How to File a Workers’ Comp Claim in NY: A Complete Guide
Work related injuries or illnesses can have a huge impact on your life, but if you are an injured worker in New York, you are safeguarded by the state’s workers compensation law. Filing a workers compensation claim may appear daunting, but we have created a guide to help you through the process. Our “how to file a workers’ comp claim in NY” guide will take you through each step starting from informing your employer to navigating the complexities of the New York State Workers’ Compensation Board system.
Understanding Workers Compensation in New York
Workers’ compensation benefits aim to offer treatment, wage replacement and other assistance to employees who have experienced work-related injuries or illnesses. In New York, workers compensation operates on a no-fault basis, which means that you don’t have to prove your employer was negligent to start receiving benefits. However, you do need to follow certain steps to ensure your claim is processed smoothly.
Exploring Workers’ Compensation Benefits
Workers’ compensation benefits cover a wide range of expenses and losses resulting from work related injuries. These may include:
Medical Treatment: Ongoing lifetime healthcare related to the injury.
Wage replacement: Payments covering a portion of lost wages while you are unable to work.
Permanent disabilities: Compensation for injuries leading to permanent impairment, incliuding but not limited to lump-sum awards.
Rehabilitation services: Support in recovering from or adjusting to an injury, such as physical therapy, occupational therapy, and more.
Death benefits: Compensation provided to the family members of a worker who passes away due to a work-related injury.
Who Qualifies for Workers Compensation?
The majority of employees in New York are eligible for workers compensation benefits. This includes full-time, part-time and seasonal workers. Certain categories of workers may not qualify (such as some contractors and volunteers, however even they may be covered in certain circumstances). It is important to confirm your specific employment status to ensure you are eligible for workers comp in NY, and Tomack Law, PLLC can help you with this.
Step 1: Notify Your Employer
The initial step in starting a workers compensation claim is to inform your employer about your injury or illness. This should preferably be done directly after the injury occurs. If your claim is an occupational disease (such as carpal tunnel syndrome), you should notify your employer as soon as you have a reason to believe the issue is work-related (such as once a doctor tells you the issue stems from work). It is important to do this within 30 days of the incident. Delaying notification can impact the success of your claim.
Why You Must Notify Your Employer
Informing your employer is vital as it initiates the workers compensation procedure. Your employer must be aware of the injury to initiate a report, which is essential for validating your claim with the New York State Workers Compensation Board. The longer an injured worker waits to report an injury, the more likely it is for the insurance carrier to attempt to fight or deny the claim.
How to Notify Your Employer
You can inform your employer verbally or in writing. However, providing written notice is better for record keeping purposes.
Your written notification should contain information about the injury, detailing how it occurred and when it took place. It’s important to report minor injuries as some may worsen over time. Preferably, an incident report will be generated by your employer, which you can retain a copy of.
Step 2: Get Immediate Medical Attention
Once you inform your employer, the next crucial step is to seek help promptly. Seeking medical care not only aids in your recovery but also serves as essential evidence for your workers compensation claim. Insurance carriers, as well as the Workers’ Compensation Board itself, prefer to see “contemporaneous medical evidence” of the injury (in other words, as short a time frame between the injury and initial treatment as possible).
Initial Medical Care
In the event of a work-related injury, it is important to seek immediate medical attention. For emergencies, you should consider going to (or being taken to) the hospital or an urgent care facility. For non-emergencies, your employer might direct you to a healthcare provider or network (Tomack Law, PLLC can assist you in making sure your choice of provider accepts New York Workers’ Compensation insurance). It is vital to inform any and all providers that your injury is work-related. It is illegal for any provider to bill a patient directly for a work-related injury.
Ongoing Medical Treatment
Depending on the seriousness of your injury or illness you may require ongoing medical care. This can involve follow up appointments, physical therapy or specialized treatment. Maintaining records of all medical visits, treatments and expenses is crucial for supporting your workers compensation claim. If you are out of work due to your injuries, you are required to see your doctor at least once every ninety (90) days, in order to obtain up-to-date opinions on your temporary degree of disability. The better your medical record is, the better your case is likely to proceed.
