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How to Navigate the Workers’ Compensation System in New York and Recover Maximum Benefits

How to Navigate the Workers’ Compensation System in New York and Recover Maximum Benefits

Workers’ compensation benefits can be a lifesaver if you get injured on the job. However, just because you have a work-related injury and your employer has insurance doesn’t mean you’ll automatically walk home with an adequate payout.

To increase your chances of recovering maximum benefits, you need to understand how workers’ compensation in New York works. In this basic guide, we cover some of the things you need to know about maxing out your workers’ comp claim.

Know What’s Included in Workers’ Compensation Benefits

Workers’ compensation insurance covers your medical expenses and some of the lost wages associated with an injury, illness, or disability that developed during the course of your employment. If you lost a family member in a workplace accident, you may also qualify for death benefits.

Medical Benefits

Workers’ compensation medical benefits pay for all medical expenses related to your job injury, including:

  • Hospital stays
  • Surgical procedures
  • Doctor’s examinations
  • Diagnostic tests
  • Medications
  • Physical therapy
  • Rehabilitation

Note that your medical care providers shouldn’t charge you for anything but should bill your employer or their insurance carrier instead.

Death Benefits

If you’ve lost a loved one in a workplace accident, you may be entitled to collect a percentage of their weekly earnings for the previous year. Workers’ compensation death benefits may be available to the following family members depending on the circumstances:

  • Spouse
  • Minor children
  • Parents
  • Siblings
  • Grandparents
  • Grandchildren

If there are multiple eligible dependents, the benefits may be divided among you. You may also qualify for payment toward the costs of your loved one’s funeral.

Cash Benefits for Lost Wages

Some job-related injuries can take you out from work for days, weeks, and even months. Other times, you may be able to return to your workplace but not at your full capacity.

Workers’ compensation cash benefits can provide you with a much-needed financial boost by covering some of your lost wages. Use this formula to determine how much you can be paid each week:

2/3 x average weekly wage x % of your disability = weekly cash benefit

For instance, if you make $1,000 per week and have a 40% disability, your weekly cash benefits will be:

.6667 x $1,000 x .40 = $266.68

Keep in mind these payments are capped and can’t exceed the maximum regardless of your weekly wages. The current maximum weekly benefit amount in New York for accidents between July 1, 2023, and June 30, 2024, is $1,145.43.

However, you only qualify for cash benefits if you miss eight days of work or more. Also, cash benefits only become available when you’ve been off from work for 14 days, at which point you may be paid for the entire period of time you’ve been gone.

Section 32 Lump Sum Settlement

In some cases, you may elect to receive a lump sum settlement, also known as a Section 32 settlement agreement, instead of weekly payments. Note that you must negotiate your Section 32 settlement with the insurance company — there is no guarantee that you will be offered one.

The main benefit of a Section 32 settlement is that you won’t need to fight the insurance company over your continued medical or cash benefits going forward. You will be paid a large, tax-free lump sum to spend as you wish.

On the flip side, a Section 32 settlement typically closes your workers’ compensation case forever. As you will be signing away your future rights to medical and weekly cash benefits, be sure to consult with an experienced New York workers’ comp lawyer before accepting a lump sum settlement.

Know What to Do Immediately After the Accident

Knowing what to do in the immediate aftermath of a job-related injury is essential to maximizing your workers’ compensation benefits. Here are the three essential steps to take right after your accident:

  • Notify your employer: You must notify a supervisor about your injury in writing within thirty (30) days of your accident. However, keep in mind that merely notifying your employer doesn’t mean they will file a claim on your behalf.
  • Seek immediate medical attention: Have a medical professional examine and document your injuries as soon as possible. You must also request a Doctor’s Initial Report (Form C-4) no later than 48 hours of treatment.
  • Contact a workers’ compensation attorney: Filing a claim for workers’ compensation in New York is complicated. In 2022, the New York State Workers’ Compensation Board received some 11 million claims documents, but the number of assembled and completed claims was just 161,808. To designate a claim as complete, the Board must receive a formal injury notice from the insurance company and a qualifying medical document. Getting your paperwork right and completing all required steps can be difficult without a workers’ compensation lawyer.

