What Is Workers' Compensation Insurance?

In the aftermath of an on-the-job accident, even the hardest working New Yorker may find it impossible to get up and go back to work on his or her own strength. That's why our state makes sure that employers provide workers' compensation insurance, which is a federal program that’s regulated by the state of New York. Through workers’ compensation insurance, employees have the right to receive benefits when they are seriously injured, develop an injury, or contract an illness at the workplace.

Every employer in the state of New York is required by law to purchase workers’ compensation insurance, which provides money and benefits to injured employees. These benefits replace the income that is lost when you are unable to work and help you heal as completely and as quickly as possible.

Although workers’ compensation is a government program, workers’ compensation insurance is provided by private insurance companies, and they are in business to make money. That’s why workers will often encounter obstacles in their search for compensation, even when their injuries obviously qualify for benefits. Workers have the right to seek the assistance of an attorney when filing a workers’ compensation claim.

If you are an injured employee whose workers’ compensation application has been denied, you have the right to file an appeal with the New York State Workers’ Compensation Board, the organization that is tasked with protecting the rights of employees by ensuring the proper delivery of benefits.

The New York workers' compensation lawyers at Wingate, Russotti, Shapiro, Moses & Halperin, LLP understand the toll of on-the-job injuries and their long-lasting repercussions. Our legal team has helped countless New Yorkers find success in their search for compensation and recovery from their devastating losses. To learn more about your rights and how we may be able to help you, call (212) 986-7353 and receive a FREE consultation from our skilled legal team.

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What Injuries Qualify for Workers' Compensation in New York?

If you have been injured while at work, it is vital to understand what is and is not covered by New York's workers' compensation laws. These rules create strict guidelines concerning workers and their rights to pursue compensation. Just because you were at work when you were injured does not mean that you automatically qualify for benefits.

To be covered by New York compensation laws, your injury-causing incident must fall into the following categories:

  • You must work for a company and in a capacity that is mandated to have workers' compensation coverage under New York law.
  • The injury, illness, or disability that you suffered occurred because of your job and while you were performing the duties involved in your employment.
  • You gave your employer a written notice of the incident that caused your injury or illness within 30 days of when it happened.
  • A medical report states that your injury, disability, or illness was caused by an on-the-job accident or condition.

Unfortunately, even incidents that clearly qualify for compensation may be disputed by employers and their insurance providers. You will need to collect sound evidence and the support of medical professionals to prove that you do indeed deserve compensation for as long as it is needed.

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What are Workers' Compensation Benefits in New York?

New York State law provides many different types of benefits for injured workers with the goal of preventing financial hardship and helping victims return to work as soon as possible.

If you are found to qualify for workers' compensation, you can receive benefits including:

  • Payments equal to 2/3 of your average weekly wage
  • Reduced earning compensation to make up for a decreased ability to work if you have suffered a partial disability
  • Medical treatment from doctors and chiropractors that is paid by the workers' compensation provider
  • Compensation for extremity injuries, such as damage to arms, legs, hands, and feet or a facial scar, even when the damage does not keep you from working
  • Reimbursement for traveling to doctors or therapists and out-of-pocket expenses related to your injury, such as bandages and prescriptions

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Workers’ Compensation Filing Process

Immediately after a work-related injury, or as soon as you become aware of an occupational illness, get any necessary medical attention. You will want to make copies of all medical records, bills, invoices, and receipts related to the injury, as you will need this when verifying your claim. The doctor will also need to complete a preliminary medical report and mails it to the district office within 48 hours after the accident, another important step in the claim’s process.

After receiving medical attention, submit a written notification of the injury or illness to your employer as soon as possible and within 30 days. Any claim submitted after this deadline can be denied and become ineligible for compensation. Once you have notified your employer, they are required to submit an employer report within ten days to the Workers’ Compensation Board (WCB).

Once the notice is submitted, you can then file an Employee Claim (C-3) with the WCB by mailing the form to the appropriate office. The deadline to file your claim with WCB is within two years from the date of the accident, or from the date you knew or should have known that your injury or illness was related to your employment. This means that if you have an injury that presents itself at a later date, such as a back injury or soft tissue injury, it may still be eligible for compensation.

