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What Does New York Workers’ Compensation Cover?

What Does New York Workers' Compensation Cover

Most employers try to keep their employees safe from harm, but even with stringent health and safety standards, accidents still happen. In 2021, New York employers reported a total of 125,500 non-fatal workplace injuries, which equates to 2.2 injury cases per 100 full-time employees.

To protect employees, NY law requires most New York employers to have workers’ compensation insurance. But what is covered under workers’ comp? Workers’ compensation pays for medical bills, lost wages, and other benefits you need while you’re recovering. In 2020, the New York Workers’ Compensation Board assembled 139,843 claims documents, indicating that workers’ compensation is an invaluable resource for New Yorkers who were injured on the job.

If you were injured at work and have questions about workers’ compensation benefits, New York’s workers’ compensation lawyer is here to help.

Do You Qualify for Workers’ Compensation in New York?

Workers’ compensation in New York covers most work-related injuries, accidents, and illnesses. However, not every employee qualifies for workers’ compensation benefits. To collect benefits through workers’ compensation, all of the following must be true:

  • You are covered under the law
  • Your injury, illness, or disability is directly related to your job duties
  • The accident happened while you were performing your job duties
  • You notified your employer of the incident within 30 days of it happening
  • The treating physician reports that a workplace accident or incident caused your injury

If all of the above criteria apply, you are likely eligible for workers’ compensation benefits.

Does My Employer Have to Provide Workers’ Compensation?

Under New York Law, nearly all for-profit businesses must have workers’ compensation coverage. 

Most nonprofit organizations must have workers’ compensation insurance as well, but it doesn’t have to cover all workers. Some exceptions are:

  • NYC Public School teachers 
  • Members of supervised amateur athletic activities at nonprofit institutions
  • People who perform charitable work in exchange for aid from the institution
  • Uniformed NYC Police Officer and sanitation workers

 

What if you performed work for an independent contractor? Anyone who was injured while working for an independent contractor is an employee of the contractor for workers’ compensation purposes.

New York Workers’ Compensation Benefits

If you’re approved for benefits, what is covered under workers’ comp? Specific workers comp benefits depend on how severe your injuries were, but here are examples of some of the benefits you could expect.

Medical Benefits

Workers’ compensation fully covers the cost of medical care for injuries you sustained at work. It might also reimburse you for the miles driven to and from doctor’s appointments. Healthcare professionals who treat you must be covered by the Workers’ Compensation Board unless they are providing emergency treatment.

You can use workers’ compensation medical benefits to pay for treatment related to your workplace injuries including:

  • Surgery
  • Hospital stays
  • Medications
  • Medical supplies
  • Assistive devices
  • Any other healthcare services you need

Cash Benefits

Workers’ compensation pays for lost wages when you’re unable to work due to injury in the form of a cash benefit equal to up to two-thirds of your average weekly wages. To seek the maximum amount of compensation, your injury must be severe enough to prevent you from working and your doctor must report that you are totally disabled. If you’re found to be partially disabled, workers’ compensation will award you cash benefits at less than two-thirds of your average weekly wages.

Rehabilitation Programs

If you were disabled due to your injury, workers’ compensation pays for rehabilitation programs to help you recover and return to work. Programs can include:

  • Medical rehabilitation, such as physical and occupational therapy
  • Vocational rehabilitation, including career guidance and job placement
  • Selective job placement for people with disabilities
  • Social services

Permanent Disability Benefits

If you incurred a permanent disability, permanently, which prevent you from returning to work, you may be eligible for more benefits. The amount you are awarded depends on the severity of your disability. If you are totally and permanently disabled, New York does not have a time limit on how long you can be on disability benefits.

Workers’ compensation benefits are based on the severity of your disability once you reach Maximum Medical Improvement (MMI). MMI means that your healing process has slowed, and healthcare providers don’t expect your condition to improve further. Usually, you’ll reach MMI no more than two years after the date you were injured.

