If you sustained an injury on the job that renders you unable to work, you likely face extensive medical bills and lost wages. This may cause you to worry about how you will support yourself and your family until you achieve a complete recovery.
The good news is that you should receive workers’ compensation benefits, regardless of how the incident occurred or who caused it. The bad news is that, though workers’ comp is a no-fault system, both your employer and the insurer may choose to dispute your claim, which could delay your settlement for benefits.
Though for how long the delay will last depends on several factors, you can speed up the process by partnering with an experienced workers comp lawyer.
The Typical Workers’ Compensation Time Frame
New York maintains a strict timeframe for the workers’ compensation claims process. Each party to the process — meaning you, your employer and your employer’s insurer — has certain responsibilities he, she or it must meet by certain points within the process.
If everyone fulfills their obligations in a timely fashion, and if the claim remains undisputed, you should receive your benefits within weeks of the incident.
When you sustain an injury at work, it is your responsibility to notify your employer as soon as possible. To encourage you to do so, the New York State Workers’ Compensation Board sets a 30-day deadline from the date of injury to notify your employer of your accident.
If you fail to inform your employer of your injury within 30 days of the incident, you may forfeit your rights to compensation.
In addition to notifying your employer of your injury, you must also report your injury to the Board as soon as possible. You have up to two years to complete this process before you lose your rights to benefits.
Your Employer’s Responsibilities
Once you inform your employer of your injury, your employer must then notify its insurance carrier. It must do this within 10 days of receiving your notification.
Your employer must only notify the insurance carrier if your injury or illness requires medical care beyond first aid treatment or if you miss at least one day of work, outside of the day on which the injury or illness occurs.
The Insurer’s Responsibilities
Once your employer notifies the insurer, the ball is in the insurer’s court. The insurer must provide you with a Statement of Rights and a list of requirements. It must do this within 14 days of receiving notice of your injury.
Within 18 days of receiving notice of your injury or illness, and if your injury or illness results in seven days of missed work, the insurer must begin paying out benefits. However, the insurer can dispute your claim for various reasons.
If it chooses to contest your claim, it must file a notice of controversy with the Board within 10 days of learning of your injury or illness or within 18 days of the date that your disability began, whichever is later. The notice must specify the reasons the insurer is denying your claim.
What Is a Workers’ Compensation Settlement?
Whether the insurance company denies your workers’ comp claim, requests more information or plans to stop paying your biweekly benefits, you may find yourself embroiled in negotiations with it. If this is the case, you, your workers compensation attorney and the insurer will often work toward a workers’ comp settlement.
New York recognizes different types of workers’ compensation settlements or resolutions. Your workers’ comp lawyer can help you understand the differences between each and decide which you want to work toward, if any.
A stipulation agreement is one that may arise when you and the insurance company agree on the degree of your disability and how much it is worth in either weekly benefits or a lump sum payment. This may only occur if you sustain a scheduled loss.
A scheduled loss is a loss involves the loss of use of a body part or sense. Examples of scheduled losses include vision loss, amputation and hearing loss. New York is one of the few states that recognizes other types of injuries as scheduled losses, such as disfigurement and scarring. Scheduled losses have assigned values. The degree of your permanent injury may result in litigation.
If you come to a stipulation agreement, you and the insurer would sign the agreement, which should identify both the scheduled loss and its associated value. Once you sign the agreement, the insurer will pay out the benefits weekly for the number of weeks outlined in the schedule of injuries.
States assign values to scheduled losses in terms of weeks. While your weekly benefit amount would still be two-thirds of your average weekly wage, which is how much you would receive for an scheduled loss, the law guarantees that you will receive benefits for a predetermined number of weeks. For instance, the award for the complete loss of use of an arm in New York is for 312 weeks.
If you sustain a partial loss, you may receive a percentage of the listed award. For example, if the Workers’ Compensation Board determines you lost 25% use of your arm, you may receive benefits for 78 weeks.
