When to call a lawyer for your New York workers’ compensation claim
Workers’ compensation is a complex system of benefits. However, if you’re seriously injured and are facing medical bills and unsure of when (or if) you can return to work, it’s how you can remain financially stable. Here’s what you need to know.
Workers’ compensation is the legal mechanism that allows you to receive benefits if you’ve been injured at work. It’s designed to benefit the injured worker, the employer, and the legal system because it helps to keep injury cases out of the courts.
Workers’ compensation is available in all 50 states, but each has its own set of rules and benefits. New York State requires nearly every employer to carry workers’ compensation insurance coverage, including for most domestic and agricultural workers.
Workers’ compensation basics
Workers’ compensation benefits are an exclusive remedy for a person injured at work. That means if you’re injured at work, your only method for recovering costs associated with your treatment and other expenses is to file a workers’ comp claim. You are not permitted to file a lawsuit against your employer for a work-related injury.
Workers’ compensation insurance covers injuries that happen under the following circumstances:
- You were injured at your workplace. The injury doesn’t even need to be related to your actual job, as long as it happened while you were at work. This includes situations like a trip-and-fall accident or other mishap, even if you were not engaged in tasks related to your job at the time. For example, if you work as a receptionist in a medical office and you’re injured because you slipped on a wet floor while walking to the bathroom on a break, that would be included as a workers’ compensation claim.
- You were injured while performing tasks related to your job but not in your actual workplace. One example of this would be if you are in an accident while driving from one off-site location to another (to meet clients, make sales calls, etc.). Or, if you have a fall or injury at a construction site, a customer’s office or home, or any other injury that happens while you’re doing your job at another location. There are even circumstances where you would be eligible for workers’ compensation benefits while working from home.
Workers’ compensation does not cover injuries that happen if you’re on a lunch break outside of your workplace or during your commute back and forth to work.
If your boss asks you to run out and pick up their dry cleaning—even if it’s not job-related—you could claim workers’ comp for an injury that happens during that time. However, this becomes a little murkier if they ask you to do this personal errand on your way to or from work. It would depend on whether you’re “on the clock” when the injury happened.
How and when to file a New York workers’ compensation claim
1. Notify your employer
You must notify your employer/supervisor of an injury within 30 days of the date of the injury.
2. File a claim with the Workers’ Compensation Board
You must complete an Employee’s Claim for Compensation (Form C-3) within two years of the date of your injury. However, it’s advised to file your claim as soon as possible after the injury. The sooner you file a claim, the sooner you can begin receiving benefits.
The form is available from the Workers’ Compensation Board website. You also need to have your treating physician complete a C-4 form that’s submitted to the WCB to complete your claim. You do not need prior authorization for a workers’ compensation medical office visit and follow-up.
3. Do I need to take time off from work to file a workers’ comp claim?
You can receive benefits without having lost wages, but you must be receiving (or have received) medical treatment related to the injury to make a claim.
Types of benefits from a New York workers’ compensation claim
1. Medical treatment/health care
- Medically necessary drugs
- Assistive devices
2. Lost wages
- If you are out of work from the injury for more than seven days; or
- If your pay is reduced because you’re currently working fewer hours or in a different capacity because of the injury.
Benefits are paid based on your degree of disability. An opinion is issued, either by your doctor or by an independent medical examiner retained by the insurer. This opinion determines the rate at which your benefits can be paid. If the doctor and independent medical examiner disagree, you can either negotiate with the insurer or request a hearing to determine which opinion is more accurate. Anything less than a total disability is called a partial disability.
You can calculate your weekly benefit:
⅔ x (average weekly wage) x (percent of disability based on medical evidence) = weekly benefit
The weekly benefit cannot be less than the minimum benefit amount of $150 per week. The maximum weekly benefit adjusts every July 1st.
3. Social security benefits
You might be able to claim social security disability benefits if you are seriously disabled and unable to work for one year or longer.
4. Survivor benefits
The surviving dependents of a person who dies in a work-related injury can recover benefits. These include:
- Weekly cash benefits equal to ⅔ of the deceased worker’s average weekly wage for the 52 weeks prior to the accident, but not to exceed the weekly maximum.
- Funeral or memorial expenses up to $12,500 in Bronx, Kings, Nassau, New York, Queens, Richmond, Rockland, Suffolk and Westchester counties; and $10,500 in all other New York counties.
Third-party liability in a New York workers’ compensation claim
If your injury was caused by negligence of a party other than your employer, you can file a personal injury lawsuit against that person or entity. For example, if your injury was caused by a defect in your personal protective equipment, a property hazard on property not owned by your employer, or negligence of a vehicle driver, you might be able to file a lawsuit even though you were injured while working.
If you were injured at work in New York, you might be able to file your own workers’ compensation claim. However, if your claim is denied or the amount does not satisfy your costs or needs, you should consult a workers’ comp attorney for guidance on the appeals process and next steps.
The basis for personal injury law is fairly straightforward:
If you're injured because of someone's negligence, then you're entitled to recover for your financial losses related to the injury.
The premise for the workers' compensation system is similar:
Your employer is required to have specific insurance that provides benefits if you're injured at work.