A Legal Guide to New York Workers’ Compensation Benefits

New York may be home to the city that never sleeps, but its workers are what keeps it awake. Recent reports show that NYC has more than 4.7 million jobs, but that also increases the risk of at-work injuries. Fortunately, New York workers’ compensation laws offer protection for people hurt on the job.

A form of no-fault insurance, workers’ compensation may pay for medical bills, lost wages, and even lump-sum disability payments. In return, an employee forfeits the right to sue their employer over an injury.

With that in mind, keep reading to learn more about New York workers’ compensation benefits. Because help is available if you need support after a work-related emergency.

How Does Workers’ Compensation Work in New York?

New York requires that every for-profit and most non-profit companies carry workers’ comp insurance to do business in the state.

Companies may purchase a policy through a private insurance company, or through the New York State Insurance Fund. Larger companies may also apply to self-insure their employees.

The one thing an employer cannot do, however, is require an employee to contribute to the cost of this coverage. It’s a benefit that comes along with employment, and a protection for both the employer and the employee.

The New York State Workers’ Compensation Board has a broader interpretation of what constitutes an employee than some other states. In general, the NYS WCB defines an employee as:

“A person (including family members) who performs under the supervision, direction, and control of an employer either on or off their premises.”

This definition extends to all kinds of workers at many different levels of employment including:

• Part-time
• Full-time
• Temporary
• Seasonal
• Casual/ Day Labor
• Leased
• Borrowed
• Volunteers/unpaid

Basically, employers must purchase workers’ comp coverage for any employee they have who fall in any of the above categories.

Notice of Compliance

All employers must post a C-105 Notice of Compliance for their employees in a visible location at their business.

This is a notice stating that the employer carries workers’ compensation insurance. That way employees know they have this coverage, and through which carrier.

If an employee experiences a work-related illness or injury, they will need to file a claim. Upon approval, the insurance company then provides cash benefits and/or medical care for the worker.

Who is Exempt from Workers’ Compensation in New York?

In most cases, New York businesses with any employees must have workers’ comp insurance in place. However, there are always a few exceptions to the general rule, and in New York these include:

• Sole proprietors (who don’t have any employees)
• One or two-person companies who’re owners of all company stock and hold all offices of the corporation
• Partnerships, LLCs and LLPs that don’t have employees
• Clergy/members of religious organizations performing religious duties
• Members of supervised athletic activities functioning as non-profits
• People teaching for a non-profit
• Persons performing work for a non-profit organization in exchange for charitable aid
• People engaging in a non-manual capacity for a nonprofit institution
• Compensated executive officers of a nonprofit corporation or unincorporated association

Anyone unsure if they need to provide coverage should check with the New York State Workers’ Compensation Board. They manage and process all claims and can guide employers and employees through the requirements.

What Does NY Workers’ Comp Cover?

New York state workers’ compensation covers medical care and lost wages for employees with a job-related injury or illness.

As long as the condition directly results from employment in New York, these benefits are available to every qualifying worker. This is true regardless of residency in the state, citizenship, or immigration status.

Medical Care

For approved claims, all medical care necessary to treat your work-related injury should be free of charge. The insurer pays for your care, unless the claim is invalid for any reason.

Medical care includes all hospital, doctor and surgery bills, but also things like prescription drugs, diagnostic tests, and blood work. Additionally, it will cover physical therapy, chiropractic care, and assistive devices (like wheelchairs or crutches), as well as transportation.

The caveat, however, is you must use a doctor or practitioner with authorization from the NYS WCB. To find an approved health care provider, check the Health Care Provider and IME search on the NYC WCB website.

Lost Wages

Under New York workers’ compensation law, employees may receive a portion of their wages while they recover. This benefit doesn’t kick in until the worker has been out of work due to an injury for seven days.

Starting on the eighth day, they may start to accrue a weekly cash benefit up to two-thirds their weekly wage.

The actual calculation of the payment you’ll receive for lost wages comes from two criteria:

• Your average weekly wage (AWW) 52 weeks before the date of injury or illness.
• Your degree of disability (as determined by your healthcare provider, usually in some increment like 25%, 50%, 75% or total).

A worker won’t receive lost wage benefits for the first seven missed work days, unless they’re out for more than 14 days.

In that case, payment will begin from the first day the injury or illness precludes their ability to work. The employee should start to receive funds within 18 days of their approved workers’ comp claim.

Survivor Benefits

In the unfortunate case that a worker doesn’t survive their work-related injury or illness, survivor benefits are available.

New York workers’ compensation will provide a maximum of $10,500-$12,500 to help with funeral or memorial expenses depending on location. A surviving spouse and minor dependents may also qualify for weekly cash benefits, but they must file a death claim.

Reporting My New York Workers’ Compensation Claim

If you experience a job-related injury or illness, part of the claim process falls to you to get coverage.

If it’s an emergency situation, get the help you need immediately. Don’t wait. However, you should advise them that it’s a work-related injury and make sure to get copies of treatment records.

If it’s a non-emergency situation, however, then you should follow the set workers’ comp protocol. Here are the steps you must take to initiate your New York workers’ comp claim.

Step 1: Report to Your Employer

Per New York workers’ comp laws, you must report your injury or illness to your employer within 30 days of the incident. However, it’s always best to let them know in writing as soon as possible after the incident occurs.

If you fail to notify your employer on time about your injury, you may lose your ability to qualify for workers’ compensation.

Step 2: File a C-3 Form

You must fill out, sign and send a completed form C-3 (Employee’s Claim for Compensation) to the NYS WCB. To fill out your C-3 form, you’ll need the following information:

• Your employer’s name and address
• Your pre-tax gross wages per pay period
• Names and addresses of employers you worked for at the time of your injury.
• The name and address of the medical facility that provided your initial treatment.

