Getting hurt at work, can make you eligible for workers’ compensation, but also can puts your entire life on hold.
In effect, a workplace injury becomes its own job, complete with paperwork, appointments, meetings, and deadlines. Except that nobody trained you for this, and it’s hard to tell sometimes whether your employer is on your side or the side of the insurance company.
You received—at best—a brief overview of how the workers’ compensation system works. You know that “fault” doesn’t come into play with a workplace injury claim. Yet you can’t help but feel like you need to watch what you say and what you do to keep your claim in good standing.
You were told that workers’ compensation is supposed to be simple: When you get injured or become ill on the job, you receive wage replacement and medical care through your employer’s insurance.
But in reality, going through the claims process and receiving benefits is rarely simple. There are not one, and not two, but three levels of bureaucracy and red tape: work, insurance, and state. Any one of them seems like they have the power to dispute your claim, delay your benefits, and put your career on hold. You’re not really sure you have an ally in all of this. Not even your coworkers feel safe to talk to.
At Pain Injury Law, we’re all about making injury claims as painless as possible. You get an entire team dedicated to you and your claim, and we handle everything, every step of the way. We make workers’ compensation feel less like having a second job and more like a process that puts you in charge of your health, benefits, and livelihood.
Injured workers have rights, including the right to speak with a workers’ compensation lawyer at any point after their injury. We’ll work with you to make sure the system works the way it’s supposed to.
For the vast majority of the workforce, there is no federal standard for workers’ compensation. Instead, each state establishes its own set of workers’ comp rules.
Unless you are a federal employee, your workers’ compensation claim will be governed by the laws of New York State.
In New York, most employers purchase workers’ compensation coverage for their employees through insurance companies. Only insurance companies authorized by the state’s Workers’ Compensation Board can provide this service. As an alternative to purchasing insurance, some employers provide their own compensation coverage.
Businesses that operate in New York are required to have workers’ comp coverage for all employees, whether it’s provided directly by the employer or through a third party insurer.
Covered workers include:
Generally, the way it works is that employers pay insurance premiums, and the employer’s insurance company pays weekly cash benefits and medical benefits to workers who suffer harm from an on-the-job accident or occupational disease.
Or at least, that’s how it’s supposed to work. That’s how it works in theory.
But in theory, you weren’t supposed to get hurt at work in the first place. In theory, there shouldn’t have been a tool that you tripped over, or a machine that didn’t shut down properly, or an inexperienced subcontractor who didn’t pull their weight on the jobsite and put everyone in harm’s way.
In theory, you should still be at work, earning your usual wage.
You shouldn’t have had to talk to a lawyer to get benefits that are guaranteed by law—in theory.
But the reality is, you’re here now, thinking you might need a lawyer just to make sure your very real injuries are compensable, and not just theoretical, in the eyes of the insurance company, your employer, and the WCB.
One of the things that was explained to you at work is that workers’ compensation is “no-fault.” But this explanation was followed by a series of qualifiers that made you wonder whether this is totally accurate.
Legally (i.e., theoretically), New York workers’ compensation follows a few basic rules:
This sounds straightforward enough—until you find out that substantial gray areas exist in NY workers’ compensation law. For example:
These “exceptions” can cast serious doubt on a claim and make you wonder whether there’s anything else you should know—but don’t know—about workers’ comp claims. You heard about a co-worker’s claim getting denied. Another co-worker had to file an appeal just to get their claim through.
So is “no-fault” real or theoretical?
In theory—and in reality—there are many reasons why a New York workers’ compensation claim may be denied, fully or partially. Some of them have nothing to do with your actual injury, and everything to do with hard-to-understand rules and backroom decisions that feel completely out of your hands.
Your employer or their insurer might try to argue that:
Here’s the hard truth: Despite what you may have been told about who—and what—is covered under New York workers’ compensation, there are lots of qualifiers and outliers that may apply to your case. Even though workers’ compensation is a “no-fault” system, the insurance company may still dispute your claim.
When an insurer contests a claim, they must do so within 18 days after the first day of disability, or within 10 days of first learning of the accident, whichever is greater. The insurer must provide the reason why the claim is not being paid. For claims with more than one injury/condition, they might accept one (or more) parts and deny others.
By the time you’re injured, things have already gotten more complicated than you expected. From there, they might only get more complicated as you learn—the hard way—about the various rules and “exceptions” that can apply to workplace accidents and injuries.
