New York Workers’ Compensation Attorneys
Whether you’re a construction worker who fell from scaffolding around the building you were helping to fix or a computer technician who became ill from toxic substances in an office, New York workers’ compensation (often abbreviated as workers’ comp) can help you recover and get back to work. Read on to learn the legal process around workers’ comp and what an experienced New York workers’ compensation lawyer can do for your case..
Workers’ compensation provides weekly payments of a percentage of pre-injury salary to workers who have been injured or become ill on the job, and it also pays their medical bills. Should a worker die because of on-the-job injuries or illness, workers’ comp provides death benefits to survivors.
Workplaces across the country are rife with injuries and illness. In fact, the National Safety Council estimates that injuries and fatalities related to work cost an astonishing $164.6 billion every year. A worker is killed in the workplace roughly every two hours across the country, according to Safety + Health. New York has major industries in all three of the most dangerous sectors for workplace accidents: (1) construction, (2) transportation and warehousing, and (3) agriculture. Workers’ comp may help you whether you work in one of these sectors or in others.
Workers’ compensation applies to virtually all people employed in New York. Neither employer or employee has to prove fault in workers’ compensation cases. Employers pay premiums to an insurance carrier, who in turn pays workers’ compensation benefits.
To receive these benefits, however, you’ll have to file very specific paperwork with your employer, the workers’ comp insurance carrier, and New York State itself. The process can be lengthy and complex. Your workers’ comp claim may be denied. Some denials occur because of disputes about what occurred. Others, though, may occur because the paperwork is incomplete or filed incorrectly.
Experienced New York workers’ compensation lawyers, like those at Jacoby & Meyers, LLP, can help you understand the process, help you file the claim correctly, and negotiate with insurance companies and the state on your behalf, if necessary. The more you understand the process, and the more complete your claim is, the more likely you are to receive an approval, and the quicker you and your family will receive the benefits to which you’re entitled. Call us today for a free case evaluation.
“If it were not for the integral legal team of experts at Jacoby & Meyers I would not be where I am today with my recovery. I highly recommend hiring Jacoby & Meyers should you ever find yourself injured in an accident, and an individual or company needs to be held accountable for their negligence.” -C.J.
Workers’ Compensation in New York: Understanding the Process
Receiving workers’ compensation is far from automatic. Rather, you must take specific steps with which a workers’ comp lawyer can help tremendously.
Below, we discuss these steps in greater detail:
- Get medical treatment. If you are injured on the job, seek medical treatment right away. If your work-related condition is an illness, seek medical treatment when you first notice symptoms. In New York, you can choose your own medical providers in most cases, which is different from workers’ comp requirements in other states. Keep all paperwork related to all medical treatment for your work-related injury or illness. Keep a record of where and when you visited medical providers, such as doctors, hospitals, and pharmacies. Follow any treatment recommendations that are made (for example, for surgery or rehabilitative therapy), and keep records of all follow-up treatments. Importantly, you should let the physician or other provider know that this is part of a workers’ compensation claim.
- Your doctor needs to file a preliminary medical report. Within 48 hours of your injury, your doctor needs to complete a Form C-4, a preliminary medical report. You must mail the completed form to the New York State Workers Compensation Board District Office for your location. Your doctor is also required to send Form C-4 to your employer or its insurer for workers’ comp. You receive a copy as well. Finally, doctors’ offices should know this procedure, but again, be sure to mention to them that this is all part of a workers’ comp claim.
- Notify your employer of the injury or illness. Seeing a doctor is not the last step that you need to take to file a claim. You must officially notify your employer of the injury or illness. Your employer must know specifically where, when, and how your injury occurred. You should provide the notification in writing within 30 days of the day you were injured or first noticed a symptom of illness. Although 30 days is the time frame, it’s a good idea to notify your employer as soon as possible.
- File a claim. After notifying your employer of your injury or illness, you need to file an official claim with the New York State Workers Compensation Board. This is the responsibility of the injured or ill worker, not of the employer. The correct form to file is an Employee Claim C-3 form. You can send this in online, via mail, or by dropping it off at your regional office. Form C-3 needs to be filed within two years of the injury date or the date you first noticed symptoms of an illness.
What You Should Receive
- A written statement of rights. After you notify your employer of your injury, its workers’ comp insurer should give you a written statement of your rights vis-à-vis New York law. You should receive this statement within 14 days of your notification.
- Benefits payments. In New York State, workers’ comp benefits should begin payment within 18 days of the employer’s and insurance company’s receiving your notification of injury. You will receive benefits payments every two weeks.
Follow-Up to the Initial Claim
While you are receiving benefits, your doctor should submit a progress report to the Workers’ Compensation Board every 45 days after the initial payment. There is a separate form for this, the Doctor Doctor’s Progress Report (C-4.2) Form. In the event your claim is disputed, you and the Workers’ Compensation Board must receive a notification about why. After 12 weeks, the insurer should consider whether the worker needs rehabilitative treatment.
How Much Are Workers’ Compensation Benefits?
Workers’ comp benefits will pay for all necessary medical treatment. You can also receive compensation for transportation costs to and from medical treatment. Workers whose injuries or illnesses necessitate them being off of work for more than seven days, they will also receive benefits intended to replace part of their salary. Workers only receive cash payments for the first seven days if their time off work related to illness or injury extends for over 14 days.
