New York Workers Comp Claims: Eligibility, Filing and Appeals

Workers Compensation insurance provides medical care and cash benefits to workers who have been injured or disabled on the job. This insurance is paid for by employers. Almost all employees in New York are covered by Workers Compensation, with a few exceptions for employees such as clergy members, volunteers, and workers covered by Federal programs. The New York State Workers Compensation Board oversees Workers Compensation laws in the state.

Eligible Work Related Injuries

Work related injuries or accidents that occur during the course of work are covered by Workers Compensation. These injuries may include bone fractures, sprains, burns and cuts, amputations, and other types of bodily harm. Occupational diseases such as asbestosis or occupational hearing loss are also covered. Workers are covered while engaging in work related activities, though not while commuting to and from work.

Filing a New York Workers Compensation Claim

An employee should notify their employer of any injury or illness as soon as possible or within 30 days and obtain necessary medical treatment. An employee must also complete an Employee Claim Form C-3. This form can be electronically submitted through the NY Workers Compensation Board's website, or it may be mailed to the nearest district office. Claims must be filed within two years. The worker's doctor will file a Doctor's Initial Report Form (C-4), and the employer will file an Employer's Report of Work-Related Injury/Illness Form (C-2) with their insurance provider and with the Board. If lost time is more than seven days, the employer's insurer will then begin paying benefits.

Workers Compensation Claim Denials

Most claims are accepted without incident, though denials do occur. A claim may be denied if the injury is not proven to be caused by a work related activity. Insufficient or incomplete evidence of injury may also result in a claim denial. Claims may also be denied if proper procedure is not followed, or if the paperwork is incorrectly filled out or filed.

Appealing a Workers Comp Denial

Claim denials may be appealed through a hearing before a Workers Compensation Law Judge. The judge will review evidence and take testimony before making a decision. A judge's decision may then be appealed within thirty days by applying in writing for a Workers' Compensation Board review. The board will affirm, modify, or rescind the judge's order, or it may restore the case to the law judge. Board decisions may be appealed within thirty days with the Appellate Division, Third Department, Supreme Court of the State of New York. Appellate Division decisions may be further appealed with the Court of Appeals.

Collecting New York Workers Comp Benefits

Cash benefits are usually paid every two weeks. The amount of benefits equals two thirds of a worker's average weekly wage times the percentage of disability. Benefits may not exceed the maximum allowed amount, which as of 2009 is $600.

Hiring a Workers Compensation Lawyer

A lawyer should be obtained to represent an employee in the appeals process. The precise rules and regulations of Worker Compensation Law are generally too complex for the average citizen. An experienced lawyer will defend the rights of an employee and use his or her knowledge and experience to secure a beneficial outcome in the event of a claims dispute. Attorney fees are determined by the Law Judge or Board Panel and are deducted from an employee's compensation award.

New York Workers Compensation Office Locations

New York State Workers Compensation Board
20 Park Street
Albany, NY 12207
(877) 632-4996

Albany District Office
100 Broadway–Menands
Albany, NY 12241
(866) 750-5157

Buffalo District Office
Cyclorama Building
369 Franklin Street
Buffalo, NY 14202
(866) 211-0645

Rochester District Office
130 Main Street West
Rochester, NY 14614
(866) 211-0644

Syracuse District Office
935 James Street
Syracuse, NY 13203
(866) 802-3730

Binghampton District Office
State Office Building
44 Hawley Street
Binghamton, NY 13901
(866) 802-3604

Peekskill District Office
41 North Division Street
Peekskill, NY 10566
(866) 746-0552

Manhattan District Office
215 W. 125th Street
New York, NY 10027
(800) 877-1373

Brooklyn District Office
111 Livingston Street - 22nd Floor
Brooklyn, NY 11201
(800) 877-1373

Queens District Office
168-46 91st Avenue - 3rd Floor
Jamaica, NY 11432
(800) 877-1373

Hempstead District Office
175 Fulton Avenue
Hempstead, NY 11550
(866) 805-3630

Hauppauge District Office
220 Rabro Drive, Suite 100
Hauppauge, NY 11788-4230
(866) 681-5354