In New York, known as the Empire State, injured workers may be entitled to benefits and financial compensation. This is per New York Workers’ Compensation Laws. The NY Workers’ Comp system is operated by The Division of workers’ compensation provides for the payment by employers or their insurance carriers of medical, disability and reemployment benefits to injured workers. The division is required to administer the Act in a manner that is both fair and efficient to all parties. In addition to its administrative function, the division also houses the New York Workers’ Compensation Board which hears disputes arising between employees and employers or their insurance carriers regarding the payment of benefits under the Act. If you have been hurt on the job please contact our New York LGBTQ workers compensation lawyers today.
New York Workers Compensation Laws
Workers’ Compensation is a system which requires an employer to pay an injured employee’s work-related medical and disability benefits. Workers’ compensation also requires the payment of benefits to dependents in the case of work-related death.
What To Do If Injured At Work In New York According To New York Workers Compensation Laws
If you are injured on the job in New York there are several steps you need to take immediately:
Seek medical care immediately or as soon as possible. By no means should you go home or procrastinate in terms of going to the local emergency room, hospital or to your doctor.The treating health care provider must be authorized by the Workers’ Compensation Board, except in an emergency situation. You can find out more information about authorized providers and locate authorized providers in the Injured Workers or Health Care Providers sections of this website or by calling 1-800-781-2362. If your employer has been authorized to participate in a Preferred Provider Organization(PPO) or Alternate Dispute Resolution (ADR) program, you may be required to obtain medical treatment from a participating health care provider. Participating employers are required to notify their employees, in writing, of all information pertaining to a PPO or ADR program. Also, if you are in need of diagnostic tests or prescription medicine, your employer or your workers’ compensation insurance carrier may require you to obtain your tests or your medicine from a diagnostic network or designated pharmacies or a network of pharmacies they have contracted with. It is required that you receive written notice if you are required to utilize a diagnostic network or designated pharmacies or a network of pharmacies.
The cost of necessary medical services is paid by your employer or your employer’s insurance carrier, if the case is not disputed. Health care providers may request that injured workers sign form A-9. This form is meant to provide notice to the injured worker that he or she may be responsible to pay the medical bills if the Workers’ Compensation Board disallows the claim or the injured worker does not pursue the claim.
Notify your supervisor about the injury and the way in which it occurred, as soon as possible. An injured employee who fails to inform his or her employer, in writing, within 30 days after the date of the accident causing the injury, may lose the right to workers’ compensation benefits. In the case of occupational disease, notification should be given within two years after disablement, or within two years after the claimant knew or should have known that the disease was work-related, whichever is later).
Complete a claim for workers’ compensation on Form C-3 and mail it to the nearest office of the Workers’ Compensation Board, if there is lost-time. If a claim is not filed within two years from the date of the injury or disablement from an occupational disease, (or after disablement and after you knew, or should have known that the disease was work-related), you may lose your right to benefits.
- Follow doctor’s instructions to speed full recovery.
- Attend an Independent Medical Examination if you are required to do so.
- Go back to work as soon as you are able.
- Attend such hearings as may be held in the case, when you are notified to appear.
New York Workers’ Compensation Benefits
Cash Benefits
Cash benefits are not paid for the first seven days of the disability, unless it extends beyond fourteen days. In that case, the worker may receive cash benefits from the first work day off the job. Necessary medical care is provided no matter how short or how long the length of the disability.
Claimants who are totally or partially disabled and unable to work for more than seven days receive cash benefits. The amount that a worker receives is based on his/her average weekly wage for the previous year. The following formula is used to calculate benefits:
2/3 x average weekly wage x % of disability = weekly benefit
Therefore, a claimant who was earning $400 per week and is totally (100%) disabled would receive $266.67 per week. A partially disabled claimant (50%) would receive $133.34 per week. The weekly benefit cannot exceed the following maximums, however, which are based on the date of accident:
If you can return to work but your injury prevents you from earning the same wages you once did, you may be entitled to a benefit that will make up two-thirds of the difference.
Medical Benefits
The injured or ill worker who is eligible for workers’ compensation will receive necessary medical care directly related to the original injury or illness and the recovery from his/her disability. The treating health care provider must be authorized by the Workers’ Compensation Board, except in an emergency situation. You can find out more information about authorized providers and locate authorized providers in the Injured Workers or Health Care Providers sections of this website or by calling 1-800-781-2362. There are certain exceptions where insurance carriers or self-insured employers can direct medical treatment for the injured worker as described below:
Some injured or ill workers may require diagnostic tests, x-ray examinations, magnetic resonance imaging (MRI) or other radiological examinations or tests. As of March 13, 2007, insurance carriers, which includes self-insured employers and the State Insurance Fund, are authorized to contract with a legally and properly organized diagnostic networks to perform diagnostic tests, x-ray examinations, magnetic resonance imaging or other radiological tests or examinations or tests. In addition, insurance carriers may require claimants to obtain or undergo such diagnostic tests with a provider or at a facility that is affiliated with the network the carrier has contracted with, except when a medical emergency exists requiring an immediate diagnostic test or if the network does not have a provider or facility able to perform the diagnostic test within a reasonable distance from the claimant’s residence or place of employment. The insurance carrier must notify claimants of the name and contact information for the network it has contracted with and is requiring claimants to use at the same time the written Statement of Claimant’s Rights is sent or immediately after imposing the requirement if the time to send the Statement of Claimant’s Rights has passed. Injured or ill workers should notify their medical providers if they receive notice that the insurance carrier requires the use of a network provider or facility for diagnostic tests.
