Manhattan Workers’ Compensation Attorney
Dealing with the workers’ compensation process often proves confusing and frustrating. The Manhattan Workers’ Compensation lawyers at Jacoby & Meyers, LLP, we are committed to holding Manhattan employers accountable for the preventable accidents that their employees suffer on the job. Reach out today for a free case evaluation.
“I had an amazing experience with Jacoby & Meyers, LLP. I would highly recommend them for anyone needing a law firm.” -Paul T.
When You Are Injured at Work
Work injuries can be serious and lead to long-term physical pain and financial stress. Workers’ compensation benefits are intended to lessen the financial burden and allow employees to seek and receive the medical care that they require to treat their injuries. New York law allows employees to file workers’ compensation claims for any injury “arising out of and in the course of the employment” or from an occupational disease (a disease contracted during the performance of your job duties).
There are rules that you have to follow, though, so make sure you understand the timelines in which you have to work and don’t delay or let them pass by.
All employers, both in Manhattan and across the country, have a duty to keep their employees safe and to provide them a safe working environment. The Occupational Safety and Health Act of 1970 states clearly that “each employer shall furnish to each of his employees employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees.” Unfortunately, unscrupulous employers may cut corners or act negligently, which can result in their employees suffering injuries in entirely preventable accidents.
Under New York law, nearly all employers are required to carry workers’ compensation insurance to help employees recover physically and stay afloat financially after they’re hurt at work. When an employee is injured on the job, the employer’s workers’ compensation insurance pays certain benefits to the injured person. The amount paid depends on the extent of the employee’s injuries and degree of disability.
Notify Your Employer
It’s critically important that you do not put off notifying your employer. If at all possible, you should inform your employer immediately of your injury and the details surrounding it, including how, when, and where you were injured. Once you have told your employer, seek medical treatment for your injury right away. Within 30 days of your injury, you need to notify your employer in writing.
File Your Claim
Your next step should be to file a claim with the Workers Compensation Board. You must file your claim using the Form Employee Claim and mail it to the appropriate Board District Office. For Manhattan workers’ compensation claims, employees should file their claims with the Manhattan District Office. Injured workers must file their claims within two years of the date of the accident or within two years after the employee knew or should have known that the injury was caused by a preventable workplace accident. Although you have two years to file your claim, it probably goes without saying that the sooner you file, the sooner you can begin to receive the benefits the law allows you to recover, so don’t put it off.
Other Parties’ Responsibilities
While you, as an injured worker, have certain responsibilities, so does your employer and any other party involved in the claims process. No one is allowed to simply sit on your report of injury or claim and do nothing.
- Employers’ duties. Once you have informed your employer of your work-related injury, it is on them to report it to both the Board and its insurance company within 10 days of receiving your report. If the employer fails to report an injury within 10 days, the employer can be fined up to $2,500. Stay on top of the person at your company responsible for reporting injuries, and if the 10-day time period elapses without them having filed the report, file a complaint with the Board.
- Duties of healthcare providers. When you see a physician for your work-related injury, he or she is required to file a Preliminary Medical Report on Form Doctor’s Initial Report and must then submit it to the appropriate District Office. The doctor also has an obligation to send copies to the employer or its insurance provider, as well as the injured worker. As the patient receives follow-up treatment, every 45 days the physician must submit to the Board a report of the patient’s progress on a Form Doctor’s Progress Report.
- The insurance company’s responsibilities. After the insurance company receives the employer’s report of the worker’s on-the-job injury, the company has an obligation to provide the injured worker a written statement of his or her rights under New York law within 14 days of receipt of the report or with the first check sent to the worker, whichever is earlier.
When an employee is entitled to cash benefits, the insurance company must begin payment within 18 days. There are times when employers or insurance companies dispute the employee’s claim. In such cases, the insurer has an obligation to inform the Board as well as the person making the claim. After a determination has been made as to disputing or paying the claim, the insurer has to notify the Board that either the insurer has begun to make payments or the reasons for why it has failed to issue payments. Once it begins to make payments, the insurance company pays the injured worker every two weeks.
