At its core, New York state’s workers’ compensation system is a direct bargain: if an employment-related injury occurs, workers forfeit the right to sue their employer but gain a guarantee of Workers’ Compensation benefits.
In practice, surprises lurk for what injuries qualify — and do not qualify — for benefits. Understanding some of the finer points of New York’s workers’ compensation system will empower you in the event you suffer a workplace injury, and help you know when to enlist the skills of a workers’ compensation lawyer.
Workers’ Compensation Basics
New York requires nearly every employer to carry workers’ compensation insurance. Under this arrangement, all businesses must acquire insurance for each employee from a state-approved provider.
Premiums vary by industry segment, insurance company, and the employer’s long-term safety record. Employees who suffer an injury in the course of work duties and lose more than seven consecutive workdays may file a claim for compensatory benefits. Depending on the severity of an injury and several other factors, payments may range up to two-thirds of a worker’s average weekly lost wages.
In New York, workers’ compensation is a no-fault system; even if an employee is liable for their injury, the benefits still accrue. Is there a catch to obtaining workers compensation benefits? Yes, and this potential roadblock takes the form of the 30-day rule.
To maintain eligibility for workers’ comp benefits, employees must notify their supervisors within 30 days of an injury. Failure to meet this requirement may well mean forfeiting all benefits, even if a worker’s injury easily meets every other standard. In practice, notifying a supervisor immediately is the wisest action. Prompt notification buttresses a workers’ comp injury claim and improves the odds of quick approval.
With many types of workplace injuries, the state’s system works reasonably well. Bone fractures, cuts, and burns are no picnic for the affected workers, but these injuries provide readily verifiable evidence that leads to a smooth claim resolution.
Other workday injuries introduce ambiguities in the process. These gray areas, include vehicle operation, repetitive stress injuries and work-derived mental disorders, are worth looking into for employees who wish to understand their workplace rights.
Experienced NYC workers’ compensation lawyers can explain your rights and the details of your workers’ compensation insurance benefits.
Vehicle Operation Injuries
From bicycles to bulldozers, the chance of incurring an injury while operating a vehicle exists every workday. The foundational rule is straightforward: if you operate a vehicle while acting on behalf of your employer — whether on company premises or not — you are eligible for benefits if you suffer an injury and lose more than seven workdays. Owing to decades of court decisions and state-issued rule revisions, that admirably compact rule now comes with a few exceptions.
On-Premises Vehicle Operation
Workers who suffer an injury while lawfully operating a vehicle on their employer’s premises are likely to qualify for New York workers’ compensation benefits. This applies even if a worker violated company rules and was largely at fault for any resulting injuries. That is the nature of a no-fault system such as workers’ compensation: If an employee’s actions do not cross the line into criminal behavior, the benefits should flow.
Off-Premises Vehicle Operation
For workers whose jobs have them driving on public roads to deliver goods and services, the rules resemble on-premises injuries: steer clear of criminal actions and the benefits should follow. A decade ago, establishing criminal action while operating a vehicle was a difficult endeavor.
A common question that many workers asks is: Am I covered for my commute from home to work? In nearly all cases, the answer is “No.” New York state’s coming and going rule excludes workers comp benefits for trips directly between home and workplace.
However, these are some exceptions. If workers have an employment contract compensating them for travel time between home and workplace, these employees are “on-the-clock” when they exit the driveway, not when they enter their workplace parking lot. This rarely seen contract provision will likely entitle these employees to workers’ comp injury benefits.
Just like a home-to-office commute, a midday car trip for lunch typically falls under the coming and going rule, thus excluding this excursion from workers’ compensation benefits. It is a different story, however, if you run an errand for your employer or pick up lunch for coworkers who continue to work on-premises.
If you suffer an injury while making this type of lunch run, you may well qualify for workers’ comp benefits. Because you embarked on this errand at the behest of your employer, your action likely qualifies for benefits under New York’s special mission rule. Under this rule, your seemingly mundane errand directly contributed to your employer’s productivity and would qualify you for payments in the event of an injury.
A similar situation applies to workers who begin their workdays at locations other than their employer’s premises. A building inspector who drives directly from home to a construction site would qualify for benefits in the event of an on-route accident.
The nuances of the coming and going rule and the special mission rule are compelling arguments for consulting a workers’ comp attorney if you suffer an injury in an off-premises vehicle collision.
