Have you suffered an on-the-job injury in Brooklyn? If so, you may be eligible to obtain compensation for medical treatments and lost wages through the state’s Workers’ Compensation program. An experienced workers’ compensation lawyer can answer the questions you might have about making a claim or appealing a decision and can provide guidance throughout the process.
What Is Workers’ Compensation?
Workers’ compensation is a no-fault insurance program purchased by employers for their employees. The policy provides benefits to workers who have experienced an injury or illness directly related to work, including weekly cash payments to partially compensate the injured or ill worker for missed wages, as well as coverage of medically necessary injury- or illness-related expenses.
As worker’s compensation is no-fault, an employee’s benefits don’t decrease due to his or her own carelessness, nor does the coverage increase due to liability on the part of the employer. The one exception to this rule is that the employee loses the right to be compensated for his or her work-related illness or injury if he or she was found to be under the influence of drugs or alcohol at the time when the injury occurred, or if he or she became injured intentionally or in an attempt to injure another person.
In New York, the injury or illness must be work-related for the worker to be compensated through the Workers’ Compensation program. If the employer or insurance carrier disputes whether the injury or illness was work-related, compensation will stop until the state Workers’ Compensation Board holds a hearing to determine the cause of the injury. While waiting for a resolution to the case, the employee may be eligible to receive disability payments.
The state’s Workers’ Compensation program is overseen by the Workers’ Compensation Board. According to the New York Workers’ Compensation Board’s 2018 annual report, in one year, there were more than 65,000 reopened claims in Brooklyn, as well as nearly 27,500 assembled claims. As noted in the report, reopened claims are those that were previously considered resolved and needing no further action, but have been reactivated due to new issues. An assembled claim is a reported workplace injury in which the Workers’ Compensation Board has been asked to resolve issues, monitor compliance, and ensure timely and appropriate payment of benefits.
Who Is Eligible to Receive Workers’ Compensation?
Nearly every employer in New York is required to provide workers’ compensation coverage for their employees and to post a notice of coverage in their place of business. The people covered by workers’ comp include:
- Employees of for-profit businesses, including part-time, borrowed, or leased employees, as well as family members and volunteers of for-profit businesses.
- County and municipality employees who are engaged in work that the state has deemed hazardous.
- Public school teachers, except those employed by New York City, and public school aides, including those employed by New York City.
- State employees and volunteers.
- Domestic workers who are employed at least 40 hours a week by the same employer, including live-in maids, full-time sitters, and companions.
- Farmworkers, if the employer paid more than $1,200 for farm labor in the preceding calendar year.
- Corporate officers if the corporation has more than two officers or two stockholders.
- Officers of one- or two-person corporations where there are other individuals employed.
- Most employees of non-profit organizations.
Those whose employers are not required to provide workers’ compensation insurance include:
- Volunteers of non-profit organizations who receive no compensation for their work, including stipends, room and board, and other items that have a monetary value.
- Ministers, rabbis, priests, and other members of religious orders.
- Members of non-profit, supervised, amateur athletic activities, provided those members are not employed by or compensated by any person, firm, or corporation involved in the athletic activity.
- People working as teachers for a non-profit religious, charitable, or educational institution.
- People performing work for a religious or charitable organization in exchange for aid from the organization, provided they are not under any contract for hire.
- Railroad employees, federal workers, employees of foreign governments or Native American Nations who obtain coverage through a different workers’ compensation program.
- The spouse or minor children of a farmworker who are not under contract for hire.
- Uniformed officers, firefighters, or sanitation workers who are employed by New York City and other municipality workers who are covered by New York State General Municipal Law.
- Individuals, including minors, who do occasional yard work or other tasks for a single-family residence or the premises of a non-profit, charitable organization.
- Individuals who are sole proprietors with no other workers providing integral services to the business.
- Independent contractors working in the real estate, media sales, or insurance industries.
What Benefits Are Available to Me?
Workers’ compensation benefits include coverage of medically necessary expenses, as well as weekly wage benefits. The weekly wage benefits are not paid for the first seven days of missed work, unless the injury or illness renders the individual unable to work for at least 14 days. At that point, he or she will receive benefits for each day of missed work due to the injury or illness, starting with the first day. The formula used to determine weekly wage benefits is based on 2/3 of his or her average weekly wage before the injury or illness x the percent of disability.
The Workers’ Compensation Board provides the following explanations about disability that are used to determine the claimant’s weekly benefits:
- Temporary total disability: The injured worker has temporarily lost complete wage-earning capability
- Temporary partial disability: The injured worker is still able to earn some of his or her wage, and the condition is temporary
- Permanent total disability: The injured worker’s wage-earning capability is totally and permanently lost. He or she is not limited on the number of weeks of payments available. He or she may be able to engage in business or employment and still receive benefits, provided the wages and benefits do not exceed the wage maximum set through the state’s workers’ compensation law.