If you sustain a scheduled loss, you typically receive payments for the set number of weeks no matter what. This is the case even if you can return to work before the number of weeks is up.
Section 32 Settlement
The second type of settlement you may receive for a workers’ compensation claim in New York is a Section 32 settlement. A Section 32 settlement is one that the insurer may offer in an attempt to end its obligation to pay you.
These types of settlements typically come via lump sum payment. Insurance companies often turn to Section 32 settlements when a case is being controverted or litigated.
If you accept a Section 32 settlement, know that the payment is likely full and final. What this means is that, by signing the agreement, you forfeit your rights to future benefits if you decide you need them. Rarely will an insurance company agree to pay certain benefits on an ongoing basis, such as medical expenses, in addition to making a lump sum payment.
If you are considering accepting a Section 32 settlement, it is important that you discuss the implications of doing so with your workers’ comp lawyer before signing anything.
Are Workers’ Compensation Settlements Final?
In workers’ compensation cases, as in personal injury cases, insurance companies offer Section 32 settlements to avoid future legal action from the claimant in question. When a claimant accepts a Section 32 settlement, he or she essentially waives his or her right to seek further compensation for the same action.
Whether you accept a stipulation agreement or a Section 32 settlement, chances are that, in doing so, you may forfeit your rights to pursue additional benefits. However, the level of finality of your agreement depends on the type of settlement you accept.
If you enter into a stipulation agreement with the insurer, you may be able to negotiate for additional benefits in the future if your medical condition worsens. If you accept a Section 32 settlement, on the other hand, the agreement is much more final.
For this reason, the Board gives you 10 days from the date of acceptance of a Section 32 settlement to back out of the agreement. If you back out, you must do so in writing. If you follow through with the agreement, you waive your legal right to reopen the claim or file for additional benefits, regardless of if your condition worsens with time.
How Long Will It Take To Reach a Workers’ Compensation Settlement Agreement?
The type of settlement agreement you work toward does not directly affect the length of the settlement process. If the insurance company disputes your claim, you are looking at anywhere from a couple of weeks to a few years before you settle.
If your employer’s insurer does deny your claim, you should partner with a workers’ compensation attorney as soon after receiving the determination as possible.
Factors That Affect the Length of a Workers’ Comp Case
Several factors affect the workers’ compensation settlement time frame. By familiarizing yourself with these factors, you can take steps to mitigate delays and speed up the time from injury to recovery:
- The severity and nature of your injury
- The permanency of your injury
- The time it takes you to recover from your injury
- Whether you retain the help of an experienced workers’ comp lawyer
- Whether you plan to negotiate with the insurer or are willing to accept the funds it offers the first time around
- Whether your case requires a hearing
- Whether you need to file an appeal
While every delay may cause you increasing frustration, it may give you peace of mind to know that longer workers’ comp cases often yield higher settlement awards. Though you should not base the anticipated award amount on the length of your case, know that having a longer case is not always a bad thing.
Common Delays in Workers’ Compensation Cases
In addition to the above factors, there are certain occurrences that may further delay your recovery.
Some delays are more common than others in workers’ comp cases:
- Poor communication between you and your employer, your employer and the insurer, or you and the insurer
- Slow response times on behalf of you, your employer and/or the insurer
- Long wait times for doctor appointments
- Doctors and medical professionals who are slow to get your medical records over to your workers’ compensation attorney
- Lack of cooperation on your part in seeking medical treatment
- Delays in meeting key deadlines, such as filing deadlines or deadlines for receiving medical examinations
- Failure to retain a workers’ compensation lawyer
Some of these occurrences are typical of any workers’ comp case. However, others may be unique to your case. For instance, an insurance company may deliberately take weeks to respond to you or your attorney in the hopes that you will grow frustrated and give up.
It is important to not let your frustration interfere with your judgment and drive you to make rash decisions.
