[2019] The Ultimate Guide to Workers’ Compensation Laws in New York

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If you’ve been injured in a workplace accident, you may be entitled to claim workers’ compensation benefits from your employer. The workers’ comp process can be confusing and entail many different events. You may have a lot of questions regarding the process, benefits, and what you can and can’t do in certain situations.

People frequently wonder what compensation they are entitled to if their specific injuries are covered, and what steps to take during the workers’ comp process. Other questions include what steps to take in certain situations, such as what to do if your claim is denied, whether pre-existing conditions will hurt your claim, how much workers’ compensation will pay out and for how long, and whether you have to comply with certain requests by the workers’ comp insurance company, among many other questions. Our New York legal team is here to answer your questions about workers’ comp and the entire process of filing a claim.

Below is a list of frequently asked questions about workers’ compensation in New York that our legal team is here to answer. If you have any additional questions, please don’t hesitate to contact us. A skilled workers’ comp attorney can make filing your claim and handling any and all aspects of the workers’ comp process as smooth as possible, and make sure you get the maximum benefits that you are entitled to after a workplace accident.

What is Workers Compensation?

New York Workers’ compensation insurance provides cash benefits and/or medical care for workers in NY that are injured or become ill as a direct result of their job. Employers pay for this insurance and aren’t allowed to require an employee to contribute to the cost of compensation. Any weekly cash benefits or medical care that you receive are paid by your employer’s insurance carrier, as directed by the Workers’ Compensation Board. As a state agency, the Workers’ Compensation Board processes the claims and if it is necessary for the Board to intervene in the matter, it will determine whether the insurer will reimburse you with cash benefits and/or medical care, and the amounts that you will receive.

Whether you’re on Wall Street or working Upstate, if you’re ever injured on the job or suffer a work-related illness while working in New York, there are several laws of which you should be aware. New York requires all employers to carry workers’ compensation insurance coverage, including most employers of domestic and agricultural workers and knowing your rights can be critical when considering filing a workers’ compensation claim.

Am I Eligible for Workers’ Compensation?

In New York, any employee who is injured in an on-the-job accident is eligible for workers’ compensation. If you have been involved in a workplace accident, you will have to report the injury to your employer and file a claim with your employer’s workers’ comp insurance company. Your eligibility is not affected by the circumstances of the accident, or whether or not you or your employer was at fault. Your employer’s payment into the New York State Workers’ Compensation Fund means that you are eligible to claim this payment from the state fund through the workers’ comp insurance. The only situation in which you will not be entitled to workers’ comp after a workplace accident is if your injury resulted solely from your intoxication due to alcohol or drugs, or from the intent to injure yourself or someone else.

What Should I Do if I Have a Workplace Accident or Injury?

If you have been involved in a workplace accident, there are a few steps you should take to ensure the claims process is as smooth and problem-free as possible.  Firstly, you should contact a New York workers’ comp attorney as soon as possible.  A New York attorney will have the knowledge and skill to handle your case and advise you about the best possible steps to take, as well as crafting a defense on your behalf in case you encounter any snags in the claims filing process.  It is additionally important to report your injury to your employer right away and to file your claim as soon as possible.  Any delay in reporting your injury or filing a claim may be later used against you to dispute the validity of your claim or the nature of your injuries.

You should make a note of what kind of work you can do and whether or not you can work at all.  If you can work with restrictions such as reduced time, not lifting more than a certain weight or reduced movement, then you may want to return to work and work within these constraints.  Just make sure to document any further injuries or illness that occurs while you are working.  If you were working within your restrictions and were re-injured, then this may strengthen your argument for a different disability classification or increased benefits.

Take care to document any changes in your condition and injuries, and seek medical attention for these and report it to your employer right away.

What Types of Injuries Does NY Workers’ Comp Cover?

Workers’ compensation covers any injuries sustained in an on-the-job accident as well as any necessary medical care as a result of these injuries and cash benefits based on the wage-earning capacity of the employee due to the injury or illness.  It does not matter if the injuries were the result of the employee’s negligence, as long as the injuries were sustained in the course of his or her work.

The only workplace injuries that are not covered by workers’ comp are those that result from the employee’s intoxication or from an intent to harm oneself or others.

How Much Will Workers’ Comp Pay?

Costs for medical and treatment costs are paid out immediately regardless of how long the injury lasts or the disability classification.  Cash benefits will be paid out if the condition lasts for more than seven days and are calculated on a percentage basis of the employee’s wages.  How long the employee is eligible to receive benefits is determined on a weekly schedule based on his or her loss of wage-earning capacity.

 

Workers’ compensation claims will pay two-thirds of the average of your weekly wages pre-tax up to the maximum amount of benefits allowed for your particular injury.  A New York workers’ comp attorney can help you get a true, fair value of your average weekly wage so that you are not short-changed on the amount of benefits you are paid.

 If you have been disfigured to your head, face, or neck seriously and permanently, you may be entitled to up to $20,000 compensation depending on the date of injury.

How Long Can I Receive Workers’ Comp?

In New York, workers’ compensation cases do not involve a determination of fault.  The amount that you receive is not decreased or increased based on you or your employer’s negligence.  A predetermined schedule determines the amount of benefits according to the classification of your disability.

