comp insurance company denies your claim, you should appeal the claim to try to get the decision reversed. (To learn more about the appeals process, check out our article on Appealing a New York Workers Compensation Denial).

A workers' compensation law judge will review evidence and take testimony. The judge will then render a decision regarding the issues on appeal. You can appeal the judge’s decision to the 3-member board panel, and appeal that decision to the Appellate Division and the Court of Appeals. 

If you are considering an appeal of any kind, you should strongly consider talking to an attorney. The process is a sophisticated legal process, and you want to ensure all of your workers’ compensation rights are protected.

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