New York Workers Compensation FAQ

 

What is New York State Workers Compensation?

New York State Workers’ Compensation is a form of insurance providing wage replacement and medical benefits to employees who have been injured on the job or have a condition which has been caused by activities performed on the job.

 

 Why should I make a New York State Workers’ Compensation claim?

If you become injured or disabled as a direct result of your work activities you will require medical attention and perhaps hospitalization and follow up care.  If no claim is filed you may be found personally responsible for the medical bills.  Serious injuries or conditions may cause extensive loss of time or perhaps even a loss of your job.  Filing a New York workers’ compensation claim with Scheine Law while seeing a New York workers’ compensation approved doctor for medical care may entitle you to financial benefits, medical coverage for your injury and a possible settlement for your injuries if they are permanent.

 

Do I go to my employer to file a New York State Workers’ Compensation claim?

As a general rule the first step in filing a New York Workers’ Compensation Claim is to notify your employer that you were injured on the job.  A notice to the employer should be in writing, but can be oral.  You have 30 days from the date of the accident to tell your employer, but sooner is definitely better than later.  Generally the longer you wait to report an accident the more likely the employer or insurance carrier will fight or reject the claim.

 

Must an injured worker submit to a medical examination when requested to do so by the employer or insurance carrier?

Yes.  The employer or insurance carrier is entitled to have the worker examined by a qualified physician.  Refusal to submit to an exam may affect your New York Workers’ Compensation Claim.

 

Who is involved in a New York State Workers’ Compensation Claim?

There are many people involved in a claim.  You as the injured or disabled worker will be referred to as the claimant; your boss is called the employer; your doctors is called the health care provider; your representative is called the claimant’s attorney; the insurance carrier representative is normally called defense counsel; the judge is called the ALJ (Administrative Law Judge); the IME (Independent Medical Examiner) is the insurance carrier’s medical examiner … just to name a few!

 

How are my weekly wages calculated and is overtime a factor?

To calculate your average weekly wages, divide the amount of your earnings plus overtime for the 52-week period before your accident happened by 52.  There are a number of variations available in calculating your average weekly wage and in determining your New York Workers’ Compensation rate.

 

Is there an appeal process if I’m not satisfied with the decision is my claim?

Yes, within the New York State Workers’ Compensation Law there is an appeal process.  Generally, the employee and the employer and its insurer can seek a state court appeal, which is usually heard by the state’s 3rd Department Appellate Division.  Rules for appeals vary by state, and help from a workers’ compensation attorney will be needed.

 

Should I apply for Social Security Disability?

If your injury is serious enough to keep you out of work for six months, but last a year, yes you should apply.  Your application, like most, may be denied, regardless of your medical condition.  Many disability claims are successful on appeal.  At Scheine Law we specialize in Social Security Disability so we can help you.

 

Who is covered by the New York State Workers’ Compensation Law? 

Virtually all employers with one or more employees in New York State must provide workers’ compensation coverage for their employees.

 

How do you file a New York State Workers’ Compensation Claim?

If your injury or condition was directly caused by your work activities you must take the following steps to make a workers’ compensation claim:

 

  • Notify your employer as soon as you can.  The law says you have 30 days, but sooner than later is stressed here.

 

  • Seek medical attention as soon as you can.  Your injuries require medical care.  In most instances except in emergencies the care must come from a health care provider authorized to treat workers’ compensation patients. 

 

  • If your injuries are serious consult with an attorney.  Attorneys do not charge for a consultation in New York Workers’ Compensation Claims and you are under no obligation to retain the attorney after the consultation.  Permanent or serious injuries are those injuries that result in a permanent condition or will require extensive care and lost time of more than a few weeks at work.

 

  • At The Law Offices of Edward R. Scheine I can help you file a claim to cover the medical care for your injuries or condition and to receive wage support while you are unable to return to work.  If you don’t file a claim you’re on your own.  I am here to help you.  Depending on how you were hurt you may be entitled to benefits in addition to New York Workers’ Compensation.  Consulting with The Law Offices of Edward R. Scheine could be a vital element in protecting your rights.

 

What are some of the processes used in a New York Workers’ Compensation Claim?

There are many different processes and pathways in which a typical workers’ compensation claim may take.  Change one fact in a claim and a new process or direction will be needed.  Factors include lost time, average weekly wage, date of accident, medical proof, returning to work, reduced earnings, need for tests or treatment, causality, degree of disability, earning capacity, etc.  File the claim with your employer – if your employer or insurance carrier dispute the claim a hearing will be conducted to discuss the nature of the dispute.  Normally after a hearing there is a decision that will be made by a judge.  At this time all involved will receive a copy of the Notice of Decision within a week or so from the date of the hearing.  Appeals can be made by either side, if the decision is being disputed.  The appeals process can take several months before a decision is even made.

 

When do you need a lawyer or representative and what will it cost?

The workers’ compensation system in New York is both complex and frustrating.  In many situations representation may be advisable.  If you lose very little time from work and your injuries are minor and not permanent you may find it difficult to obtain an attorney since you may not be entitled to financial benefits.  Most attorneys do not accept cases where you as a claimant will not be entitled to a financial award.  The representative is not allowed to charge you directly for their representation.  Any fee that may be authorized will come from the financial benefits you are awarded.  If no financial benefits are awarded, you will not be charged a fee.  The Law Offices of Edward R. Scheine offers free consultations for New York Workers’ Compensation and other disability related claims.  It pays to consult someone with experience to determine your rights and to be made aware of what you are entitled to.