The New York State Workers’ Compensation provides are a maximum time limit set out in weeks that a person may receive workers’ compensation benefits according to the percentage of wage-earning capacity loss and the date of injury.

The most recent class of time limits ranges from 300 weeks for a 40–50% loss of wage-earning capacity to 525 weeks for a 95–100% wage-earning capacity loss.

For a full list of maximum time limits for receiving workers’ compensation, visit the New York State Workers’ Compensation Board site here.

What Are the Different Classifications of Wage-Earning Capacity?

The different classifications of wage-earning capacity are determined according to different levels of disability provided by the New York State Workers’ Compensation Board.

 

Permanent partial disability is a permanent loss of part of an employee’s wage-earning capacity.  This can be either a scheduled loss of use disability involving loss of use of any part of an extremity or loss of hearing or eyesight on a permanent basis.  A scheduled loss of use disability entitles the employee to benefits for a number of weeks depending on the body part and disability.  A non-schedule disability is any permanent partial disability that is not a scheduled loss of use injury, usually involving a vital organ.

 

Temporary partial disability is a partial loss of the employee’s wage-earning capacity for a temporary amount of time.

Temporary total disability is a total loss of wage-earning capacity but only for a temporary amount of time.

Permanent total disability is a permanent and total loss of an employee’s wage-earning capacity and this type of disability.

What Is the Time Limit for Filing a Workers’ Comp Claim?

The time limit to notify your employer of your work-related illness or injury is 30 days.  The time limit to file a workers’ comp claim in most situations is two years from the date of the incident, and claims due to disability from hearing loss but me submitted either within two years of the date of injury or within 90  days of realizing the hearing loss is due to an incident or condition at your workplace.  Even though you have two years to file a claim, it is important to file your claim as soon as possible.

 

Compensation benefits will not be allowed for the first seven days of disability; however, if the injuries or illness result in impairment for more than 14 days, the payment shall be recognized from the date of the disability (meaning you will be compensated for the first seven days of disability at the 14-day mark).

 

One critical thing to remember is to seek treatment from doctors that are authorized by the New York State Workers’ Compensation Board if you require medical treatment for your work-related injuries.  To find WCB authorized doctors, you may visit the medical provider search on the WCB website, see NY’s top workers’ comp doctors here,  or go to  Injured Call Today.com. You can also call 1-800-897-8440 if you need help finding a workers’ comp doctor near you.

Workers’ Compensation Law for New York is fairly straightforward and is designed to protect both the employee and employer.  The advocates here, at Accident Help Zone, specialize in helping those injured on the job and know what it takes to ensure that you get what you deserve after a workplace accident or illness.  Knowing your rights and obligations under New York law for Workers’ Compensation could be the difference between a comfortable recovery and a worry-filled accident or illness.

Are Subcontractors Covered Under Workers’ Comp?

Section 306 of New York’s Workers’ Compensation Law provides that a contractor whose work involves hazardous conditions and who subcontracts any part of the job out is responsible for compensating employees in the case of death or injury if the employer would normally be required to make payments into the state special fund.

This means a subcontractor can file a workers’ compensation claim with the contractor for on-the-job injuries if their job contains hazardous conditions.  These types of jobs can include construction, factory work, or other jobs where dangerous conditions are a normal part of the job.

My Workers’ Comp Claim was Denied. What Are My Options?

If your workers’ comp claim was denied, it is important to consult a workers’ comp attorney in New York to explore your options and to prepare the best case on your behalf.  If you disagree with the denial of a workers’ comp claim, you may request a hearing before the New York Workers’ Compensation Board to appeal the decision by the workers’ comp insurance company and present evidence about the true nature of your injuries and the ability for you to work.

Can I Sue My Employer for a Workplace Injury?

According to Section 53 of the New York Workers’ Compensation Law, employers that contribute premiums to the New York state fund are released from liability for injuries or death sustained by any employee. In other words, the only recourse for compensation that you have is via the state fund and not your actual employer.

This means you will not be able to sue your employer for any workplace injuries if they have workers’ compensation insurance and contribute to the New York Workers’ Compensation Fund.

I’ve been Requested to Undergo an Independent Medical Exam (IME). Do I have to Attend?

After filing a workers’ compensation claim, the workers’ comp insurance company will often ask you to undergo an Independent Medical Examination (IME) with an IME physician of its choice.

This will involve a separate evaluation of your injuries or illness to make another determination of the nature and severity of your condition and whether or not you are able to work.

The IME can often be a basis for the insurance company to counter the extent and effect of your injuries on your wage-earning capacity, resulting in a reduction or termination of your benefits.

If you have been called for a workers’ comp IME, you may think about not attending to avoid hurting your compensation; however, not attending an IME will often result in the termination of your benefits by the insurance company.

Your best bet is to attend the IME and be completely honest with the worker’s comp IME physician.  Any inconsistencies in your statements or falsities can be used against you later.  It is best to consult a New York workers’ comp attorney to advise you about the IME process and help you through any of the next steps.

