New York State has a workers’ compensation system that was one of the first in the U.S. New York’s workers’ compensation law came into existence after the tragedy at the Triangle Shirtwaist Company in New York City in 1911, in which 146 women died. It was one of the worst factory fires in U.S. history. The fire prompted a change in the New York State Constitution, which allowed the state’s workers’ compensation system to be adopted in 1914.
In New York State, a person with a work-related injury or illness may be entitled to benefits under the state’s workers’ compensation system. These benefits compensate for lost wages and medical treatment required by illness or injuries sustained on the job.
In New York, employers and workers have specific rights and duties under the law. A person must understand New York’s workers’ compensation system before filing a benefits claim.
Who Is Eligible for Workers’ Compensation in New York?
Eligibility for workers’ compensation in New York is quite straightforward. The system 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:
- Since October 2010, workers who are injured while performing work for a contractor are considered employees of the contractor for workers’ compensation, disability benefits, and paid family leave. Eligibility is subject to exception for independent contractors, per a legal test that is applied;
- An independent contractor does not have to be a resident of New York State to be eligible for workers’ compensation coverage. They must have worked in the state during the accident or other event that caused their injury.
How Do I File a New York Workers Compensation Claim?
Under New York law, most employers must have workers’ compensation insurance. If a worker suffers a work-related injury or illness, they should immediately notify their employer and their employer’s human resources department, if they have one, of their condition and request benefits.
Of course, it is always important to get medical attention right away in cases of emergency, such as a broken leg or torn muscle, for example. Getting that should be the number one priority if a person needs immediate medical attention.
Within 30 days of an injury or 2 years of the onset of an occupational illness, a worker should notify their employer if they have not done so already. If this 30-day deadline is missed, a person might lose their right to workers’ compensation benefits.
A person may begin the claims process by filing the C-3 claim form online with the New York Workers Compensation Board. Or, a person may get paper forms from their employer or the Workers Compensation Board. If a person does not have access to a computer, they can file a claim in person at any of the 9 statewide Workers’ Compensation Board offices or satellite service centers to file a claim. Paper forms can also be mailed to the Board via the United States Postal Service. The C-3 form must be filed within 2 years of the injury or onset of the illness.
Once a person has filed a claim for benefits, their employer’s insurance company investigates the claim. Typically, the insurance company reviews the person’s medical records and other information relevant to their claim. If the company approves the claim, the person should start receiving benefits.
Experts recommend that a person take great care in filling out the C-3 claim form. They suggest reading through the entire form before beginning to fill it out. It is important to remember that an insurance company’s job is always to pay out as little as possible. So it pays to take the time to fill out the C-3 form carefully. If someone is uncomfortable filling out the form on their own, they can consult a New York workers’ compensation lawyer for help.
Some of the information that is requested by the form is as follows:
- The employer’s name and address;
- The dollar amount that a person earns in gross wages per pay period. This means before taxes and any other amounts are deducted from a person’s paycheck;
- The names and addresses of any other employers the person worked for at the time they were injured or became ill;
- The name and address of the doctor or hospital that provided the person with their first treatment for the injury or illness.
What If My Claim Is Denied?
If a workers’ compensation claim is denied, a person can appeal. On appeal, there is a hearing before a panel of three judges of the State Board. A person should file their application for Board review within 30 days of the date on which their claim is denied. The person’s employer or insurance company has 30 days to file its rebuttal.
Experts assert that research shows that more than two-thirds of claims initially denied are paid within 12 months of the denial. Moreover, the worker often collects more than they would have gotten in benefits if the claim had been paid in the first place. An experienced New York workers’ compensation lawyer representing the worker may make the difference. So, it is a good move to have a lawyer represent a worker on appeal of a denial.
What Does Workers Compensation Cover?
Workers’ compensation benefits are paid to workers who have suffered injuries and illnesses on the job or caused by their work. The ill or injured worker must show that their injury or illness arose from their employment.
Pre-existing conditions may also be covered if a worker can show that their work activities significantly aggravated the condition. A worker would need medical evidence showing that their work aggravated or worsened their injury.