This form is not generally something your employer will give you; it’s your responsibility to submit it yourself. You may complete this step one of several ways:

• Online. You can complete the C-3 form online through the NYS WCB online submission portal.
• Print and mail/email. Download the Form C-3, print and complete, then submit by mail or email.
• In person. You may visit a worker’s comp district office to file your claim in person. Call 1-844-337-6301 or 1-877-632-4996 (toll free) to schedule an appointment in advance.

Legally you have two years to submit this form. However, you’ll want to submit this well before the statute of limitations expires.

Step 3: Gather Evidence

When the NYS WCB receives notification of your injury/illness, the Board will send you and your employer a notice. It will indicate the creation of a claim and will assign it a unique case number.

During this time, make sure you gather as much information about the specifics of your injury and your treatment. Hopefully you won’t need it, but if there are questions about your claim, you want to be ready with details. Things to keep track of include:

• What led to the injury or illness
• The date of the incident or realization of the condition
• When you made a report of your injury/illness to your employer
• When you first seek treatment
• Which body part(s) it affects, or the nature of your illness
• How much time you had to miss work as a result

How Long Does Workers’ Comp Last in NY?

The duration of workers’ compensation benefits depends on several variables. These include the type of injury, whether the disability is temporary or permanent, and how it affects your earning potential.

Typically, the worse and more permanent your injury, the longer you’ll receive benefits.

In New York, all claims start off as “temporary.” A disability will only transition to “permanent” status after a claimant reaches their maximum medical improvement (MMI).

How Much is a New York Workers’ Compensation Claim Worth?

Again, the amount a New York worker can receive for their claim depends on their level of disability. It will also be a function of the duration that the injury or illness spans. It’s impossible to predict what one person’s claim might pay without the specifics.

However, it can be helpful to know the different disability classifications and what those are worth.

Temporary Disability

Temporary disability is a worker’s comp wage replacement benefit for employees who cannot work for a limited time. There are two types of temporary disability for which someone can qualify:

• Temporary permanent disability
• Temporary partial disability

If someone has temporary permanent disability, then they’re able to receive the full allowable weekly wage benefit.

Workers eligible for temporary partial disability can receive two-thirds their worker’s average weekly wage (AWW) up to the state maximum.

Permanent Disability

Once a worker reaches their maximum medical improvement (MMI), their condition cannot recover more than it already has. If their MMI leaves them in a condition that is forever less capable than they were, then there’s permanent disability.

If someone has permanent total disability, it means their wage earning capacity is permanently and totally lost. Their condition also restricts them from working an alternate role in the job market. In that case, there is no limit on how long a person can receive workers’ comp disability payments.

With permanent partial disability, the worker has some permanent physical loss of use and wage-earning capacity. In that case, the person may receive a payout in the form of a settlement reflecting their permanent disability percentage.

New York Workers’ Compensation Settlements

Ultimately, New York workers’ comp settlements consider the degree of disability, the severity of the injury, and the lasting effects. If an employee is unable to return to their previous career that may also influence payouts.

Once a worker reaches their MMI (usually two years max from the incident date), then the insurance will reassess continuation. At that point the insurer may extend an offer for a final settlement to effectively close the claim.

Lump-Sum Claims

If you receive an offer to permanently close your claim, it’ll usually be in exchange for a single lump-sum payment. In this case, you’ll settle the claim with a Section 32 Waiver.

No doubt it can feel good to get a large check for what you’ve gone through with a work-related injury. However, it’s important to recognize that by entering this agreement you waive all rights to future compensation.

So, it’s important to consider if your injury will require any ongoing care or could regress at some point.

Otherwise, the payout may not be enough for it to be worth it, and you should request a stipulation instead. A stipulation is an agreement that allows for further coverage.

It’s also a good idea to consult with a workers’ compensation lawyer before accepting a lump-sum payment.

Can My Workers’ Comp Case Be Contested?

If your employer or the insurer thinks the evidence is not strong enough, you may face a contested claim. If that happens, the party contesting a claim must file a notice of controversy (C-7 form) with the NYS WCB.

This must happen within 18 days after the disability begins or within 10 days of learning of the accident.

Reasons an employer might question a claim could include suspicions it didn’t occur during the course and scope of employment.

Injuries that happen at work that aren’t job-related may not receive approval. For example, common reasons for denial include that the injury was:

• Self-inflicted or intentional
• Due to horseplay or fighting
• A result of being under the influence of drugs or alcohol
• In violation of company policy

If you disagree with your claim’s determination, you do have the right to file an appeal with the NYS WCB. However, you’ll want to retain a lawyer before entering an appeal owing to the complexity of these cases.

Can I File Separate Lawsuits From Workers’ Comp in New York?

Remember that if you accept workers’ comp benefits, you do so in exchange for not suing your employer. The system is set up to keep employees and employers out of messy personal injury lawsuits following work-related injuries.

However, if you’re hurt at work and your employer doesn’t have the proper workers’ compensation insurance, you may sue. You may also bring cases against third parties, like other employees who contributed to your work-related injury.

How a LegalASAP Workers’ Comp Attorney Can Help

While you’re recovering from a work-related injury, you don’t want to delay any benefits you’re owed. However, workers’ compensation cases are sometimes complicated to navigate, especially if you don’t know the system.

Having a skilled workers’ comp attorney in your corner can really help. Especially since they can evaluate your case, help with paperwork, and negotiate settlements.

The good news is that workers’ comp attorneys work on a contingency basis. So, you won’t have to pay anything out-of-pocket for legal services if you qualify for a claim.

Let us help connect you with a lawyer in your area! The sooner your case gets going, the faster you can start healing and hopefully get back to work.