Death Benefits

If your loved one passed away due to a workplace injury, you may be entitled to death benefits. Workers’ compensation gives death benefits to surviving children, spouses, and other dependents. The death benefit settlement covers funeral expenses plus additional weekly compensation. If the employee had no dependents, workers’ compensation may award a lump-sum payment of $50,000 to their estate.

Filing for Workers’ Compensation in New York

If you want to file for workers’ compensation, the quickest way to do so is by submitting Form C-3 online. You will need to provide:

  • Contact information for you and your employer
  • Information about your job duties
  • The date and nature of your injury or illness
  • Information about any medical treatment you have completed

Although you can file the workers’ compensation claim form on your own, it is recommended that your attorney prepare the form to help you avoid constant mistakes.

Reasons Why Your Workers’ Compensation Claim Was Denied

You probably expect your workers’ compensation claim process to go smoothly, and for many people, it does. However, several factors can cause the Workers’ Compensation Board to deny your claim:

  • You don’t have clear evidence that your injury happened at work
  • Your employer disputes that the injury happened at work
  • You waited longer than 30 days to report the injury to your employer (valid reports must be in writing)
  • Your injury wasn’t directly related to your job duties
  • You didn’t seek medical attention for your injury, or your doctor’s office did not supply proper reports to support your claim

If there’s a medical dispute with your claim, you may need to undergo an independent medical examination (IME). Doctors chosen by your employer’s insurance company conduct IMEs. These doctors are meant to be a neutral third party, but they don’t have your interests at heart.

IME doctors review your medical condition and make a report on how severe your injuries are. Although these doctors should be unbiased but, they usually are not. Some may try to downplay your injuries so the insurance company pays you less in benefits. In some cases, insurance companies might use the doctor’s report to deny your claim entirely.

If you feel that you were denied benefits due to an unfair IME or any other reason above, reach out to a workers’ comp lawyer in Queens as soon as you can.

Let Us Help with Your Workers’ Compensation Claim in New York

Workers' Compensation Claim in New York

Filing for workers’ compensation and qualifying for benefits for your injuries should be straightforward, but that isn’t always the case. For example, some injuries can be difficult to prove, and your employer’s insurance may use this to their advantage to deny your claim.

Fortunately, it is possible to contest workers’ compensation claim denials with the help of an experienced attorney. Our firm can walk you through what is covered under workers’ comp, how the appeals process works, and your rights during an insurance medical examination

We can help if your employer is contesting your workers’ compensation claim. Contact Pyrros & Serres, LLP at (718) 626-7730 for a free case evaluation today.

New York Workers’ Compensation FAQs

We put together these answers to some of the most frequently asked questions about workers’ compensation in New York.

Who needs workers’ compensation insurance in New York?

Virtually all employers are required to have workers’ compensation insurance in New York. However, there are some exceptions. For example, a truck driver who drives their own truck for different businesses, but is not considered an employee of any of those businesses, isn’t covered under the workers’ compensation law. Another example would be a hairstylist who rents space from a business to assist their own customers. The business doesn’t need to have workers’ compensation to protect them because the hairstylist is not their employee.

How long does workers’ comp last in NY?

In New York, workers’ compensation can last from 225 to 525 weeks and sometimes for life. How long it lasts depends on the severity of your injuries and other individual circumstances.

Do you have to pay workers’ comp back in NY?

You don’t need to repay your workers’ compensation in NY. One exception is if person commits insurance fraud. For example, if you said your injuries were too severe to work, but you’re making money under the table, that would be considered fraud. It is illegal for New York employers to take money out of your wages to repay workers’ compensation benefits.

How long does it take to get paid from workers’ comp in NY?

New York has a statutory waiting period of seven days for workers’ compensation benefits. Insurers must start payments within 18 days of the onset of injury or disability. However, payments will not begin if the insurer chooses to dispute your claim. If you’re dealing with an insurance dispute or have questions about what is covered under workers’ comp, contact Pyrros and Serres today. 

About The Author

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.

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