The Workers’ Compensation Law allows insurance carriers and self-insured employers to contract with New York State Health Department certified Preferred Provider Organizations (PPOs) to provide services, to diagnose, treat and rehabilitate an injured or ill worker requiring medical treatment. PPOs are required to make available at least two providers in every medical specialty and two hospitals. An injured worker is required to seek initial treatment with a provider affiliated with the PPO however, after initial treatment, he/she may select any authorized provider outside the PPO 30 days after the initial treatment.
The Workers’ Compensation Law also allows, by negotiated labor agreement, a non-Workers’ Compensation Board adjudication claim process called the Alternate Dispute Resolution(ADR) system for employers and employees in the unionized construction industry. Injured workers covered by the ADR program are required to obtain medical treatment from medical providers participating in the ADR program.
Beginning July 11, 2007, when a claimant or pharmacy submits a claim to an insurance carrier for payment or reimbursement of the cost of prescribed medicine for the work related injury or illness, the insurance carrier must pay the amount set forth in the Pharmacy Fee Schedule within 45 days of receipt of the claim, unless the claim has not been established or the prescribed medicine is not for a casually related condition. If the claim is not established or the prescribed medicine is not for an injury or illness related to the work accident or disease, the insurance carrier must pay any undisputed portion and notify the injured or ill worker or the pharmacy in writing within 45 days of receipt of the claim that the claim is not being paid, why it is not being paid and requesting any additional information needed to establish the claim.
Also, beginning July 11, 2007, insurance carrier may contract with a pharmacy or pharmacy network to provide prescribed medicines to injured or ill workers and may require injured or ill workers to obtain their prescribed medicines from such pharmacy or pharmacy network. The only exceptions are when a medical emergency occurs and it is not reasonably possible to obtain immediately required prescribed medicines from such pharmacy or pharmacy network or the pharmacy or pharmacy network does not offer mail order service and do not have a physical location within a reasonable distance from the claimant. If an insurance carrier requires injured or ill workers to use the pharmacy or pharmacy network it has a contract with, it must provide the injured or ill workers with notice which includes the contact information for the pharmacy or pharmacy network and instructions on how to obtain prescribed medicines.
The cost of necessary medical services is paid by the employer or the employer’s insurance carrier, if the case is not disputed. The health care provider may not collect a fee from the patient. When appropriate, claimants will be awarded reimbursement for automobile mileage to and from a health care provider’s office.
Health care providers may request that injured workers sign form A-9. This form is meant to provide notice to the injured worker that he or she may be responsible to pay the medical bills if the Workers’ Compensation Board disallows the claim or the injured worker does not pursue the claim.
Supplemental Benefits
Supplemental benefits were made available to claimants thought to be most affected by rising costs. The combination of weekly benefits, death benefits and supplemental benefits cannot exceed $215/wk. This is the rate that was in effect on January 1, 1979.
Two categories of claimants/beneficiaries are eligible for supplemental benefits:
- Claimants classified permanently and totally disabled as the result of an injury or disability incurred on the job prior to January 1, 1979;
- Widows or widowers receiving death benefits as the result of the death of their spouse occurring prior to January 1, 1979.
If you qualify for these benefits, you must contact the insurer or administrator for your claim to let them know. If you believe that you have been denied these benefits in error, please contact the Workers’ Compensation Board’s Advocate for Injured Workers: Phone: (877) 632-4996; E-mail: advinjwkr@wcb.ny.gov.
Social Security Benefits
A worker who becomes seriously disabled, either permanently or for a continuous period of not less than 12 months, as a result of a medically determinable physical or mental impairment may be entitled to the payment of monthly Social Security benefits. For additional information about these Federal Disability Insurance Benefits, write or call the nearest Field Office of the Social Security Administration.
Death Benefits
If the worker dies from a compensable injury, the surviving spouse and/or minor children, and lacking such, other dependents as defined by law, are entitled to weekly cash benefits. The amount is equal to two-thirds of the deceased worker’s average weekly wage for the year before the accident. The weekly compensation may not exceed the weekly maximum, despite the number of dependents.
If there are no surviving children, spouse, grandchildren, grandparents, brothers or sisters, parents or grandparents entitled to compensation, the surviving parents or the estate of the deceased worker may be entitled to payment of a sum of $50,000. Funeral expenses may also be paid. For all deaths on and after June 8, 2016, the maximum amount for funeral expenses was increased from $6,000 to $12,500 in Metropolitan New York counties, and from $5,000 to $10,500 in all other counties.
Contact Our New York LGBTQ Workers Compensation Lawyers
To begin your case review with one of our gay New York work injury attorneys please click here. They provide free case evaluations and charge no fees if they are unable to recover for you. Let them put their experience handling New York workers’ comp claims to work for you.
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