What is Workers' Compensation in New York City?
What is Workers' Compensation?
In New York State, if you are injured while you are working, you are entitled to receive workers' compensation benefits. In fact, if you tell your doctor that you were hurt at work, you can't use any other medical insurance to pay for your treatment. Workers' compensation is best described as insurance that provides financial benefits and medical care for workers who are injured or become ill as a direct result of their job. If you are unable to work because of your on the job injury, workers' compensation will provide you with money to help replace your lost paycheck. Workers' compensation will also pay for medical treatment for your injuries, as well as prescription medicines, regardless if you miss time from work.
A claim is paid if the employer or insurance carrier agrees that the injury or illness is work-related. If the employer or insurance carrier disputes the claim, no benefits are paid until the Workers' Compensation Law Judge decides who is right. If a worker is not receiving benefits because the employer or insurance carrier is arguing that the injury is not job-related, he/she may be eligible for Disability Benefits in the meantime. Any payments made under the Disability Program, however, will be subtracted from your future workers' compensation awards.
If you are injured on the job, you must follow these simple steps to file a claim:
- You should first receive emergency treatment or other necessary medical treatment as soon as possible. Your doctor must be authorized by the Workers' Compensation Board in order for him or her to treat you. Your doctor's office will tell you if they are able to treat you under workers' compensation. However, in an emergency situation, you can be treated by any doctor, regardless if they are approved by the workers' compensation board.
- When you are hurt at work, you must notify your supervisor about your injury and how it happened as soon as possible. You can speak to your supervisor about the injury or put the claim in writing, but you must do so within thirty (30) days after the date of your accident. If you don't, you may lose the right to receive workers' compensation benefits.
- If you suffer an occupational disease from exposure to job-related conditions, such as exposure to asbestos causing asbestosis, you must file a claim within two (2) years after you became sick, or within two (2) years after you knew or should have known that the disease was work-related, whichever is later. So if you are diagnosed with an occupational disease, you must file for workers' compensation benefits within two (2) years from when you are diagnosed or you may waive your right to receive workers' compensation benefits.
- Besides notifying your employer, you must complete a Form C-3, Claim for Workers' Compensation, and mail it to the nearest Workers' Compensation Board office location. The C-3 provides your employer and the Workers' Compensation Board with specific details about you and how the accident happened. Once the C-3 is filed, the Workers' Compensation Board will open a claim file and assign a case number, which you will use to obtain medical treatment. If your claim is not filed within two (2) years from the date of your accident, you may lose your right to workers' compensation benefits.
After your claim is filed, you should continue to follow your doctor's instructions and receive any recommended treatment or tests. Workers' compensation requires that your doctor provide periodic updates of your medical condition, usually every 45 days, as long as you are receiving treatment.
From time to time, your employer or their insurance company may notify you to attend an Independent Medical Examination, or IME. At the IME, a doctor selected by your employer or their insurance company will examine you to determine if you are still in need of medical treatment or able to return to work. You must attend the IME or risk losing any further workers' compensation benefits.
The Workers' Compensation Board may schedule a hearing in your case, depending on the circumstances. You must attend any hearings as scheduled in order to receive benefits.
Cash benefits are not paid for the first seven (7) days that you are unable to work, unless your disability lasts more than fourteen (14) days. If you are out of work for more than fourteen (14) days, you may receive cash benefits from the first day of work that you missed.
If you are totally or partially disabled and unable to work for more than seven (7) days, you will receive cash benefits. The amount that you receive is based on your average weekly wage for the previous year. The Workers' Compensation Board uses following formula to calculate your benefits based upon your average weekly wage and the percentage a doctor determines that you are disabled:
2/3 x average weekly wage x % of disability = your weekly benefit
As an example, if you were earning $400 per week, which is your average weekly wage, and a doctor says that you are totally (100%) disabled, you would receive $266.67 per week. If your average weekly wage was $400, and you were partially disabled (50%), you would receive $133.34 per week based on the formula. Your weekly financial benefit cannot exceed the Weekly Maximums, regardless how much money you were making, at the time you were hurt. Depending on the date of your accident, you may be entitled to receive up to $600 per week.
If your employer or their insurance carrier disputes or contests your claim, your employer or their insurance carrier must notify the Workers' Compensation Board why they are not paying you benefits. The dispute will be resolved through a pre-hearing conference or a hearing before a workers' compensation law judge.
Although the workers' compensation system is set up so hiring a lawyer is not necessary, there are many circumstances that may arise where the need for legal representation becomes apparent. One of the most misunderstood provisions of workers' compensation is when an injured employee receives benefits from their employer without filing a claim with the workers' compensation board. They may feel that filing a claim is not necessary as they are receiving benefits but when the employer or carrier stops benefits with little or no notice, the injured worker is unable to quickly act to have the benefits reinstated. As long as a workers' compensation law judge has not ordered the employer or carrier to pay benefits, they have done so voluntarily and can stop at anytime. If you have not retained a lawyer and have not filed a claim, it may take months before your claim is established with the workers' compensation board and a hearing scheduled. All the while you will be unable to work and not receiving any financial benefits.
Workers' Compensation will continue to pay for your benefits unless a stipulation agreement or a Section 32 Waiver Agreement was entered providing for a schedule loss of use award.
A Schedule Loss of Use Award is an award that is issued by the Judge that determines the amount of loss of use you have to the injured body part (Usually limbs/digits). This percentage is determined by your treating doctors' report and any Independent Medical Examiners report. The award allows you to continue to receive medical treatment but your financial benefits may be paid to you in a lump sum award or over time, based upon your total disability rate.
A Section 32 settlement closes your workers' compensation claim forever. It pays you a lump sum of money which represents what your future medical care is anticipated to cost and your future financial benefits. Although the monetary award may be higher than that of a Schedule Loss of Use award, you are responsible for any future medical care, even if your condition gets worse or you need surgery in the future.