Workers Compensation in New York

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 Is Workers’ Compensation Mandatory in New York?

Pursuant to the workers’ compensation laws in the State of New York, an individual who has a work-related injury or illness may be entitled to benefits. These benefits can compensate workers for lost wages and medical treatment that is required due to illness or injuries sustained on the job.

In the State of New York, workers and employers have specific rights and duties under the law. Under New York laws, the majority of employers are required to have workers’ compensation insurance.

What Is the Penalty for Not Having Workers’ Compensation?

Under New York labor laws, there are penalties for not having workers’ compensation, which vary depending on how many employees they have. An employer could have five or fewer employees. In this case, failing to secure workers’ compensation coverage within a 12-month period is punishable by a fine that ranges between $1,000 and $5,000.

An employer may have more than five employees. If so, failing to secure workers’ compensation coverage within a 12-month period is a Class E felony that is punishable by a fine ranging between $5,000 and $50,000, in addition to any other penalties that may apply. If an individual has any questions regarding these penalties, they should consult with a local New York attorney.

Who Is Eligible for Workers’ Compensation in New York?

The workers’ compensation system in the State of New York covers the following workers:

  • All employees at for-profit businesses in New York State;
  • Most employees at non-profit organizations;
  • Many workers who might be characterized as independent contractors are as follows:
    • Workers who are injured while performing work for a contractor are considered employees of the contractor for:
      • Workers’ compensation;
      • Disability benefits;
      • Paid family leave;
    • An independent contractor does not have to be a resident of New York in order to be eligible for workers’ compensation coverage. However, they must have worked in the state during the accident or other incident that caused their injury.

How Do I File a New York Workers’ Compensation Claim?

If a worker suffers a work-related illness or injury, they should notify their employer immediately. In addition, they should notify the human resources department, if there is one, of their condition and request benefits.

It is important for an individual to seek medical attention right away if there is an emergency, such as a torn muscle or broken leg. Medical help should be the number one priority if an individual needs medical attention.

A worker should notify their employer within 30 days of an injury or two years of the onset of an occupational illness. If the 30-day deadline is missed, an individual may lose their right to receive workers’ compensation benefits.

An individual may begin the process of obtaining workers’ compensation benefits by filing the C-3 claim form online with the New York Workers’ Compensation Board. An individual may obtain paper forms from their employer or the Workers’ Compensation Board.

An individual might not have access to a computer. If not, they can file their claim in person at any of the nine statewide Workers’ Compensation Board offices or satellite service centers. The paper forms can be mailed to the Workers’ Compensation Board using the United States Postal Service.

The C-3 form has to be filed within two years of the injury or onset of the illness. Once an individual has filed a claim for benefits, their employer’s insurance company will investigate their claim.

Usually, the insurance company will review the individual’s medical records as well as other information that is relevant to their claim. If the claim is approved, the individual should start receiving benefits.

It is important to carefully complete the C-3 claim form. It is important to read the entire form before filling it out.
Insurance companies will typically try to pay out as little as possible. If an individual is uncomfortable filling out their form, a New York workers’ compensation lawyer can help.

Examples of information that is required by the form include:

  • The employer’s name and address;
  • The dollar amount that an individual earns in gross wages per pay period before taxes and any other amounts are deducted from their paycheck;
  • The names and addresses of any other employers the individual worked for at the time they were injured or became ill;
  • The name and address of the doctor or hospital that provided the individual with their first treatment for the injury or illness.

What if My Claim Is Denied?

If an individual’s workers’ compensation claim is denied, they can appeal. When an individual appeals, there will be a hearing before a panel of three judges of the State Board.

An individual should file their application for Board review within 30 days of the date that their claim was denied. Their employer or insurance company has 30 days to file a rebuttal.

Research shows that more than two-thirds of claims that are initially denied will be paid within 12 months of being denied. In addition, the worker will often collect more than they would have if their claim had been paid the first time.

A New York workers’ compensation lawyer can be the difference in an individual’s claim being successful. It is also important to have a lawyer if an individual appeals a denial.

What Does Workers’ Compensation Cover?

Workers’ compensation benefits are benefits that are paid to individuals who have suffered injuries or illnesses on the job as a result of their work. The injured or ill worker will be required to show that their injury or illness arose from their employment.

A pre-existing condition may also be covered if the worker can show that their work activities significantly aggravated their condition. The worker would need medical evidence that showed that their work aggravated or worsened their injury.

Can I Recover Other Damages in Addition to Workers’ Compensation?

Workers’ compensation is a worker’s only remedy for a work-related injury or illness. This means that an individual typically cannot sue their employer for negligence or request compensation for pain and suffering. This is referred to as the exclusive remedy rule. It is important to note that there are exceptions to the exclusive remedy rule in New York.

An individual may file a negligence lawsuit if:

  • Their employer does not have workers’ compensation insurance;
  • A third party was responsible for the injuries the worker suffered.

Fellow employees are typically not third parties and cannot be sued for negligence. A valid third-party claim may involve:

  • Motor vehicle accidents;
  • Premises liability if an individual is injured on a third party’s property and the owner is insured;
  • Strict product liability claims.

What Do Workers’ Compensation Benefits Cover?

The benefits provided to compensate an injured or ill worker may include:

  • The cost of medical treatment;
  • Compensation benefits for wage loss;
  • Vocational rehabilitation, if the individual cannot continue in the same job;
  • Death and survivor benefits if the worker was killed.

Every workers’ compensation claim in New York is different. An individual’s benefits may differ by individual, depending on the severity of their medical condition and their ability to return to work.

There are three types of compensation benefits provided under New York law:

  • Temporary disability;
  • Permanent disability;
  • Permanent total disability.

The benefits are usually paid at a rate of two-thirds of an individual’s average weekly wage. Benefits, however, may also be paid proportionately based on the individual’s degree of disability.

It is important to note that there may be a cap on the amount of the benefits.

What Are Temporary Disability Benefits?

Once an injured worker is disabled for over seven days, they can be paid temporary disability benefits. The worker will receive two-thirds of their average weekly wage, then multiplied by the degree of their disability expressed as a percentage value.

What Are Permanent Total Disability Benefits?

Once an individual reaches their maximum medical improvement, they may be eligible for permanent disability benefits if they have not fully recovered. If an individual is totally disabled by their injuries, they will receive two-thirds of their average weekly wage for as long as they are disabled.

What Are Permanent Partial Disability Benefits?

There are two types of permanent partial disability benefits in New York. These benefits may provide an individual with an award of benefits for a permanent partial disability for either a scheduled or non-scheduled loss.

An individual is paid a scheduled loss of use (SLU) benefit for the following:

  • An amputation;
  • Functional loss of a body part;
  • Facial disfigurement.

An SLU award is only paid for injuries that are listed on the state’s schedule. Depending on an individual’s injuries, they will receive two-thirds of their average weekly wages for a specific number of weeks.

SLU benefits are paid regardless of the individual’s ability to work after their injury or illness.

Do I Need a New York Lawyer for Help With My Workers’ Compensation Issue?

If you need workers’ compensation in the State of New York, it is important to consult with a New York workers’ compensation lawyer. Workers’ compensation laws can be technical and complex, and the success of your claim may depend on medical experts.

Your attorney can review your claim, help maximize your benefits, and appeal a denial if necessary. Having an attorney is your best chance at a successful claim.

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