Twelve weeks after the accident, the insurer is obligated to consider the necessity of rehabilitation treatment for the injured worker.
Types of Workers’ Compensation Benefits
Employees may be entitled to two main categories of benefits. Of course, the amount and type of benefits that an employee receives depend on the facts of his or her accident and the severity of the resulting injuries. In addition, families of workers who suffer fatal injuries may be able to collect death benefits.
Injured workers can receive the medical care necessary and directly related to the diagnosis, treatment, and recovery from their work-related disabilities. Unless it is an emergency, the Board must authorize the medical professional providing treatment.
The law does allow insurance companies to contract with the New York State Health Department certified Preferred Provider Organizations (PPOs) for the diagnosis, treatment, and recovery from work-related injuries. All PPOs must have at least two providers in every medical specialty and operate in two hospitals. While an injured employee is required to receive initial care with a PPO, after 30 days from his or her initial treatment, the employee may use any authorized provider, whether or not the provider is part of the PPO.
New York law also allows insurance carriers to require that employees whose injuries require diagnostic tests, radiological exams/testing, x-rays, or other types of testing to undergo these tests with a provider and at a facility with which the insurance company has contracted. The carrier is required to notify the person who filed the claim if this is a requirement.
Workers who require medication to treat their illness or injuries may submit a claim to the insurance company, or the pharmacy may do it on the employee’s behalf. As with other types of medical care, a carrier may require that injured workers receive their prescriptions from approved pharmacies, unless an emergency exists and it is impracticable to do so. Carriers must reimburse employees for the cost of their prescriptions within 45 days.
Employees whose illnesses or disabilities last more than seven days are entitled to cash benefits from the date of their injury. This includes workers who are both totally and partially disabled due to their injuries. The amount of the benefit is based on the worker’s weekly salary over the previous year. Each year, the maximum cash benefit that an employee is eligible to receive is reviewed and adjusted. Currently, the limit is around $900 per week for both partial and total disability. Insurance companies use the following formula to calculate the cash benefits due to an employee: 2/3 x average weekly wage x percent of disability = weekly benefit.
So, for example, if an employee makes $1,000 per week and is 50 percent disabled, his or her weekly benefit would be $333.33 (1,000 x 2/3 x .5). Some employees can return to work, but to a job that pays less than what he or she was making pre-accident. In these situations, the worker may be able to receive cash benefits that make up 2/3 of the difference between pre-accident and post-accident wages.
Because of all of the towering construction in the city—and the accidents that have come with it—New York long ago passed LAB § 240, the Scaffold Law. If you fell from a height while working on a construction site, this gives you the chance to secure additional compensation. At Jacoby & Meyers, LLP, we have experience with cases involving LAB § 240. If it applies to your case, we’ll know to seek out the advantages it can bring you.
When a worker suffers a fatal injury but would have been eligible for compensation had he or she survived, the worker’s surviving spouse, minor children, or other lawful dependents are entitled to receive weekly cash benefits. Death benefits are paid at an amount equal to 2/3 of the deceased employee’s average weekly wages for the year before the fatal accident. Just as with cash benefits paid to a worker who survives his injuries, death benefits may not exceed the weekly maximum. The deceased worker’s family may also receive funeral and burial expenses not to exceed $12,500 in metro New York counties.
When Your Workers’ Compensation Claim Is Denied
Insurance companies, while not inherently evil, have a vested financial interest in paying out as little as possible to injured workers. Given that mindset, these companies may begin payments within the required timeframe, only to later dispute your claim.
Carriers dispute claims for a variety of reasons. The carrier may argue that you didn’t suffer your injury in a preventable work-related accident. For instance, if you had previous back problems, the carrier may attempt to argue that the injury didn’t occur at work, in which case you would need to show that perhaps the original injury wasn’t a work injury, but that the accident you suffered made it more severe.