Accepting a Lump Sum Instead of Continuing To Receive Weekly Payments
Typically, insurers pay workers’ compensation benefits on a weekly or biweekly basis. They may continue this for as long as you continue to remain injured and unable to work, or until you can resume your normal work activities. To ensure you continue to qualify for benefits, the insurer will conduct checkups on you. If it detects a change in your condition, it may reassess your claim and your need for benefits. If it finds evidence that you are well, it may stop paying out benefits altogether.
For many claimants, undergoing these reviews can be stressful. For these claimants, a lump sum payment acquired via a settlement may be a more attractive option than continuing to receive weekly payments. If you do not want to remain under scrutiny for the duration of your recovery, you may want to discuss the possibility of negotiating a settlement with your workers’ comp lawyer.
Another reason you may want to negotiate a settlement is if you want to return to work. When you accept a settlement, you can return to work without fear that the insurer will stop paying your benefits. Once an insurer agrees to a settlement and issues the payment, that payment is yours to keep.
Though workers’ comp settlements do come with a few drawbacks, such as having to waive your rights to pursue additional compensation, they do come with a few distinct advantages. Before you make any concrete decisions regarding your case, weigh the pros and cons of each option, and consult with your attorney about what makes the most sense for your situation.
Appealing a Workers’ Compensation Decision
If you are dissatisfied with the insurer’s decision — whether that decision involves an appeal or a low-ball settlement — you may take your case before a workers’ compensation judge. The judge will review the evidence and arguments for and against your claim. You have 30 days from the filing date of the unfavorable decision to file an appeal.
If the workers’ comp judge rules against you, you have an additional 30 days to file an appeal with the Workers’ Compensation Board Panel. The Panel consists of three workers’ comp law judges. If the Panel rules against you as well, you may take your case to the NY Appellate Division. Again, you must file your Notice of Appeal within 30 days.
You may also apply for a rehearing, or request that the Board reopen your claim. To do so, you must submit an Application for Board Review. You must also make one of three assertions:
- You are making your request in the interest of justice
- You possess certain material evidence that was not available at the time of your initial hearing
- A change in your condition has occurred, and that change is material to the issue at hand
- The judge did not properly apply the law.
The 30-day time limit does not apply when you submit a request for a rehearing or reopening of your claim. However, it is in your best interests to make the request within a reasonable amount of time from the date on which you obtain new evidence that constitutes grounds for submitting an Application for Board Review.
Why Hire a Workers’ Comp Lawyer in New York, NY?
Many workers’ comp claimants are hesitant to hire an attorney to help them with their claims for one main reason: cost. Many injured parties assume that the cost of retaining a lawyer will exceed what they stand to recover in benefits.
For injured workers who have strong cases, this is rarely true. In fact, claimants who work with experienced counsel from day one recover significantly more than those who never retain legal help, or who retain help late in their cases.
If cost is what is keeping you from hiring an attorney, it may give you peace of mind to know that our New York workers’ compensation lawyers will not collect payment unless your claim is successful. Moreover, a reputable attorney will only request payment if the amount of compensation you recover is above and beyond what the insurer may have voluntarily paid you.
Even if cost were not an issue, you may have several reservations about hiring a lawyer. Can a lawyer make that much of a difference in the outcome of a workers’ compensation claim?
The right lawyer can. The right lawyer will advise you on what documentation you need to gather and what you need to do to strengthen your case. He or she will handle all the details on your behalf, ensure you meet appropriate filing deadlines and negotiate with insurers so that you do not have to. He or she will use the law to your advantage and take the steps necessary to help you recover the maximum amount of compensation.
If you want to learn more about how the right NYC workers’ compensation attorneys can help with your particular case, schedule your free consultation today. You can call our office directly or submit a request online.
New York State Workers Compensation Board: http://www.wcb.ny.gov/content/main/Workers/HowSystemWorks.jsp