New York Workers’ Comp Claims: Eligibility, Filing and Appeals

Learning more about the way workers’ compensation works in the state of New York

If you get sick as a result of your employment or you’re injured on the job in NY, you’ll be able to file a workers compensation claim. With the help of the following guide, you’ll be able to determine if you’re eligible for receiving compensation in NY as a result of a work related injury and if so, the steps you should take to file it.

New York Workers’ Comp Claims: Eligibility, Filing and Appeals
New York Workers’ Comp Claims: Eligibility, Filing and Appeals

It’s also important to note that not all workers are covered under the workers compensation system in New York, including federal employees, volunteers and also clergy members.The majority of employers have workers compensation insurance, including yours, meaning that if any employee is injured on the job, the insurance is going to cover the costs of treatment. If you’re currently working in NYC, then your employee needs to provide you with workers compensation benefits in the event you’re injured or get ill as a result of your employment.

Eligible Work-Related Injuries

The NY workers compensation law covers all work injuries that take place during the course of work. Occupational diseases are also covered and these are basically illnesses that develop over long or short periods of time, during the course of employment. To include some examples of such diseases, they are hearing loss and asbestosis.

There are also other types of work related injuries, such as industrial injuries and these include amputations, cuts, burns, sprains, but also bone fractures and other kinds of injuries that cause employees immediate harm. If you’re injured in the course of your employment and to treat your injury more than a simple first aid is needed, then you’re eligible for filing a workers compensation claim.

Any activities that take place outside the individual’s scope of employment, including commuting from work and to work aren’t covered. Therefore, any diseases or injuries arising from these kinds of activities cannot be covered by the workers compensation.

What to Do if You Are Injured at Work

If you get injured at work, then the first thing you need to do is let your employer know about it in writing. There’s a 30-days limit to reporting the event that led to you getting injured or else, you won’t be able to file a workers compensation claim. On the other hand, if you think you have an occupational disease, it’s recommended to let your employer know about it within 2 years of when you found out the disease may have been caused by the conditions at your previous workplace.

For the purpose of reporting the workers compensation claim, you’ll be required to complete a C-3 Form which your employer needs to provide you with. Next, the form should be mailed by either of you to the closest office of the WCB (Workers Compensation Board). By doing so, you’ll have started the process of filing your claim.

Within ten days of being notified about your occupational disease or injury, the employer will report the claim on the C-2 form and mail it to his workers compensation insurance carrier and to the WCB.

It’s also important to see a doctor as soon as possible, so he can document and assess your current condition. Please note that it’s mandatory for the doctor is authorized by the WCB so he can treat injured workers. To learn more about where you can find one in your area, you can visit www.wcb.ny.gov or call (800) 781-2362.

Furthermore, it’s recommended that you get in touch with your employer regarding the doctor you should use, since he may want you to get treated by one that participates in their PPO. If it turns out that your employer does participate in an Alternative Dispute Resolution Program or PPO, it’s recommended that the employer informs you about these programs. For prescription medications and diagnostic studies, your employer may also want you to use certain pharmacies and providers.

New York Workers’ Compensation Benefits

If your claim is accepted, then you’ll be able to receive workers compensation benefits right away. The costs for treating your injuries are going to be covered by the employers’ workers compensation insurance policy.

In case the work related injury or illness won’t allow you to work for more than a week (7 days), your lost wages are going to be compensate by the employers’ workers compensation insurance carrier. These benefits amount to 2/3 of your average weekly salary and then multiplied by your disability’s percentage.

These payments will be deposited in your account on a weekly basis until you’re able to return to work or until your workers compensation claim is closed. The benefits also vary based on the situation at hand, like death benefits for the family of the injured employee.

Your Appeal Rights

If you do not agree with a decision taken by the employer’s workers compensation carrier or by the employer himself, you can appeal it to the WCB. For instance, if your claim is denied by the workers’ compensation insurance carrier, it is possible to reverse the decision by appealing the claim.

After your appeal, the evidence will be reviewed by a workers’ compensation law judge who will take testimony and then take a final decision concerning your appeal. The judge’s decision can be appealed to the three member board panel and that decision can then be appealed to the Court of Appeals and the Appellate Division.

It’s very important to speak to a lawyer when planning to appeal. Since this is a complex legal process, it’s best to hire someone who can make sure your workers compensation rights are protected.

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