My Workers’ Comp Benefits Were Reduced or Terminated after the IME. Is This Allowed?

Often, after undergoing an IME, the workers’ comp IME physician will issue a report that contradicts your doctor’s findings.  The report may say that you can work with restrictions or that you have reached maximum recovery for your injuries.

Unfortunately, the insurance company can use these findings as a basis to limit or cut off your workers’ comp benefits until you are able to successfully appeal the decision with the New York State Workers’ Compensation Board or are able to arbitrate the dispute.

Can My Employer Fire Me for Missing Work After an Injury?

If your workers’ compensation claim is denied, you are cleared for work by an IME physician, or you are determined to have reached maximum recovery, you may be required to return to work.

Although you can appeal this decision with the New York State Workers’ Compensation Board at a workers’ comp hearing, not returning to work after you have been determined to be able to work may serve as a basis for your employer to fire you.  Of course, if you are unable to work because of your injuries, you should not risk re-injuring yourself unless you can work with certain restrictions.  This is why it’s important to contact an experienced workers’ comp attorney to help expedite the appeals process and advise you about your best next steps if you have been prematurely cleared to work.

What Is a Workers’ Comp Hearing?

A workers’ compensation Hearing is a hearing conducted by the New York Workers’ Compensation Board.  There are a few situations in which you may need to attend a workers’ compensation hearing.  After filing a claim for a workplace injury or illness, you may be asked to attend a hearing before the Board so that a judge may determine the nature of your injury or illness.

If you disagree with the classification of your injury, or your claim has been denied, you can also request a hearing to appeal the decision.  At the workers’ comp hearing, you will be asked to present evidence that shows that your injury or illness is more severe than what the workers’ compensation insurance has determined it is, or that you are unable to work.  After the judge has rendered an opinion, you may appeal the judge’s decision if you disagree with his or her findings.

A workers’ comp attorney in New York can represent you on your behalf at a workers’ comp hearing, and collect all the necessary evidence to prepare the best case to receive the benefits you are entitled to. The insurance company will almost surely be represented by counsel, so it is absolutely beneficial for you to have a skilled attorney on your side.

Can I Still Get Compensation if I Was Injured but Didn’t File a Workers’ Comp Claim?

If you missed the time limits for filing a workers’ compensation claim, you may be in a sticky situation. Since employers who contribute to the New York State Workers’ Compensation Fund are released from liability for any workplace accidents, the only compensation available is through the state fund and you may not be able to obtain benefits and medical care.

This is why it is important to report your injuries and file a workers’ comp claim as soon as possible after you have been injured, even if your injuries aren’t immediately apparent. Symptoms can sometimes take a while to manifest, and it is important to the claims process that you report any accidents or injuries within the deadline.

If you missed the deadline for filing a workers’ comp claim and are suffering from injuries from a workplace accident, contact a New York workers’ comp attorney right away to advise you of your options

Will a Pre-Existing Injury or Condition Hurt My Workers’ Comp Claim?

If you have an injury or condition that was worsened by a workplace accident, you are not barred from receiving workers’ comp just because you had a pre-existing injury or condition at the time of the accident.

Many insurance companies will attempt to dispute the nature of your injuries using your pre-existing condition. They may argue that the pre-existing injury or condition was the actual cause of your injury or symptoms or that your worsened condition is not due to the workplace accident. A New York workers’ comp attorney can help you fight such findings and make sure you are not denied any compensation you are entitled to.

The Insurance Company Wants Me to Make a Recorded Statement and Sign Medical Releases. Do I Have to Do This?

Whether you are required to give a recorded statement depends on the insurance contract for your employer’s workers’ comp policy. Some may include a cooperation clause that requires you to give a recorded statement to an insurance adjuster in order to be eligible for benefits. Contact your attorney so that he can look at the language of the contract and advise you of what you are or are not obligated to do. If you are obligated to give a statement, the information can be used against you in the claims process, so it is important to ask your attorney to request a written transcript of the statement.

You do not have to sign any medical releases that you receive from the insurance company, nor should you. If you receive these, contact your attorney right away.

What Should I Do If I Need Further Medical Care After the Resolution of My Claim?

If you should require further medical care after the resolution of your workers’ comp claim, a New York workers’ comp attorney can make sure you are able to receive compensation in the future.

Workers’ comp insurance attorneys may attempt to entice you to sign a release of liability or enter into a settlement of your claims. This is so that they are protected from any future obligation to pay for injuries that arise in the future.

An experienced workers’ comp attorney can also advise you of your rights, the best steps to protect your rights to compensation in the future, and the best steps for you to take.

Will Hiring a Workers’ Comp Attorney Be Helpful?

If you have been injured on the job, consulting an attorney as soon as possible is not only beneficial but potentially crucial to the success of your workers’ comp claim.

An expert attorney can represent you at any proceedings such as hearings or depositions, make arguments on your behalf, and make sure that you get what you are entitled to for your injuries and medical care.  Don’t rely on the insurance company’s findings, as they are obligated to their insured, your employer.  Their obligation is to their insured, and they often do not have your best interests in mind.

Contact an experienced workers’ compensation attorney today to get advice and a rundown of your workers’ comp options.