Don’t Miss the Deadline to File Your Workers’ Compensation Claim

You typically have just two years from the date of the accident or learning about your injury to submit your claim with the New York State Workers’ Compensation Board. Contact an attorney immediately if you have missed the deadline.

Don’t Be Discouraged If the Board Denies Your Claim

Many workers’ compensation claims are denied on the first attempt. Don’t let that discourage you from pursuing compensation. If you suspect your claim was wrongfully denied, you can pursue an appeal with the Workers’ Compensation Board.

Know How Much to Settle For

According to the National Council on Compensation Insurance (NCCI), the average cost of all workers’ comp claims in 2019-2020 was $41,353.

Before filing your claim, make sure that you have a clear understanding of how much it is worth, especially if you’re looking to pursue a Section 32 settlement. This will ensure that you don’t inadvertently accept a lowball offer. An experienced New York workers’ compensation attorney can evaluate your claim and recommend an adequate settlement range.

While no two cases are alike, the following factors will usually determine the value of your claim:

  • The nature and severity of your injury, illness, or disability
  • Any defenses raised by the insurance company
  • The probability of you returning to gainful employment
  • Whether you will require future medical or other care
  • Past awards and settlements in similar claims

Know That Your Employer and the Insurance Company Aren’t Looking Out for Your Interests

Many workers believe their employer will ensure their benefits will be paid out quickly and will keep their job open for when they return. Likewise, you might think that if you just show your medical documents to the insurance company, you can expect a reasonable payout.

Unfortunately, that isn’t always the case. Workers’ compensation in New York has many hidden pitfalls, and the various stakeholders, such as your employer, their insurer, and even the Workers’ Compensation Board, aren’t always as cooperative as they should be.

You shouldn’t navigate this system alone. To maximize your benefits, consider hiring an experienced workers’ compensation attorney who will look out for your interests and negotiate on your behalf.

Know You May Have Other Options

When you make a workers’ comp claim, you give up the right to sue your employer for negligence. However, you may still be able to sue third parties who were partially or wholly responsible for your injury, such as independent contractors. Your lawyer will advise you if you can pursue other forms of compensation in addition to your workers’ compensation claim.

Hire an Experienced Workers’ Compensation Lawyer

Hire an Experienced Workers’ Compensation Lawyer

Navigating workers’ compensation in New York can be challenging without the support of a legal professional. Don’t leave the outcome of your claim to chance: Hire an experienced attorney with a proven track record in workers’ comp cases.

Do You Need Help With Your Workers’ Compensation Claim?

At Pyrros & Serres, LLP, we have been helping victims of work-related injuries in New York maximize their claims for over a decade. Call us at 718-626-7730 for a free consultation with a workers’ comp lawyer in Queens.

To learn more about workers’ compensation in New York, read our article What Does New York Workers’ Compensation Cover?

FAQs: Workers’ Compensation in New York

Read the answers to frequently asked questions about workers’ comp in New York:

Is Workers’ Compensation Mandatory in New York?

Workers’ compensation is mandatory for all employers in New York. There are some very limited exceptions if your employer is:

  • The New York City Police Department ( uniformed NYPD)
  • The New York City Fire Department (uniformed NYFD)
  • The City of New York Department of Sanitation (uniformed DSNY)
  • New York City Public School teachers

Who Is Eligible for Workers’ Compensation in New York?

You are eligible for workers’ compensation in New York if you develop an injury, illness, or disability in the course of your employment. This is regardless of what caused your injury and whether or not you missed less than eight days from work.

Who Is Exempt From Workers’ Compensation in NY?

Workers’ compensation insurance is not mandatory for one- and two-person-owned corporations if those individuals own all stock and hold all offices of the corporation and do not have any employers. To qualify for the exemption, each individual must own at least one share of stock and hold an office.

About The Author

Picture of Michael Serres, ESQ.

Michael Serres, ESQ.

Michael Serres, ESQ. is a reputed Workers’ Compensation Lawyer in Astoria, Queens, NY. He graduated from St. John’s University School of Law in 1989. Mr. Serres was admitted to practice law in New York State in 1990 and is admitted in the Federal District Courts for the Southern and the Eastern Districts of New York. He has served on the Board of Directors of the Workers’ Compensation Bar Association and is currently serving on the Board of Directors of the Queens County Bar Association.