How The Workers’ Compensation Claim Process Works In New York

New York workers’ comp lawyers explain what you need to know

An estimated 2.8 million workers sustain an injury or illness on the job each year nationwide, according to statistics compiled by the U.S. Bureau of Labor Statistics (BLS). This includes more than 140,000 work-related injuries and illnesses each year in New York.

And in many cases, sick or injured workers in New York are eligible to receive workers’ compensation benefits. But how does the process work? Who decides who’s eligible to receive benefits? What deadlines apply?

Below, you can learn more about this complex process in New York and what you should do if you believe you’re eligible to receive workers’ compensation benefits. Since every case is different, we also encourage you to contact our law firm as soon as possible to learn more about your particular legal options.

What is workers’ compensation?

Workers’ compensation is a form of insurance that provides financial benefits to workers who sustain an injury or illness on the job. Such benefits generally cover:

• Cost of medical care related to a workplace injury or illness.
• Replacement income (generally two-thirds of someone’s average weekly salary, up to a maximum amount) if an employee cannot work.
• Travel expenses for medical appointments.

In addition, injured or sick workers might be eligible to receive money for future anticipated medical care and lost future income if an employee has a permanent disability due to their work-related injury or illness.

Who can receive workers’ comp benefits?

Nearly all full-time and part-time New York workers are entitled to receive workers’ compensation benefits. Workers’ compensation is a no-fault form of insurance. This means that injured or sick workers can receive benefits regardless of who was at fault, so long as they were hurt or became ill on the job and within the scope of their work.

All employers in New York State, regardless of how many people work for the company, are required to have some form of workers’ compensation insurance. Employers can purchase workers’ compensation insurance from a private insurance carrier or through the New York State Insurance Fund.

There is no residency requirement to receive workers’ compensation in New York. All people working in New York are covered by the state’s workers’ comp system, according to Section 201, Chapter 67, Article 9 § 201 in the Consolidated Laws of New York.

How do I get workers’ compensation in New York?

The State of New York advises workers who become sick or injured on the job to take the following steps right away:

• Seek immediate medical treatment.
• Tell your supervisor as soon as possible about your work-related injury or illness.

The next step is to file a workers’ compensation claim. However, before filing a claim, many people choose to talk with a workers’ compensation lawyer to help them navigate the system. This is because the application process can be extremely complicated and confusing. An attorney can assist with filling out your C-3 Employee Claim Form, which is the official form required to apply for workers’ compensation benefits in New York.

Your C-3 Employee Claim Form must be filed with the appropriate District Office of the New York Workers’ Compensation Board. There are nine workers’ compensation district offices in New York State, including three district offices in the New York City area. Those offices are located in Manhattan, Brooklyn, and Queens.

New York workers’ comp statute of limitations

There are two important deadlines to meet when it comes to seeking workers’ compensation benefits in New York:

• Employees generally must notify their employer within 30 days of their workplace injury or illness. The clock starts ticking on the date of the injury or on the date that the worker becomes aware (or reasonably should have become aware) of the injury or illness.
• Sick or injured workers then have up to two years to file a workers’ compensation claim in New York State, in most cases.

These deadlines are known as “statute of limitations.” If you miss these deadlines, you could miss out on your opportunity to obtain workers’ compensation benefits.

What other deadlines apply?

Many other deadlines can apply when it comes to workers’ compensation claims in New York, including:

• If you have an occupational hearing loss injury, you only have 90 days (instead of two years) to file a workers’ compensation claim in New York.
• Within 48 hours of seeking medical treatment, the doctor who examined you must file a Doctor’s Initial Report (Form C-4) with the appropriate New York workers’ compensation district office.
• Within 10 days of notifying your employer about your work-related injury or illness, your employer must notify your company’s insurance company and the New York Workers’ Compensation Board by submitting an Employer’s First Report of Work-Related Injury/Illness (Form C-2F).
• Within 14 days of your company’s workers’ compensation insurance company receiving the Form C-2F, your employer’s workers’ compensation insurance company must respond to you in writing.
• Four days later, within 18 days of your employer’s workers’ compensation insurance company receiving the Form C-2F, your company’s workers’ compensation insurance provider must start paying you benefits.
• One week later, within 25 days of your employer’s workers’ compensation insurance company first receiving the Form C-2F, the insurance provider can choose to accept or deny your application for benefits.

If any of these deadlines are not met, make sure you take action right away. Otherwise, you could be missing out on benefits you’re legally entitled to receive as a sick or injured worker. Make sure you talk to an experienced New York workers’ compensation attorney immediately to get a clear understanding of your options.

Who decides if I’m eligible to receive benefits?

Your employer’s workers’ compensation insurance provider is often the first one to decide whether you’re eligible to receive benefits for your work-related injury or illness. They often base their decision on your employer’s and doctor’s assessment of your injury or illness.

Your employer’s workers compensation insurance provider has 25 days to decide whether to accept or deny your application for benefits. If your claim is denied, the insurance company will send you a Notice of Controversy, a formal notification as part of the Notice of Indexing. The Notice of Controversy form is officially called a First Report of Injury (FROI) form, also known as a First Report of Injury Report Type (MTC) 04 Denial.

The New York Workers’ Compensation Board also has the power to deny your application for workers’ compensation benefits. In particular, the board can decide to uphold your employer’s denial of your benefits application.

What are my options if my claim is denied?

If your application for workers’ compensation benefits has been denied by your employer’s insurance provider or by the New York Workers’ Compensation Board, the board will schedule a pre-hearing conference at the appropriate board district office. You have the right to have an attorney present with you at your pre-hearing conference.

At your pre-hearing conference, a New York workers’ compensation judge will make an initial decision on whether to uphold the denial of benefits. During the pre-hearing conference, both sides (the insurance company and you, the sick or injured worker) present evidence.

One of the most important pieces of evidence presented by injured or sick workers at the pre-hearing conference is a Pre-Hearing Conference Statement, officially known as a PH-16.2. Your attorney can help you fill out this form, which states the circumstances of your work-related injury or illness, the names of any witnesses, and legal case precedent for your claim.

Then, the workers’ compensation judge will likely schedule an Independent Medical Exam (IME) and a subsequent court date, where you can present evidence in support of your claim and your employers’ workers’ compensation insurance provider can present evidence as well.

If the judge decides to deny your claim, you have other legal options available, including filing a formal appeal of your denied workers’ compensation claim. You can often appeal your denied application to either the state Workers’ Compensation Board or to a New York Court of Appeals. In such cases, your lawyer can assist with your appeal and represent you at all board or court hearings.

How can a workers’ compensation attorney help?

Applying for workers’ compensation benefits in New York is often a complicated process. Any mistake along the way – whether it’s filling out the wrong form, missing deadlines, or not including a particular piece of information – could jeopardize your ability to obtain the benefits you rightfully deserve.

This is why it’s critical that you consult with an experienced New York workers’ compensation attorney as soon as possible. We understand what’s at stake at Pasternack Tilker Ziegler Walsh Stanton & Romano, LLP. That’s why we want to help.

Since the 1930s, our law firm has been fighting for the rights of injured workers and their families in the greater New York City area. We thoroughly understand the state and federal labor laws that apply to injured workers in New York. We know how the legal system works and regularly represent people at hearings and other court proceedings before judges in New York Workers’ Compensation District Offices in New York City and throughout the state. We get the job done right.

Don’t take chances when you’re sick or injured and need benefits. Make sure you have an experienced New York workers’ compensation lawyer on your side, fighting for your rights throughout the entire process. Contact our law firm and schedule a free consultation today. With five offices in New York City, we have 12 offices conveniently located throughout New York.