- Permanent partial disability: A portion of the injured worker’s wage-earning capability has been permanently lost. The benefits the worker is eligible to receive are dependent on the part of the body that sustained permanent injury and the nature of the disability.
For workers who were permanently and totally disabled due to a job-related injury that occurred before 1979, supplemental income payments may also be available. The Workers’ Compensation program also provides death benefits to the spouse and dependent children of fatally injured workers, including 2/3 of the worker’s average weekly wages and up to $6,000 for funeral expenses.
7 Steps in the Process for Making a Claim?
When an employee suffers a job-related illness or injury, he or she should seek medical assistance right away, and be sure to inform his or her healthcare provider that the illness or injury he or she is being treated for is job-related. The employee should not pay for this medical treatment or file a claim with any other health insurance policy. In addition, the employee has 30 days to inform his or her employer of the injury. After that, the process generally follows the following steps:
- The employee fills out a C-3 form and submits it to the appropriate district office for the state’s Workers’ Compensation Board. This form can either be submitted online or by paper. Workers should submit the form as soon as possible to begin receiving medical coverage and payments for missed work.
- Within 48 hours following medical treatment for a job-related illness or injury, the physician who provided treatment must fill out a C-4 Doctor’s Initial Report form and send it to the WCB district office. Copies of the form must also be sent to the employer and the employee.
- Within 10 days of the injury or illness, the employer must report it to the board and to the insurer.
- Within 14 days of receiving the employer’s report of a work related injury or illness, the insurer must provide the worker with a written statement of his or her rights. Additionally, the insurer must inform the employee if claimants are required to use a specific network to obtain diagnostic tests, and—if so—must furnish the name and contact information of the network.
- If lost time from work due to the job-related injury or illness exceeds 7 days, the insurer must begin making wage payments to the employee within 18 days of receiving a report of the employee’s injury or illness. If the insurer is disputing the claim, it must notify the Workers’ Compensation Board within 18 days, as well as the claimant and his or her attorney representative.
- The insurer continues to make payments every two weeks if the case is not being disputed, and must notify the board if the payments are stopped or modified.
- After 12 weeks, the insurer evaluates the need for rehabilitation for the employee.
If the insurer disputes the employee’s claim, the board must be notified and will attempt to work with both sides to resolve the issue. However, if no resolution can be reached, hearings will be held by the Workers’ Compensation Board before a judge, who will hear testimony and review medical records before making a determination. Either side may appeal the judge’s decision within 30 days. Appeals can be made within 30 days to the Appellate Division, Third Department, or the Supreme Court of New York.
What If My Employer Fires Me for Filing a Claim?
It is against the law for an employer in New York to fire an employee or otherwise discriminate against them for filing a workers’ compensation claim, and will face a fine of $100 to $500 for doing so. An employee who feels that he or she has been discriminated against for filing a workers’ compensation claim can file a complaint with the Workers’ Compensation Board within two years after the discrimination has occurred. If the Board finds that the employee was improperly discharged due to his or her filing of a workers’ compensation claim, the employer may be ordered to restore the employee to his or her previous position and may have to compensate the employee for wages lost due to the improper discharge.
How Can a Workers’ Compensation Lawyer Help Me?
Workers’ compensation law in New York can be complicated, particularly if your employer’s insurer opts to dispute your claim. While it’s not required that claimants hire an attorney, it is allowed and the attorney’s fees will not be charged upfront, but rather after the employee receives an award. An experienced workers’ comp lawyer can provide invaluable knowledge and guidance as you make your way through the process. Below is a list of what a workers’ comp attorney will do for you:
- Timely filing of all forms, ensuring that your case is not lost due to a missed deadline
- Help understanding all of the benefits that you are eligible to claim given the facts of your case
- Someone willing to fight for you to be fully and fairly compensated for your job-related injury or illness
- Gathering all of the medical and factual evidence needed to make your case
- Representation at hearings if your case should be disputed or the insurer appeals the award of benefits
- Ensuring that you only return to work when you’re fully able to and that you’re not prevented from returning to work at that time
- Ensuring that your medical treatment continues until your condition has been resolved
- Helping to file a complaint against an employer for discrimination following a workers’ compensation claim
- Helping you address delayed benefit payments
- Help understanding how to obtain or retain social security disability payments while also receiving workers’ compensation payments
- Help filing an additional personal injury lawsuit due to being injured by a third party on the job site or due to your employer’s serious misconduct
Call Sibley Dolman’s Workers’ Comp Attorneys Today if You Need Help Claiming Compensation
If you suffered a job-related injury or illness, we would be happy to answer your legal questions. Contact us today or call our Brooklyn office at 833-552-7274 (833-55-CRASH) for a free consultation and case review.