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Workers Comp Questions

New York State Workers Compensation: FAQs

Q. What Is Workers Compensation?

In New York State, workers compensation is a legal right. Almost every employee in the State is guaranteed insurance coverage in the event of a work-related injury or illness. Your employer pays for this insurance, and it’s illegal for them to request or demand that you contribute to the cost of the policy.

In exchange for this guarantee, every worker forfeits the right to sue their employer for negligence. In other words, workers comp claims do not take “fault” into account. It doesn’t matter whether your employer’s careless actions led to your accident. But as we’ll see, there are certain exceptions to this restriction specific to New York State law.

Q. Am I Covered By Workers Comp?

Almost every employee is covered by the law. Exceptions include:

  • Volunteers for nonprofit organizations who receive no financial compensation for their service.
  • Members of religious orders who perform religious duties.
  • Employees in certain industries. For example, railroad workers are covered by a different law: the Federal Employers Liability Act (FELA).

Unless your job fits into one of those categories, it is very likely that you are covered by a workers comp insurance policy. Your employer is required by law to post information regarding your workers compensation program in the workplace.

Q. Does My Injury Qualify?

All injuries sustained directly on the job are covered, along with illnesses that develop due to to workplace conditions.

You do not need to lose time at work to receive benefits.

In The Course Of Employment

Injuries must be suffered “in the course of employment.”

If you have to drive somewhere for your job, and get hurt in an accident, your injuries will be covered. Injuries sustained during your commute to and from work, on the other hand, are not covered in most cases. There may be an exception if you use a company vehicle to get to work.

Accidents that take place on breaks are usually not covered. Generally, injuries at company events, like parties or picnics, are covered.

Employee Misconduct

If you sustained injury on the jobsite solely because of your own drug or alcohol use, you have most likely lost the right to benefits. Self-inflicted injuries aren’t covered, either.

But many injuries that arise from employee misconduct are covered. Even if you were injured while breaking a company policy, you will most likely be compensated. This is part of the “no fault” aspect of workers comp.

Q. How Long Do I Have To File A Claim?

New York State requires that you report your accident, in writing, to your employer within 30 days. The injury must be reported to the Workers Compensation Board within two years, or you will forfeit your right to benefits.

If you have contracted an occupational disease, you have two years from the date that you knew “or should have known” about the illness.

Q. How Do I File For Benefits?

After notifying your employer, you will have to complete Form C-3, describing your accident and any medical treatment you received as a result.

You will then be notified, by mail, of any action that the Board takes in your claim.

Q. Should I Contact An Attorney First?

In many cases, injured workers are approached preemptively by their employers or insurance carriers. Your workers comp insurance company will most likely present you with a settlement offer.

Remember, every workers comp claim is a legal matter, and your insurance carrier’s primary goal is to offer you as little as possible and minimize their own legal costs. With these considerations in mind, your insurer will offer you a low initial settlement, in the hopes that you will accept a quick, assured payout.

Settlements are always negotiations, but after you’ve signed, they are legally binding. You always have the right to decline an insurer’s initial offer, and you always have the right to an attorney.

Do not sign any document before consulting an experienced construction accident attorney. Many settlements include a clause that waives your right to future benefits. In other words, accept the settlement, and you’ll lose out on compensation down the road, whether or not your condition worsens.

Q. What Benefits Does Workers Comp Provide?

The typical workers compensation insurance policy will cover:

  • Necessary medical expenses

Workers comp will pay for any health care costs that arise directly from your job-related injury or illness.

Surgical procedures, hospital care, chiropractors, lab tests, prescriptions, any costs associated with nursing, surgical appliances, prostheses, and modifications to your home are all generally covered, although the insurance company may require preauthorization.

Note that New York State’s Workers Compensation Board requires injured workers to receive treatment only from doctors and specialists pre-approved by the Board. This is called a “network of providers,” and your insurance company may have a more limited network that you must use. In some cases, you will have to receive your insurer’s authorization before receiving treatment.

  • Lost wages

If you are unable to work due to your injury, your insurance carrier will cover a portion of the wages you would have made. They are not required to do so unless you are partially or totally disabled for more than seven days.

Your lost wages will be calculated based on your average weekly wage. Take the wages you made over the last 52 weeks, including overtime, and divide by 52. Now multiply that number by two-thirds, to simulate taxes. Based on your doctor’s opinion, the Board will determine how disabled you are. They will multiply this percentage (like 50%, if your ability to work has been cut in half) by two-thirds of your average weekly wage. That’s your weekly cash benefit.

Your insurer is allowed to dispute the percentage of disability reported by your physician. In this case, they may require that you receive an assessment from one of their doctors. The Board will then review the two divergent assessments and make a final decision.

  • Reduced Earnings

If you are able to work, but only in a reduced capacity, you have the right to receive a cash benefit that will make up a portion of the difference in your wages. If you made $14 per hour before your injury, and can now only earn $8.75, you may be eligible for a benefit of $3.50 per worked hour, or two-thirds of the difference.

  • Rehabilitation

Many injuries require on-going rehab, like physical therapy, for a full recovery. If the Board agrees that these services are necessary for your welfare, they will be covered by your insurance policy.

  • Incidental expenses

If you need to take the bus or a taxi to and from your doctor’s appointments, these costs will be covered.

  • Death benefits

In the event of death, a worker’s surviving dependents (generally spouse and children) are entitled to certain benefits. A funeral benefit of up to $6,000 is paid out in New York City; $5,000 in counties not considered “metropolitan.”

Survivors will receive a cash benefit of two-thirds the worker’s average weekly wage, a total shared among all dependents. Children receive this benefit until 18, or 23 if they purse college education. Blind or physically-disabled children receive the benefit for life.

Q. Can An Insurance Company Deny Me Benefits?

Yes, and it happens far more often than you would expect.

According to the Office of Workers Compensation Programs, 6,359 New York workers filed a total of 12,192 claims in January of 2015. Only 5,209 of those claims, around 42%, were approved.

Q. Do I Need A Lawyer?

Workers comp was designed to eliminate the need for attorneys and litigation almost entirely. Instead of pursuing justice and compensation through lawsuits, workers are tethered to insurance companies that can deny or reduce benefits at a moment’s notice.

But New York State is different. While every other State prohibits employees from suing their employers, New York protects a worker’s right to fair compensation in certain circumstances.

Most importantly, workers injured in falls from heights may be entitled to file a lawsuit against negligent property owners and employers. If you suffered injury in a ladder or scaffolding accident, an experienced construction accident attorney may be able to help you seek maximum compensation.

In addition, your rights are not restricted in relation to third-parties. Other people on the jobsite, like architects, engineers and independent contractors, cause numerous worker injuries every year. If your personal injury lawyer can prove that the negligence of a “third party” led to your accident, you may be entitled to file a lawsuit and hold them accountable in court. You can find more information here.

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