It can also be hard to tell whether the insurance company made a mistake or is acting in bad faith. After all, accidents happen. One just happened to you. How do you know another “accident” isn’t holding up your claim or shortchanging you?
The fact is that you don’t know. And the not knowing—the wondering and hoping that everything is being handled properly—can be almost as painful as your injuries.
If you’ve come this far on your internet sleuthing journey about New York workers’ compensation claims, it’s because you have questions about how the statewide system works.
That’s understandable. Anything to do with the government can spark confusion and frustration. When it involves the government and your employer and an insurance company, misunderstandings are the rule—not the exception.
We’re here to set the record straight, answer your questions, and step in when you decide that something doesn’t seem right, you’re being treated unfairly, or you’d just feel better getting help from somebody who knows how the workers’ comp system works—in theory and in practice.
New York workers’ compensation benefits include:
New York workers’ compensation does not provide compensation for pain and suffering that results from a work-related injury.
To recover damages for physical pain and mental anguish, you’ll need to file a personal injury lawsuit against a negligent third party.
This third party could be a product maker, a negligent driver, a subcontractor, a general contractor, a property owner, or somebody else who is not your employer or coworker.
New York calculates the weekly disability cash benefit as 2/3 x average weekly wage x % of disability.
In most cases, the average weekly wage (AWW) is based on the 52 weeks prior to the injury, unless the worker was employed for a shorter period. While shorter timeframes can be used when appropriate, 52 weeks is the standard calculation.
If you can return to work in some capacity, but at a lesser wage than you previously earned, you may be able to receive a benefit worth 2/3 of the difference between the two wage rates.
For temporary disability and permanent partial disability, cash benefits are available for a maximum number of weeks. Permanent total disability has no limit on the number of weeks the injured employee may receive benefits.
Instead of going through the regular claims process and receiving ongoing weekly payments for a specified period, you may have the option to settle your claim for a one-time, lump sum payment. A Section 32 settlement is negotiated and agreed upon by the insurance company and the injured worker.
Once the settlement is finalized, it is binding on all parties and can’t be renegotiated. If your condition gets worse and you face financial hardship, you can’t go back and ask for more benefits.
Workers’ compensation law requires that you file a claim within two years of your accident date or within two years of when you knew, or should have known, that your injury or occupational disease was work-related. You must also notify your employer about the accident within 30 days of the date of the incident.
The two-year statute of limitations for workers’ comp claims is different from the requirement that you give 30 days’ notice to your employer. Since the workers’ comp claims process is time-sensitive, we recommend that you tell your employer right away about a workplace injury, even if you do not need to miss any time from work as a result.
You should follow these steps if you are hurt in a workplace accident. Failure to abide by deadlines could cause you to lose benefits.
If any party (you, your employer, or the insurance company) disputes the claim, or if your claim is denied, the case is decided by a workers’ compensation law judge.
The judge’s decision may be appealed by you or the insurer. Appeals are heard by a 3-member Board panel. Further appeals may be made, first to the full Board, and then to a New York State appeals court.
You might want to dispute the claim not only if you were denied coverage, but also if you suspect that your injuries (and the resulting payments and treatments) are being underestimated or downplayed.
For example, the insurance company might refuse to authorize specialist visits, second opinions, diagnostic tests, or specific treatments. There could also be disagreement about the end date for your benefits or whether you meet disability criteria.
In New York, you generally can use your own doctor for workers’ comp, but they must be authorized by the NYS WCB, and if your employer uses a Preferred Provider Organization (PPO), you must use a network doctor for the first 30 days, after which you have free choice—but only if the PPO is WCB certified and the employer gives proper written notice.
After 30 days, you can switch to any WCB-authorized doctor, including your own, or change providers as needed—as long as the doctor is registered to treat workers’ comp cases.
Typically, your employer’s workers’ comp insurance company is responsible for paying your wages while you remain out of work because of your injuries. The rate at which you are paid directly correlates to your average weekly wage and your degree of disability.
Some employers and/or union contracts allow you to receive your full salary— paid directly by the employer—while you are unable to work. These employers tend to be New York City Transit Authority or other self-insured state or city employers. To confirm whether you are eligible for your full salary, you must reach out to your payroll department and/or union.
If your employer uses your sick leave or vacation time to pay you while you remain out of work, your employer may be entitled to reimbursement and you are entitled to have your time restored.
