19 Mar Workers’ Compensation Claims: A Complete Guide

Workers’ Compensation Claims: A Complete Guide

A workplace injury can turn your life upside down in an instant. Medical bills pile up, you can’t work, and you’re left wondering how you’ll support yourself and your family. New York’s workers’ compensation system exists to provide benefits to workers injured on the job — but navigating the claims process can be complicated and frustrating. This guide explains everything you need to know about workers’ compensation claims in New York.

What Is Workers’ Compensation?

Workers’ compensation is a state-mandated insurance program that provides benefits to employees who suffer work-related injuries or illnesses. Unlike a personal injury lawsuit, workers’ compensation is a no-fault system — meaning you can receive benefits regardless of who was at fault for your injury, as long as the injury occurred in the course of your employment. In exchange, workers typically cannot sue their employers directly for a work injury, though there are important exceptions.

Who Is Covered by Workers’ Compensation in New York?

Nearly all employers in New York State are required to carry workers’ compensation insurance. Most employees are covered, including full-time, part-time, and seasonal workers. However, independent contractors are generally not covered, though misclassification of workers as independent contractors is a common issue that an attorney can help address. Undocumented workers are also generally covered under New York law.

Types of Workers’ Compensation Benefits

Medical Benefits

Workers’ compensation covers all reasonable and necessary medical treatment related to your work injury, including doctor visits, emergency care, surgery, hospitalization, physical therapy, prescription medications, and medical equipment such as crutches or wheelchairs. You must generally treat with authorized medical providers unless it is an emergency.

Disability Benefits

If your injury prevents you from working, you may receive weekly wage replacement benefits. The benefit amount is generally two-thirds of your average weekly wage, subject to a maximum set by the state. Benefits are classified as temporary total disability (you can’t work at all temporarily), temporary partial disability (you can work in a reduced capacity), permanent total disability (you can never return to work), or permanent partial disability (you have a permanent impairment but can work in some capacity).

Death Benefits

If a worker dies from a work-related injury or illness, their surviving spouse and dependents may be entitled to weekly death benefits and a burial expense allowance.

How to File a Workers’ Compensation Claim

The first step after a work injury is to report it to your employer immediately — New York law requires you to notify your employer within 30 days of the injury. You should also seek medical attention promptly and tell your doctor the injury occurred at work. Your employer’s workers’ compensation insurance carrier will be notified and will investigate your claim.

To formally file a claim, you must file a C-3 form (Employee Claim) with the New York Workers’ Compensation Board within two years of the injury or within two years of when you knew or should have known the injury was work-related. Missing this deadline can permanently bar your right to benefits.

Common Reasons Workers’ Comp Claims Are Denied

Unfortunately, insurance companies frequently deny or dispute workers’ compensation claims. Common reasons for denial include claims that the injury didn’t occur at work, that it was a pre-existing condition, that the injury wasn’t reported promptly, that medical treatment was unauthorized, or that the worker was intoxicated at the time of the injury. If your claim is denied, you have the right to appeal and can request a hearing before a workers’ compensation law judge.

Third-Party Claims: Going Beyond Workers’ Compensation

In some cases, a third party other than your employer may bear responsibility for your workplace injury. For example, if you were injured due to a defective piece of equipment, you may have a product liability claim against the manufacturer. If you were injured by a negligent contractor on a job site, you may have a claim against that contractor. Third-party claims allow you to recover damages — including pain and suffering — that are not available through workers’ compensation alone.

Why You Need a Workers’ Compensation Attorney

The workers’ compensation system is designed to be employee-friendly, but in practice, insurers work hard to minimize benefits. An experienced workers’ compensation attorney can help you navigate the process, gather necessary medical documentation, represent you at hearings, and ensure you receive all the benefits you are entitled to. If you have a potential third-party claim, an attorney can pursue both simultaneously to maximize your total recovery.

At Tannenbaum, Bellantone & Silver, P.C., our attorneys help injured workers on Long Island and throughout New York get the workers’ compensation benefits and additional compensation they deserve. Contact us today for a free consultation.