Can I Recover Other Damages in Addition to Workers’ Compensation?
Workers’ compensation is an employee’s only remedy for a work-related illness or injury. This means a person usually cannot sue their employer for negligence or request compensation for pain and suffering. This is called the “exclusive remedy rule.”
There are exceptions to the exclusive remedy rule in New York. A person may file a negligence lawsuit if:
- Their employer does not have workers’ compensation insurance,
- A third party was responsible for the worker’s injuries.
A fellow employee is usually not a third party and cannot be sued for negligence. Valid third-party claims may involve motor vehicle accidents, premises liability if a person is injured on a third party’s property and the owner is insured, or strict product liability claims.
What Do Workers’ Compensation Benefits Cover?
An injured worker’s benefits compensate the ill or injured worker for the following:
- The cost of medical treatment,
- Compensation benefits for wage loss,
- Vocational rehabilitation, if the person cannot continue in the same job, and
- Death and survivor benefits if the worker is killed.
Every New York workers’ compensation claim is different. A person’s benefits may differ from those of a different person, depending on the severity of their medical condition and their ability to return to work.
New York law provides three types of compensation benefits. They are benefits for temporary disability, permanent partial disability, and permanent total disability benefits. Benefits are typically paid at a rate of two-thirds of a person’s average weekly wage. However, benefits may also be paid proportionately based on a worker’s degree of disability. A maximum benefit amount caps benefits.
What Are Temporary Disability Benefits?
After an injured worker has been disabled for over seven days, they are paid temporary disability benefits. The worker receives two-thirds of their average weekly wage, multiplied by the degree of their disability expressed as a percentage value.
For example, a worker might suffer a head injury, resulting in post-concussion syndrome and complete disability for a period of time. Their pre-injury average weekly wage was $600. Their temporary benefit rate will be $400 weekly, two-thirds of $600.
Another worker undergoes work-related carpal tunnel surgery, and their injury results in a 40% disability. Their pre-injury average weekly wage is also $600. They should receive a temporary disability benefit of $160 per week, 40% of their workers’ compensation rate.
What Are Permanent Total Disability Benefits?
Once a person reaches their maximum medical improvement, they may be eligible for permanent disability benefits if they have not fully recovered. If a person is totally disabled by their injuries, they receive two-thirds of their average weekly wage for as long as they are disabled.
What Are Permanent Partial Disability Benefits?
New York workers’ compensation law recognizes two permanent partial disability benefits. A person may receive an award of benefits for a permanent partial disability for either a scheduled or non-scheduled loss.
A person is paid a scheduled loss of use (SLU) benefit for the following:
- An amputation,
- Functional loss of a body part, or
- Facial disfigurement.
SLU awards are paid only for injuries listed on the state’s schedule. Depending on a person’s injury, they are going to receive two-thirds of their average weekly wage for a set number of weeks as an SLU benefit. SLU benefits are paid regardless of a person’s ability to work after the injury or illness.
For example, a worker may completely lose their vision in one eye in an injury on the job. Their average weekly wage was $600. According to the schedule, they are entitled to 160 weeks of SLU benefits, so that they would receive $400 a week for 160 weeks.
Or, suppose that a worker loses all functional use of their hand in a crush injury. Their average weekly wage was $500. The schedule indicates that the worker should be paid 244 weeks of SLU benefits. They would receive an SLU award of $333 for 244 weeks.
Or, a worker may suffer a partial amputation of their first finger. Their doctor finds that they have lost 25% of the function of their finger. The schedule indicates that the maximum SLU benefit should be paid for 46 weeks. The worker will receive 11.5 weeks of SLU benefits, 25% of 46 weeks.
Do I Need a New York Lawyer for Help with My Worker’s Compensation Issue?
Workers’ compensation law can be complicated and technical. The success of a claim can depend on skillfully deploying medical experts. If you have a workers’ compensation claim, you want to consult a New York workers’ compensation lawyer.
Your lawyer can evaluate your claim, maximize your benefits, and appeal a necessary denial. Your lawyer knows the system and can make it work for you.