Workplace violence is an unhappy fact of life, with the Bureau of Labor Statistics tallying nearly 40,000 incidents in 2020. Workers who suffer an injury after initiating violence forfeit workers’ comp benefits and may face criminal assault charges. Workers injured by assault naturally retain their workers’ comp injury rights, including for injuries suffered in self-defense efforts.
Unlike many states, New York allows workers’ compensation benefits for mental disorders arising from the workplace. Nonetheless, to obtain benefits, a worker must surmount one of three narrowly drawn tests:
- A Linked Physical Injury: When employees can prove a mental disorder arises from a verified physical injury suffered in the course of work, the door opens to workers’ comp benefits. Depression or anxiety linked to the inability to work may meet this test.
- Witnessing a Traumatic Work-Related Incident: An employee does not need to suffer a physical injury to qualify for benefits. Witnessing a workplace incident that led to the death or severe injury of coworkers may cause post-traumatic stress disorder, an acceptable affliction for New York workers’ comp injury benefits.
- Long-Term Adverse Employment Conditions: In addition to physical injury and PTSD-inducing incidents, New York law permits workers’ comp benefits for exceptionally stressful working conditions. With this test, claims that win approval usually meet one of two standards. One acceptable benchmark is stress triggered by a verified pattern of misconduct from a supervisor — one or two incidents will not clear this hurdle. Alternatively, New York will also accept long-term workplace stress above and beyond what is typical for a worker’s chosen occupation.
Pressing a successful workers’ compensation for a mental disorder is a daunting task. First, a claimant must submit a report from a psychologist or psychiatrist approved by the New York Workers’ Compensation Board.
Next, a worker must gather documentation from coworkers. Coworker testimony is particularly vital for incidents involving supervisor misconduct. Finally, as with all work-related injuries, the worker must notify their supervisor within 30 days of the injury’s onset.
With a mental health workers compensation claim, the assistance of an attorney becomes a practical necessity. Between the documentation burden and the possible necessity of appealing a rejected claim, engaging a workers comp attorney from the beginning of the claim improves the odds of approval.
Repetitive Stress Injuries (“RSI”)
According to the Bureau of Labor Statistics, workers with repetitive stress injuries lose a median of 15 workdays per year. With many repetitive stress injuries, there is no definitive fixed point to the onset of an injury. With employers incentivized to minimize workers’ comp claims, obtaining benefits for these injuries is often a high hurdle for workers.
Carpal Tunnel Syndrome
The best-known RSI takes its name from the carpal tunnel, a narrow passageway In the wrist on the hand’s palm side. Passing through the carpal tunnel is the median nerve, the nerve that controls the hand’s pinching muscles.
The syndrome often begins with nighttime tingling in the thumb, index and middle fingers. Symptoms may progress to daytime tingling. Left untreated, carpal tunnel syndrome leads to weakness in the hand and the inability to hold a steering wheel or tool.
These symptoms are the result of inflammation in the wrist’s carpal tunnel, which in turn causes pressure on the median nerve. Though widely thought of as a typist’s injury, assembly line workers, meatpackers and cleaning staffers report higher rates of carpal tunnel injury. Workers who grip vibrating power tools form another risk group. Women are three times more likely than men to cope with this syndrome.
Repetitive stress is not the sole cause of carpal tunnel injuries. Any wrist injury, including a mild sprain, raises the risk. Diabetes and thyroid issues may also cause carpal tunnel inflammation.
Because of these non-workplace causes, insurance companies often resist paying workers’ compensation benefits claims for carpal tunnel injuries without comprehensive medical documentation. The wisest move for any worker is to visit a physician at the first sign of symptoms.
The human body contains nearly 150 bursae, small fluid-filled sacs that reduce the friction between bones and either tendons or ligaments. Repetitive stress can trigger inflammation in these sacs, a condition known as bursitis. This inflammation may cause pain, stiffness and even visible redness in the affected area.
In workday activity, three body locations are likely candidates for bursitis:
- Sit Bones: Workers who sit for long periods may irritate the bursae between the projecting sections of their pelvis and the gluteus maximus muscle.
- Elbows: The olecranon bursa cushions the outside of your elbow. You can cause inflammation to this bursa from overuse or even leaning on your elbows at a desk. Symptoms may build slowly over weeks or appear suddenly.