The amount of benefits is calculated on a complicated formula based on two-thirds of your pre-injury salary (averaged over a year) and the extent to which you are disabled by the injury (which your doctor will determine and report). Disability percentages fall somewhere between 0 percent and 100 percent. For example, if you were earning $500 per week on average, and your doctor indicated that you are 100 percent disabled, your payment would equate to $330 per week (two-thirds of $500).
There are also maximum amounts based on the date of the injury or illness. People who are injured between July 1, 2019, and June 30, 2020, for instance, are restricted to a maximum of $934.11.
New York’s Scaffold Law (LAB § 240) provides an exception to the limits on most workers’ comp claims if you fell from a height. Jacoby & Meyers, LLP, has experience with helping workers secure compensation under the Scaffold Law. Call us now and we can investigate whether it applies to your case.
Can My Claim Be Denied?
Yes, workers’ comp claims are often denied, unfortunately. If you receive a denial, you will not receive workers’ compensation benefits unless you successfully appeal. If you successfully appeal, you are entitled to recover retroactive benefits. Denials can occur for many reasons. Your employer may dispute that your injury or illness occurred at work or is related to work, for example. Denials also occur because of missing or inaccurate paperwork.
Appealing a Denial
There is a specific process for appealing a denial. If the insurance carrier denies your claim, it will file what is termed a “notice of controversy” with the Workers’ Compensation Board. The carrier must file this within 10 days of becoming aware of the work-related injury or illness, or 18 days after your disability begins (whichever is longer).
Following this notice, your claim goes to a judge at the Workers’ Compensation Board. The judge will have hearings during which testimony and other evidence concerning your claim will be presented. After this, the judge decides whether your claim is valid. The judge then determines what the amount of your benefits should be.
If the judge denies your claim (that is, rules in favor of the workers’ comp insurance carrier and your employer), you can appeal that decision within 30 days. (The insurance carrier also has the right of appeal within 30 days if your claim is approved.) The appeal consists of a written request to the Workers’ Compensation Board for review. In this appeal, you should cite your evidence and explain why you are appealing the decision.
A three-member panel reviews this request. First, the panel will determine whether to approve your request for review. Second, it will review the case itself, including your evidence and explanation for why you disagree with the judge’s decision. The panel can then either (1) affirm, (2) modify, or (3) reverse the judge’s ruling.
The panel may determine that your case should be sent back to the judge to review additional evidence. If the panel affirms the earlier ruling, you can appeal this decision to the Appellate Division of the Supreme Court of the State of New York within 30 days.
If You Are Permanently Affected by a Work-Related Injury or Illness
At times, workers can return to work but cannot fulfill the duties of their prior work. If this applies to you, and you are earning less due to the work-related injury, it is possible to receive two-thirds of the difference in your wages from workers’ comp benefits. If you earned $1,000 per week before your injury, for example, but your income before the injury was $700 per week, you may receive $200 per week in workers’ comp benefits (two-thirds of the $300 difference). Furthermore, if you cannot return to a previous job because of your injury, you may be eligible for job placement services or for vocational rehabilitation benefits.
Determining Benefits if You Can’t Return to Work Full Time
People drawing workers’ compensation are evaluated regarding their recovery. If your physician determines that your medical condition has stabilized, but won’t improve even if you receive further treatment, you will be evaluated to see if your injury or illness has left you with permanent limitations. Disability is evaluated on a percentage basis, from 0 percent to 100 percent.
If you are determined to be 100 percent disabled, you can receive workers’ comp benefits at two-thirds of your average weekly salary for as long as the disability continues.
Partial Disability Benefits
If the doctor determines that you are permanently partially disabled, your benefit payments depend on the body parts affected. If you have permanently lost some use of eyes, ears, and portions of your limbs, you will receive disability benefit payments of two-thirds of your average salary on a specific schedule determined by the state, multiplied by the percentage of the amount of use of these body parts you’ve lost.
If your permanent disability centers around your head, spine, organs, or another body part, you are eligible to receive permanent partial disability benefits. These benefits are two-thirds of the difference between your average weekly wage before your injury and your current earning capacity. If your injury resulted in a permanent and serious disfigurement to your face, neck, or head that may limit your earnings capacity (in the view of a judge), you may be eligible to receive an additional sum of up to $20,000.
Death Benefits for Survivors
Workers’ comp also provides death benefits if a worker dies as a result of on-the-job injuries or illness. Surviving spouses, children, grandchildren, parents, grandparents, siblings, and the estate are all eligible to file, depending on what other survivors exist. A surviving spouse with children, for example, is eligible to receive 36 ⅔ percent of the deceased person’s average weekly wage, while the children receive 30 percent divided equally.
Workers’ compensation benefits also pay for reasonable funeral and burial costs. These are determined by county. In the Bronx, Kings, Queens, Richmond, and New York Counties, for example, it is currently $12,500.
Call Our Workers’ Compensation Lawyers
The workers’ comp process is complicated. To navigate it successfully, it helps to have an experienced personal injury lawyer in New York on your side. Jacoby & Meyers, LLP, has successfully fought workers’ comp claims for years throughout New York.
Not only that, at https://www.foalaw.com/, you can learn about a tremendous resource Jacoby & Meyers, LLP, has at our fingertips—a sister law firm that for 50 years has focused on fighting for workers’ compensation and Social Security disability benefits for injured workers. Take advantage of that partnership by reaching out to us today.
For a free evaluation of your case, chat with a live representative, call us today at (877) 565-2993, or write to us using our contact page.
Jacoby & Meyers, LLP
39 Broadway Suite 1910,
New York, NY 10006