If you have a work-related injury or illness, you may be entitled to New York workers compensation benefits. These benefits can provide financial support and medical coverage while you are recovering from your injuries or illness.
However, New York workers have specific rights and duties under the law. It is important that you understand New York’s workers compensation system before you file a claim for benefits.
How Do I File a New York Workers Compensation Claim?
Under New York law, most employers must carry workers compensation insurance. If you suffer a work-related injury or illness, you should immediately notify your employer of your condition and request benefits.
If you fail to notify your employer within 30 days of the injury (or within two years of suffering an occupational illness), you may lose your right to workers comp benefits. You also must file an “Employee’s Claim for Compensation” with the New York Workers Compensation Board within two years of your illness or injury.
Once you have made a claim for benefits, your employer’s insurance company will investigate your claim. Typically, the insurance company will review your medical records and other information. If the company approves your claim, you should start receiving benefits.
If your claim is denied, you have the right to appeal. On appeal, you will have a hearing before a workers’ compensation judge.
What Does Workers Compensation Cover?
Workers compensation benefits are paid to workers who have suffered work-related injuries and illnesses. In order to be work-related, you must show that your injury or illness arose out your employment.
Pre-existing conditions may also be covered, if you can show that your work activities significantly aggravated the condition. You will need medical evidence showing that your work aggravated or worsened your injury.
Can I Recover Any Damages Along with Workers Compensation?
Typically, workers compensation is an employee’s exclusive remedy. This means that you cannot sue your employer for negligence or request compensation for pain and suffering.
However, there are some exceptions to New York’s exclusive remedy rule. You may file a negligence lawsuit if:
- Your employer did not have workers compensation insurance, or
- A third party was responsible for your injuries.
- A fellow employee is typically not a third party—and cannot be sued for negligence. Third parties claims may involve motor vehicle accidents, premises liability, or product liability claims.
What Type of Workers Compensation Benefits Can I Qualify For?
An injured worker’s benefits may include coverage of:
- Medical treatment,
- Compensation benefits (for your wage loss),
- Vocational rehabilitation, and
- Death and survivor benefits.
Every New York workers compensation claim is different. Your benefits may vary, depending on the severity of your medical condition and your ability to return to work.
There are three types of compensation benefits under New York law. They include temporary, permanent partial, and permanent total benefits. Benefits are typically paid at a rate of two-thirds of your average weekly wage. However, benefits may also be paid proportionately (based on your degree of disability) and are capped by a maximum benefit amount.
Temporary Disability Benefits
Temporary disability benefits are paid once an injured worker has been disabled for more than seven days. You will receive two-thirds of your average weekly wage, multiplied by your percentage of disability.
A worker suffers a head injury, resulting in a post-concussive syndrome. For a period of time, he is completely disabled. His pre-injury average weekly wage was $600. His temporary benefit rate will be $400 per week (two-thirds of $600).
Another worker undergoes a work-related carpal tunnel surgery. His injury results in a 40% disability. His pre-injury average weekly wage is also $600. He should receive a temporary disability benefit of $160 per week (40% of his workers’ compensation rate).
Permanent Total Disability Benefits
Once you reach maximum medical improvement, you may be eligible for permanent disability benefits. If you are totally disabled by your work injuries, you will receive two-thirds of your average weekly wage for as long as you are disabled.
Permanent Partial Disability Benefits
New York workers’ compensation law recognizes two types of permanent partial disability benefits. You may receive a permanent partial award for either a scheduled or non-scheduled loss.
Scheduled Loss of Use
Scheduled loss of use (SLU) benefits are awarded for:
- An amputation,
- Functional loss of a body part, or
- Facial disfigurement.
SLU awards are only paid for injuries listed on New York’s schedule. Depending on your injury, you will receive two-thirds of your average weekly wage for a set number of weeks. SLU benefits are paid regardless of your ability to work.
A worker completely loses vision in one eye, due to a work injury. His average weekly wage was $600. Under the schedule, he is entitled to 160 weeks of SLU benefits. He will receive $400 a week for 160 weeks.
Due to a crush injury, another worker loses all functional use of her hand. Her average weekly wage was $500. The schedule allows for 244 weeks of SLU benefits. She will receive an SLU award of $333 for 244 weeks.
If you suffer a partial amputation or functional loss, benefits may be paid proportionately.
A worker suffers a partial amputation of her first finger. Her doctor finds that she lost 25% function in the finger. The schedule allows a maximum SLU benefit of 46 weeks. She will receive 11.5 weeks of SLU benefits (25% of 46 weeks).
If your injury involves a body part that is not listed on the schedule, you may be entitled to a non-scheduled loss benefit. Non-scheduled losses may include injuries to your back and lungs. You will receive two-thirds your average weekly wage (multiplied by your percentage of disability.)
Do I Need a New York Lawyer?
If you have questions about workers comp, you should probably speak with a New York workers compensation lawyer. A workers’ comp lawyer can evaluate your claim, maximize your benefits, and appeal a denial (if necessary).