A carrier may also try to claim that your injury happened while you were not covered by an insurance plan, or the carrier may try to dispute the claim that you were even injured in the first place. In such cases, what can you do to dispute the denial of your claim?
Initially, Board Claims Examiners and Conciliators try to come to a resolution that is satisfactory to both parties. If they are unsuccessful, the Board sets the case for a hearing before a workers’ compensation judge. At your hearing, both you and the insurance company have the right to give testimony concerning your claim. The judge hears testimony and will also review your medical records and your previous year’s wages. At that point, the judge will render a decision on whether an award is proper under the circumstances and then set an amount for any award.
If either the injured worker or the insurance company is dissatisfied with the judge’s ruling, either party may appeal the ruling. The appeal must be made in writing within 30 days of the Judge’s decision. At this stage, three Board members review the case. They are permitted to change part of a decision, reject it altogether, or return the case for additional hearings.
During the Board review, the carrier is not required to pay lost wages. In some cases, the parties agree to part of the judge’s ruling, but the insurance company decides to appeal part of it. In that case, the carrier must pay the part that the parties agree to, while the other portion is reviewed by the Board.
Once the three Board members issue a decision, either party may appeal that decision to the full membership of the Workers’ Compensation Board of Commissioners. The full Board has discretion as to whether or not to accept a case, but if it takes it, it will overturn the decision, agree with the previous ruling, or modify it.
As a final stage of appeal, the parties may challenge the full Board decision in the Supreme Court of New York within 30 days.
Frequently Asked Questions FAQs
Workers’ compensation provides benefits and partial salary to people who have been injured at work in New York City. Here are some frequently asked questions:
What is workers’ comp?
As the name implies, worker’s comp is a compensation system set up specifically to pay the medical bills for workers who have been injured on the job or made ill on the job. It also pays a percentage of the injured worker’s salary for extended time off due to a work-related injury or illness.
Who’s covered by workers’ comp?
If you work in Manhattan or any of the other New York City boroughs, then you are likely covered by workers’ comp. Employers pay insurance premiums for coverage, which is required by law.
Do I have to say my company was to blame for the accident? Isn’t that risky?
Workers’ comp does not require any determination of blame or guilt. In other words, an injured worker doesn’t have to argue that the employer is to blame, and a company doesn’t have to argue that the worker is to blame.
Your employer cannot legally retaliate against you for filing a workers’ comp claim in any way, shape, or form. You cannot be fired, demoted, have job responsibilities changed, or your pay reduced. If that happens to you, call us immediately.
How do I get workers’ comp?
Take the steps below to obtain any workers’ comp benefits you deserve. The workers’ comp insurance company may deny your claim if you fail to follow these steps.
- First, see a doctor. If you have sustained a physical injury, to do the doctor immediately. If you have fallen ill because of a condition or feature of your work, go to a doctor when you first notice symptoms.
- Second, tell the doctor that this is a work-related injury or illness. This triggers the doctor’s obligation to fill out and submit a specific document, known as a Form C-4, to the New York State Workers Compensation Board District Office for Manhattan within 48 hours. The doctor must also send Form C-4 to your employer or your employer’s workers’ comp insurer. You should also receive a copy.
- Third, notify your employer of the injury or illness, in writing. It is best to do so immediately, but you must do so within 30 days. Tell your employer when, where, and how the injury or illness occurred, to the best of your ability.
- Finally, you need to officially file a claim with the New York State Workers Compensation Board. Note that you need to do this, as the worker; it is not done by your employer or the state. File an Employee Claim C-3 form online or by postal mail. You can also drop it off at a regional office. Form C-3 must be filed within two years of the date you were injured or first noticed symptoms.
Do I have to use the company’s doctor?
In most cases, you can see the doctor of your choice for any injury or illness. Your ability to choose your doctor makes New York different from, where an injured worker often must pick from a company-approved list of medical providers.
How much will workers’ comp pay me?