Most workers’ comp claims are for accidents that occur at a specific time on a specific date, such as falling off a ladder or slipping on ice in a parking lot. However, these are not the only type of claims.
Injuries that develop over time, with no single incident as the cause (e.g., carpal tunnel or another repetitive use injury), are still eligible for workers’ compensation benefits. They may be more difficult to prove, though.
If you develop a condition or occupational disease as a result of your job, you may also qualify for workers’ compensation benefits. For example, you may have a hearing loss claim if you work in an extremely loud environment. You could also develop an illness due to sustained exposure to a toxic substance.
No. A claim for workers’ compensation benefits is not a lawsuit against your employer. Workers’ compensation is paid for by your employer’s insurance company. You are making an insurance claim. You are not filing a lawsuit against anybody. This is why workers’ comp is considered a “no-fault” system.
You can’t sue your employer or a coworker for a workplace injury in New York, but you may be able to sue somebody who works for a different company or is unaffiliated with your employer.
This type of claim would be a personal injury lawsuit alleging a negligent party who is neither your employer nor a coworker. Construction workers, for example, are often able to file a lawsuit against a property owner or general contractor under New York labor laws. Subcontractors, equipment manufacturers, motor vehicle drivers, and other parties could also be liable for workplace injuries.
Workers’ compensation may not be enough to cover your medical bills and lost wages, especially when injuries result in partial disability or permanent disability.
An injured worker can file both a workers’ compensation claim and a personal injury lawsuit. The two are not mutually exclusive, but you cannot sue your employer or co-worker, only third parties.
New York has special Labor Laws that protect construction workers, especially anyone working at heights.
If these rules aren’t followed and you get hurt, you may have a third-party claim (i.e., a personal injury lawsuit) in addition to workers’ comp.
Volunteers are generally not covered under NY workers’ compensation unless they fall into a specifically covered category, such as volunteer firefighters or certain nonprofit volunteers whose organizations have opted into coverage.
Subcontractors may be covered depending on their employment classification, but independent contractors generally are not. Misclassification is common, especially in construction-related industries.
You do not need to be a U.S. citizen or permanent resident to qualify for New York workers’ compensation benefits. Even employees who are paid off the books can file a workers’ compensation claim.
Disability insurance is a type of private insurance you can purchase. It is designed to replace part of your income if you are unable to work due to disability. It doesn’t matter whether the disability is work-related. If you get hurt, it will provide payment no matter where or when your injury occurred.
Disability insurance only covers lost income. It does not cover medical care or long-term care services.
Workers’ compensation, on the other hand, is employer-provided insurance that covers medical bills and lost wages for injuries related to your job.
Your employer cannot penalize you in any way for filing a claim. They cannot legally fire you, reduce your hours, or harass you in the workplace for doing so. Employers who take such actions can face serious penalties.
Yes. As a general rule, you can’t receive workers’ compensation for your injuries if you:
There are very few circumstances where an employer and/or their insurance company may legitimately deny your claim. If your claim was denied, it’s in your best interest to speak with a workers’ compensation lawyer about next steps.
There’s a lot to be said for doing your own research and taking matters into your own hands. But when those matters involve your ability to work and provide for yourself and your family, you can’t afford to leave questions unanswered.
Workers’ compensation claims are almost never as simple as they appear on paper. They’re supposed to be blameless and painless: simply fill out the paperwork and get your benefits.
That’s not always the case, though. The “exception” could prove to be the rule in your case, even if your injuries are routine and there’s nothing exceptional about your claim. More serious injuries are exceptions all their own that may require exceptional legal representation to get right.
Getting legal help shouldn’t feel like a side hustle. At Pain Injury Law, we make the injury claims process as painless as possible. Just answer a few questions to get started. Everything can be handled right from your device. Let us know what happened, and we’ll let you know how we can help.
Answer a few simple questions to get started.
We assign a customized care team consisting of a lawyer, paralegal, and case manager to your claim.
Check in at your convenience to see how your case is going. Message your care team and upload documents right from your phone or choose another way to reach out and receive updates.
Our community is the driving force behind Pain Injury Law. For decades, our attorneys and affiliates have served as a lifeline to injured New Yorkers struggling to overcome the physical, financial, and emotional hardships that come with getting hurt. Meet the Client Care Team doing the actual work on your case.
All of the emails, paperwork, meetings, calls, court appearances… it’s all free unless we win your injury case.
All of the emails, paperwork, meetings, calls, court appearances… it’s all free unless we win your injury case.
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