After your claim has been filed, WCB may hold one or more hearings to determine if you are eligible for benefits. During these hearings, various aspects of your claim will need to be verified, including your medical records that were submitted by the attending physician during your treatment. Alongside your medical records, the WCB will review the employer report that was submitted after you notified your employer. The insurance company involved in your case may also require you to use a contracted network for diagnostic tests and must provide you with the name and contact information at this time.

If your claim is approved, the insurance company overseeing your workers’ compensation benefits must provide you with a written statement of your rights within 14 days after receiving the employer’s report, or when the first check is issued to you, whichever comes first. So long as your case is not disputed, the insurance company will pay you benefits every two weeks. The insurance company must also begin paying benefits within 18 days of receiving the employer’s report if lost work time is longer than seven days.

For claims that are disputed, the insurer must inform you and the WCB. In addition, all benefits are terminated when you return to work. If you are permanently disabled, workers’ compensation benefits end when the payment total is reached.

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What Can You Do If Your Claim Is Denied?

If your Workers’ Compensation claim was denied by your employer’s insurance company, you have the option to appeal. This is an extremely complicated process, and it is highly advisable to retain the services of an experienced New York Workers’ Compensation attorney. After a request for an appeal is made, the Worker’s Compensation Board will schedule a pre-hearing where the court will decide if the worker has enough evidence to go forward with a Worker’s Compensation claim.

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How Can a NY Workers' Comp Attorney Help?

Workers’ compensation benefits are based on the nature of your injuries, the amount of time you will be unable to work, and what is needed for recovery. As such, it is vital that you collect evidence and testimony that proves the true extent of your losses so that you can gain fair and full compensation. Injured workers will have to be regularly evaluated by doctors and complete hearings with the Workers' Compensation Board to prove that their injuries or disabilities are still present and preventing work.

Without workers' compensation benefits, the cost of recovery and lost wages from being unable to work can fall squarely on your shoulders with no assistance from insurance providers. A dedicated NY workers' compensation attorney can help you secure the settlement you need.

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What is Temporary Partial Disability?

Some injuries may affect a workers' ability to work, but not seriously enough to keep them from working completely. Temporary Partial Disability (TPD) is available to employees who have been injured at work and are healing from their injuries, but are still able to do light duty or restricted duty at work. If the injured worker is able to earn their salary while working light duty, then TPD may not be available. But, if the injury caused the worker to lose any salary at all, then TPD may apply.

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Does a NY Workers' Comp Case Affect Job Security?

Many workers who have been injured at work may feel that they can't bring a workers' compensation claim out of fear of losing their job. New York workers often assume that pursuing a workers' compensation claim will cost their employer money. This is not true. The vast majority of New York business carry workers' compensation insurance so they don't have to pay for worker injuries out of the company's pocket. Your workers' compensation claim should have no bearing on your job security.

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Can Domestic Workers Get Workers' Compensation?

Many New York families depend on the help of babysitters, housekeepers, gardeners, and nannies. When a domestic worker suffers an injury, it may not be clear if the homeowner is considered an employer or if the domestic workers are considered a contractor. Remember, a homeowner doesn't have to run a business to have "employees." Domestic workers may be considered "resident employees" who professionally provide household services. If a homeowner decides to hire residence employees, they must obtain workers' compensation insurance to cover domestic workers.

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Who Pays Workers' Compensation Insurance for Temporary Workers?

In New York, temporary workers who are injured will have their workers' compensation insurance covered by the staffing or temp agency that assigned the worker to their job. Temporary or seasonal workers in New York have all the same workers' compensation benefits as any regular, full-time employee.

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Finding a NYC Workers' Comp Lawyer Dedicated to Helping Injured Workers

If you or a loved one have been seriously injured in an on the job incident and your claim has been denied, we can help. Our legal team has helped countless New Yorkers find success in their search for compensation and recovery from their devastating losses. To learn more about your rights and how we may be able to help you, call (212) 986-7353 and receive a free consultation from our skilled legal team.

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Additional Information