If your work-related injury or illness keeps you out of work for more than 7 days, you become eligible to be paid a certain percentage of your salary under worker’s comp. You’ll only receive this payment, however, if your illness or injury itself lasts for more than 14 days.
Benefits are calculated by multiplying two-thirds of your yearly salary (before the injury) by the percentage of your disability, up to a maximum amount of weekly compensation set by law based on the date of your injury (the maximum for persons injured between July 1, 2019, and June 30, 2020, for instance, is $934.11 per week). Your doctor determines the percentage of your disability, ranging from between 0 percent to 100 percent.
Let’s say you were making $1,000 per week, on average. Two-thirds of your salary is $660 per week. If your doctor says you are 100 percent disabled by the injury, $660 is paid at 100 percent, so you’d receive $660 per week.
What about medical bills?
Workers’ comp pays for all medical bills related to the work-related injury or illness. It can also pay for necessary transportation to and from the medical offices, clinics, and hospitals you use.
How long does it take to get my benefits?
Your benefit payments should begin within 18 days of when your employer or its workers’ comp insurance company receives your notification of injury. That’s why it’s best to notify your employer as soon as possible.
How often are benefits paid?
Once benefits begin, they are paid every two weeks.
When do my benefits stop?
Workers’ comp can continue for as long as you cannot work.
Your doctor must send a progress report every 45 days to the Workers’ Compensation Board once your benefits begin, on a Doctor Doctor’s Progress Report (C-4.2) Form.
If you are still cannot work at 12 weeks, the doctor and insurance company will assess whether to pay permanent disability payments. These are also part of workers’ comp.
How Is disability related to workers’ comp?
After a certain period of time, your doctor may conclude that your condition has improved as much as it can, and that you have stabilized, but that you cannot return to work.
At this point, you may then receive a medical evaluation to see if your illness or injury means that you will have limitations permanently. Disability is evaluated on a percentage, from 0 percent to 100 percent.
If you are 100 percent disabled, you can receive workers’ comp as long as the disability is in place.
If you are partially disabled (ie, less than 100 percent but more than 0 percent), then you can also continue to receive workers’ comp as long as the disability is in place.
What are disability benefits under workers’ comp?
For a 100 percent disability, benefits at two-thirds (66 percent) of your average weekly salary pre-injury or illness.
For less than 100 percent disability, the formula depends on the body part that is disabled.
For a permanent loss of some use of ears, eyes, or all or part of limbs, disability is also two-thirds of your pre-injury average salary, multiplied by the percentage of the amount of use lost.
For a permanent loss of areas around the head, spine, organs or another body part, partial disability benefits are two-thirds (66 percent) of the difference between your average weekly income before the injury and current earning capacity.
If the injury permanently and seriously disfigured your face, neck, or head in such a way that it might hurt your earnings capacity, you may be eligible to receive a payment of up to $20,000.
What if I can no longer do my old job?
Certain benefit rules apply if you can go back to work, but can no longer do your old job due to the injury.
If you are earning less because of the work-related injury, you can receive two-thirds of the difference in income from workers’ comp benefits.
In other words, say you earned $1,000 a week before the injury. Because you cannot do your old job, you were given a new one, but you earn $600 per week. That’s a difference of $400 per week. Workers’ comp may pay two-thirds of that difference, or $400.
You may also be eligible for vocational rehabilitation or job placement services if you can’t do your old job.
Can my workers’ comp claim be denied?
Workers’ comp claims are sometimes denied. That is the reason why it is important to follow the proper steps in obtaining workers’ comp benefits.
You can appeal. Benefits are retroactive if you successfully appeal.
Claims can be denied for many reasons, so don’t lose heart if your claim isn’t successful the first time out. Missing paperwork or inaccurate paperwork is one reason, and can be fairly simple to fix.
Some denials are more complicated. For example, an employer or workers’ comp carrier can believe that your injury or illness isn’t related to work or didn’t occur at work.
