Understanding the WORKERS' COMPENSATION LAW
Am I entitled to benefits?
What if I lose days from work?
Who will pay my medical bills?
How do I file a claim?
How do I get medical treatment?
Do I need a lawyer?
Can I get a lump sum cash award?
• Lump Sum Settlements
• Trauma Injuries
• Occupational Diseases
• Back & Neck
• Carpal Tunnel Syndrome
• All Phases of Trials
The Workers' Compensation Law (WCL) assists individuals who are injured from work related accidents or occupational diseases. The WCL provides injured workers with cash benefits (to replace lost salary) and medical coverage. The WCL does not consider the issue of fault. It is important that the injured employee report the injury and be treated by a doctor as soon as possible.
Nearly every worker or employee in New York State is covered under the law. Many independently paid workers or contractors (e.g. taxi drivers or employees of construction sub- contractors) are also covered.
Filing A Claim:
The law requires the employee to notify the employer in writing within 30 days of the work related injury. The employee should state how and when the accident occurred. Even a minor accident should be reported because it can develop into a more serious injury. The employee should also be treated by a doctor within 30 days of the accident. It is crucial that the doctor carefully describe an accurate history of the accident in their records. The WCL provides that any facts written in a medical report are presumed to be true. Initial medical reports play a crucial role in establishing a claim.
The Employer must forward an accident report to its compensation insurance company within 10 days of the accident and benefits are supposed to be paid 14 days thereafter. If benefits are not paid, a claim for compensation must be filed with the Workers' Compensation Board within two (2) years of the accident. An Employee can file a claim directly with the Board by filing a C-3 form. The Board issues an index claim number and notifies the employer and insurance company to begin to process the claim. The insurance company will also issue its own claim number.
The employee's doctor should completely fill out a C-4 form and forward it to the insurance company and the Worker's Compensation Board. The doctor lists his billing on the C-4. You must inform your doctor of all the parts of your body that were injured. The doctors who completely fill out their reports will have their bills paid more promptly. You should keep a list of the dates of visits made to your doctors, and any prescriptions you paid. You are entitled to reimbursement for travel and medication expenses.
Compensation cash benefits are payable at 66.6%, of the workers average weekly salary, with a maximum cap currently of $600 per week. These benefits are tax free. If an employee stays out of work for an extended period, the insurance company may attempt to reduce or terminate benefits. A Compensation Hearing is required in order to restore benefits. If a worker dies due to a work related injury, benefits are paid to the widow and children. An injured worker is entitled to compensation for days they missed from work. If the injury is extensive and prolonged the worker is entitled to a permanent pension.
For injuries involving permanent partial loss of use of arms, legs, (i.e. fractures, carpal tunnel) or loss of vision, hearing, or facial scars, the worker is entitled to a lump sum schedule loss award according to statute. In this type of award, it does not matter how many days of work are lost - a cash award may be granted even if you return to work. For example, my office obtained a $25,000 cash award for a Con Edison worker who suffered a fractured hand and missed only one day of work.
The compensation insurance company pays the cost of medical services. The doctor is not supposed to collect a fee from the worker unless the claim is denied by the Board. An injured worker is free to choose their own physician or chiropractor. It is preferable to see a private doctor Coded by the Board rather than an employer HMO or City Hospital. Private health insurance companies are entitled to be reimbursed for any treatment they pay for.
The Board authorizes the payment for medical services to doctors in the overwhelming majority of cases.
The Compensation Law also covers diseases and repetitive stress injuries that develop as a natural result of one's job such as exposure to fumes, asbestosis, chemicals, key board operations, latex allergies, lead poisoning, repetitive trauma, carpal tunnel syndrome.
Pre- Existing Injuries:
An accident that aggravates a dormant pre-existing injury is covered by Compensation. When an old Compensation injury worsens or is aggravated, the worker can normally reopen their closed cases (within 18 years). Also, when a work related injury causes another injury, this can be claimed as a consequential injury. (e.g. serious leg injury can cause an abnormal walking which in turn can lead to lower back pain injury)
The worker does not have to pay a legal fee unless benefits are awarded. The legal fee is set and approved by the Board. It is very advisable that an injured employee retain a lawyer whose practice is concentrated in the area of Workers' Compensation law. A lawyer will be able to explain to you all your rights and enable you to get all the benefits to which you are entitled. The Insurance Companies have many lawyers representing them. You will normally get a larger award when represented. A lawyer can assist your doctors in getting their bills paid, and request for a Hearing to be held. The lawyer is crucial in obtaining information required by the Workers' Compensation Board to prosecute your claim.
It is a serious violation of law for an employer to not have workers' compensation insurance coverage for its employees. Injured employees are still able to receive cash benefits and medical care from a Special Fund created by the State.