Medical Documentation and Your Claim
Your medical documentation will play a massive role in substantiating your workers compensation claim. These documents outline the extent of your injury, the treatment you received and any suggestions from your healthcare providers. This information plays a pivotal role in determining the benefits you are eligible to receive. Tomack Law, PLLC will work with your provider(s) to make sure that their reports and documentation meet or exceed all requirements set forth by the Board.
Step 3: File a Claim with the New York State Workers’ Compensation Board
Once you have informed your employer and sought care, it is essential to file a workers compensation claim with the Workers Compensation Board in New York State.
Completing the Employee Claim Form (Form C-3)
To start your claim you need to fill out the Employee Claim Form, also known as Form C-3. This form requires information about your injury, how it happened and its impact on your ability to work. Precision is key here as inaccuracies or omissions can lead to delays or denials of your claim. Tomack Law, PLLC can assist the filling out and filing of this form, with minimal effort on your behalf!
Submitting Your Claim
After completing Form C-3 you must submit it to the Workers’ Compensation Board in New York State. You can submit this form online via mail or in person. It is crucial to do promptly to prevent any delays in processing your claim. Again, Tomack Law, PLLC can assist the filling out and filing of this form, with minimal effort on your behalf!
The Role of the State Workers’ Compensation Board
The New York Workers’ Compensation Board is the administrative agency responsible for overseeing all aspects of the Workers’ Compensation System in the state. The Board has broad jurisdiction over all aspects of your claim, and issues are adjudicated in front of Administrative Law Judges employed by the Board. Once a claim is filed, the Board will review the filing to see if any immediate action is required (such as a hearing), and will maintain an Electronic Case Folder (ECF) that contains all of the records (medical and otherwise) involved in your claim.
Step 4: Understanding the Review Process and Potential Outcomes
After filing your claim, the Workers’ Compensation insurance carrier covering your employer will review the claim and determine whether to accept or deny the claim. The insurance carrier can be looked at as the “defendant” in the claim, while the injured worker (called “claimant”) can be looked at as the “plaintiff.”
The Claims Review Process
The carrier will examine all submitted documentation, including Form C-3, medical files and any supplementary details provided by your employer. If everything aligns correctly, your claim is likely to be accepted smoothly. However inconsistencies or missing data (such as inconsistent accounts of the accident and/or non-contemporaneous medical reports) might prompt the carrier to deny the claim.
Possible Outcomes
Acceptance: Upon acceptance of your claim by the carrier, you will be able to seek related medical care, as necessary, for your injuries. If you are out of work due to your injuries, the carrier will also be responsible for monetary compensation benefits such as temporary wage replacement.
Denial: If your case is denied, you retain the right to challenge this decision. The case will be scheduled for a hearing in front of an Administrative Law Judge, and your attorney will work to have the case accepted (including by appeals if necessary). Having Tomack Law, PLLC on your side to assist in this process is not only recommended, but vital.
Partial Acceptance: In some cases, the carrier approved a part of your claim. For example, if you injured your shoulder and knee in a work accident, they might agree to only accept the shoulder while denying the knee. Again, Tomack Law, PLLC will zealously advocate on your behalf to make sure that all injury sites are accepted in your claim.
Working with a NY Workers’ Compensation Attorney
You should seek to retain a New York Workers’ Compensation lawyer such as Tomack Law, PLLC immediately after your injury, regardless of whether your claim is accepted or denied by the insurance carrier. The insurance carrier will have their own legal counsel representing them on your case, and many injured workers wait until they first have issues in their claim before calling an attorney, unaware of the fact that if they had retained an attorney such as David I. Tomack, Esq. immediately, these issues likely never would have occurred in the first place! A skilled NY Workers’ Comp lawyer can assist you through all aspects of your claim from beginning to end, ensuring that your rights are protected and that you receive the benefits you deserve.
Step 5: Receiving Your Benefits and Returning to Work
After your claim gets accepted, you will be entitled to causally-related medical care and, if out of work due to your injuries, can seek monetary workers compensation benefits for your lost wages and time. It’s crucial to grasp how these benefits function and what responsibilities come with them.