How can I appeal a denial?
You must follow very specific steps to appeal a workers’ comp claim denial. We strongly encourage anyone whose appeal gets denied to seek our help in the appeal process.
If the denial comes from the employer’s insurance company, the company will need to file a Notice of Controversy at the state Workers’ Compensation Board. The notice has a very specific time frame; it needs to be filed within 10 days of knowing about your work-related injury or illness or 18 days after your disability starts (whichever period is longer).
Next, the claim will be sent to a Workers’ Compensation Board judge, who schedules hearings at which testimony and other evidence about your claim may be received.
After the hearings, the judge decides whether to affirm or reverse the claim denial. The workers’ comp insurance carrier has a right to appeal a decision in your favor within 30 days of its being issued.
What if my appeal is denied?
Although many appeals are successful, some are denied.
You can appeal the denial within 30 days by filing a request for review in writing to the Workers’ Compensation Board. As above, we strongly encourage anyone who wishes to file this type of appeal to consult with an experienced Manhattan workers’ compensation attorney.
Your request is reviewed by a three-person panel. There are three steps to the review:
- They decide whether to approve the review request itself.
- They review the case in light of the evidence and the judge’s determination
- They can then, affirm, modify, reverse, or send it back to the judge for review of evidence
If the panel decides to affirm the first ruling, you can appeal that as well within 30 days. The appeal goes to the Appellate Division, Third Department, of the Supreme Court of the State of New York, within 30 days.
What if my loved one died?
If your loved one died as a result of a work-related injury or illness, workers’ comp pays death benefits. Certain family members (including surviving spouses, children, grandchildren, parents, grandparents, and siblings, depending on the other survivors) and the estate of the deceased can receive these benefits.
Benefits are divided between the surviving eligible family members. A surviving spouse who has children with the deceased, for instance, is eligible to get 36 2/3 percent of the deceased person’s weekly average income. The children are eligible to receive 30 percent divided equally.
Workers’ compensation benefits also include reasonable costs for a funeral and burial. The amount depends on the county. Funeral and burials cost in New York County are about $12,500.
Can I bring a personal injury suit against my employer for causing the injury or illness?
Generally speaking, no. Workers’ compensation insurance takes the place of suing your employer for causing your injury; in exchange, you don’t need to prove negligence.
However, if your work-related injury or illness results from the actions of a third-party, then you may have the right to take legal action against that party. If a construction company is subcontracted to do construction in your workplace, for example, and their error caused part of the ceiling to fall on you, a personal injury suit could likely be brought against them.
Speak with an experienced Manhattan workers’ compensation attorney about the possibility of this sort of third party lawsuit, as it may impact your workers’ compensation benefits.
Workers’ comp claims and laws can be very complicated. If you need any further information on any of these topics, or have any other questions, contact a Manhattan workers’ comp attorney for a free case evaluation.
Contact Jacoby & Meyers, LLP, Today for Help With Your Manhattan Workers’ Comp Claims
At Jacoby & Meyers, LLP, we have fought for the rights of injured workers in Manhattan since 1972. If you’ve been injured at work, our experienced attorneys stand ready to help you through the process and relieve you of the pressure of dealing with insurance companies and your employer. We can help you during every step of the process, from filing your initial claim all the way through a New York Supreme Court appeal, if necessary or appropriate.
Jacoby & Meyers, LLP, also has the good fortune of having as our sister firm a group with 50 years of experience focusing on Social Security disability and workers’ comp cases. They’re always willing to help us in especially difficult cases.
You can visit them at https://www.foalaw.com/, and see how that partnership might benefit you.
Our Manhattan office is conveniently located on Broadway, a few blocks from the Stock Exchange. If you were injured at work in Manhattan, call us today at (212) 445-7000, live chat with one of our representatives, or contact us online, for your free case evaluation. When you give us a call, you’ll never have to wait or schedule your evaluation for another time; we will do our best to evaluate your case immediately.
New York, NY 10006
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