- Knees: The prepatellar bursa, the sac cushion over the kneecap, often suffers inflammation with workers who kneel frequently: carpet layers, roofers, cleaning workers and carpenters. In most cases of prepatellar bursitis, the knee shows visible swelling. Surprisingly, pain symptoms vary, with some workers feeling pain while kneeling, others noticing discomfort only while standing and a handful experiencing no pain at all. Pain or no pain, persistent swelling is your signal to notify your supervisor and visit a physician.
Tendons are the fibrous tissues that connect muscles to bones. When stress triggers inflammation in these tissues, tendinitis is the result. The main symptom of tendonitis is a pain in the surrounding area, and — in some cases — the inability to hold a nearby joint stationary.
Like bursitis, tendonitis symptoms may build slowly over weeks and months, or become severe in a brief period. Among the thousands of tendons in the human body, the tendons in six areas are prone to injury from workplace activity:
- Shoulders: Rotator cuff injuries happen frequently among athletes, but fireball Yankee relief pitchers are not the only victims of this affliction. Any worker who needs to reach in their workdays, such as a carpenter or store stocker, can inflame the four-tendon assembly that attaches to the shoulder blade. Low-intensity inflammation of the rotor may heal with four weeks of rest. A frayed tendon may require surgery and months off the job.
- Knees: Over-40 workers who develop muscle imbalances may fall prey to patellar tendonitis, an overuse injury of the tendon that attaches the kneecap to the lower leg bone. This painful situation can prove difficult for a workers’ comp claim. An X-ray can rule out several other causes of pain but cannot image a tendon injury. Ultrasound and magnetic resonance imaging can reveal extensive tendon damage, but not early-stage inflammation. Seeking early attention from an orthopedist may head off the need to pursue a difficult claim.
- Hips: Tendonitis in the hip region may afflict employees who sit through their workdays as well as workers who spend a shift on their feet. Seated workers may inflame the tendons leading from the buttocks to the hip bone. More active workers, such as nurses, may irritate the iliotibial band, the long tendon running from the hip to the knee. When addressed early, both conditions yield to physical therapy, thus heading off another difficult workers’ compensation benefits claim.
- Elbows: Lateral epicondylitis, commonly known as tennis elbow, is a common affliction for workers who must vigorously move their forearms: butchers, painters and auto mechanics. This condition rarely requires surgery, but an orthopedist may well recommend stepping away from normal work for several weeks.
- Thumb Joints: Tendonitis at the base of the thumb afflicts many workers, and — infuriatingly — mimics many symptoms of carpal tunnel syndrome. Taking the name De Quervain’s tendinosis, this affliction causes pain at the base of the thumb. The pain is the result of tendon inflammation, irritation of the tendon’s protective sheath or both conditions. In the workplace, swinging the wrist while gripping a handle can cause this overuse injury, making carpenters a prime candidate. De Quervain’s tendinosis can develop slowly with mild symptoms or strike suddenly. Documenting this condition as a workers’ comp injury is relatively straightforward, as swelling is obvious in a video or photo.
- Achilles Tendons: The thick cord-like tendon running upwards from the back of the heel may pose a problem for active over-40 workers. Roofers, who put an extra stretch on the tendon when they walk up angled roofs, are a particularly high-risk group. Muscle imbalances may contribute to Achilles tendonitis, but high blood pressure or antibiotic use add to the jeopardy. More than most, this brand of tendonitis deserves prompt attention from workers who experience early onset symptoms. Beyond the bothersome irritation, Achilles tendonitis erodes the integrity of the tendon, hiking the risk of rupture. A ruptured Achilles tendon requires surgery from an orthopedist, and may not fully recover even with lengthy rehabilitation. With those consequences, high-risk workers should assert their rights, including a consultation with a workers comp attorney.
The Pyrros & Serres Difference
New York’s workers’ compensation rules are complex, and injured workers with medical bills and other damages may need help to claim the benefits they deserve. For an injured worker in the New York City metropolitan area, the law firm of Pyrros & Serres LLP personal injury law firm stands ready to fulfill this mission and help with workers’ compensation claims.
Our firm focuses on workers’ compensation, Social Security disability benefits and personal injury cases. With workers’ compensation and Social Security issues, we can assist at any point in the application or appeals process. If English is not your native language, our workers’ compensation attorneys or a staff member can communicate with you in Spanish, Greek, Hindi, Italian, Portuguese, or Punjabi.
If you face the consequences of an injury, we invite you to call us for a free consultation with a workers’ compensation attorney or take advantage of our online contact form.