Wage Replacement Benefits
Wage replacement benefits are determined based on your average weekly wage (AWW) before the injury and the severity of your disability. Your AWW is calculated based upon the average weekly earnings in the one full year directly prior to your date of accident. The amount of weekly benefits you receive when missing work depends on the temporary degree of disability you are found to have (which is based on your doctor’s medical opinion). In New York, the maximum amount of weekly compensation benefits you can receive, if found to be temporarily totally 100% disabled, is two-thirds (2/3) of your average weekly wage (for example, your AWW is $1,000 per week, your maximum compensation rate would be $666.67 per week). All monetary awards in NY Workers’ Compensation are tax-free to the injured worker.
Medical Benefits
Once an injury site is established/accepted in your case, you may then obtain medical care for this injury site through Workers’ Compensation. A work-related injury MUST be treated via Workers’ Compensation insurance, and never through your own private insurance. You are entitled to medical care for life for any accepted work injury, including but not limited to visits to the doctor, hospital stays, therapy, medications, and even undergoing surgery.
Permanency Awards
After at least 6 months from your date of accident (or at least 1 year after any surgery), you may be found to be at maximum medical improvement (MMI), which is a determination that you have stabilized in regard to your injury, and nothing further can be done to improve your condition. If you still have permanent impairments (such as range of motion loss) after you are found to be at MMI, you may be entitled to a large lump-sum monetary award to compensate you for these permanent injuries (such awards are referred to as “schedule loss of use” awards for extremity injuries, and “classification” awards for non-extremity injuries such as back/neck).
In addition, the carrier and your attorney may attempt to negotiate a full and final settlement of your claim, referred to as a “Section 32 agreement,” which would pay you a large lump sum award in exchange for a full and final closure of your case. Again, all monetary awards in NY Workers’ Compensation are tax-free to the injured worker. Having a firm such as Tomack Law, PLLC to negotiate and fight for these awards is vital to achieving the best possible outcome.
Returning to Work
It is almost ALWAYS beneficial to immediately return to work after having a work-related accident. This is because any wage replacement weekly benefits paid to you while out of work will ultimately be subtracted from any final Schedule Loss of Use award (see above). Should you be unable to return to work, however, Tomack Law, PLLC can work to make sure that you are paid compensation benefits timely and at an appropriate rate. If and when you feel ready to return to work, you should resume your previous job or take on a modified role if your injury requires any restrictions as per your doctor. If returning to work isn’t feasible for you, and you plan to remain out of work for an extended period, Tomack Law, PLLC can discuss the possibility of Social Security Disability benefits with you as well.
In Conclusion: How to File a Workers’ Comp Claim in NY
Navigating a Workers’ Compensation claim in New York may seem overwhelming. By following the steps detailed in this guide you can ensure that your claim is handled properly and that you receive the benefits owed to you. From informing your employer to settling your claim, each step is critical to achieving success.
You should seek guidance from a trusted New York Workers’ Compensation attorney like David I. Tomack, Esq. immediately after your injury, so that Tomack Law, PLLC can work to ensure that your case moves forward smoothly and with the most positive potential results. They will offer you the expertise needed to safeguard your rights. Give Tomack Law, PLLC a call today to assist you with your Workers’ Comp claim!
FAQs
What is the time limit for filing a Workers’ Compensation claim in New York?
You should file your claim as soon as possible. However, you have up to two (2) years from the date of the injury to submit your claim to the Board.
Can my employer terminate me for submitting a Workers’ Compensation claim?
No, it’s against the law for an employer to retaliate against you for filing a workers compensation claim. If you feel you’re facing retaliation, it’s important to reach out to a NY Workers’ Compensation firm such as Tomack Law, PLLC.
What happens if my claim gets denied?
If your claim is denied, you have the right to challenge the decision. Tomack Law, PLLC can assist you through the entire process, including but not limited to appeals.
Do I need to cover my medical expenses upfront?
No, your medical expenses linked to a work-related injury should be taken care of by your employer’s workers compensation insurance policy. You shouldn’t be required to pay anything upfront, and it is illegal for a provider to attempt to bill a patient directly for work-related injuris.
What does Form C-3 entail? Why does it matter?
Form C-3 is the Employee Claim Form that gets submitted to the New York State Workers’ Compensation Board in order to properly report a new work-related accident claim.
Am I allowed to select my physician for workers compensation treatment?
You generally have the freedom to select your doctor for continued care as long as they are approved by the Workers Compensation Board in New York.
