This page provides answers to the following questions:
- I had an accident at work. How do I file a workers compensation claim in my state?
- Should my employer have workers compensation insurance? How do I know I am covered?
- What are the conditions that enable me or prevent me from claiming benefits under my state's law?
- What benefits might I be eligible to receive?
- How much time do I have to file my claim? What are the stages of the claim process? What should I expect?
- If I'm not happy with the determination, how do I appeal?
1. I had an accident at work. How do I file a workers compensation claim in my state?
If you are injured on the job, you must: 1) obtain the proper and necessary medical treatment 2) notify your supervisor about the injury, either as soon as possible or within thirty (30) days in writing (in the case of an occupational disease, notify your employer as soon as you receive a diagnosis or within 2 years in which you reasonably should have known the illness was work-related); and 3) complete a Form C-3 to submit to the District Office closest to you.
2. Should my employer have workers compensation insurance? How do I know if I am covered?
Almost all employers in the state of New York are expected to provide workers' compensation coverage to their employees. The information pertaining to your employer's coverage plan should be posted at your place of work or readily accessible should you request the information.
3. What are the conditions that enable me or prevent me from claiming benefits under my state's law?
The best way to ensure a successful claims filing is to keep accurate records and documentation from the time of you first medical visit and onward. It is important that you establish open communication with your employer and observe all filing requirements as closely as possible. Being educated on the process is the best way to approach the workers' compensation system. You may contact the New York State Workers' Compensation Board to receive additional information or even choose to speak with an attorney to guide you through the process; however, hiring an attorney will not be an expense covered by workers' compensation benefits and is purely at your own election.
4. What benefits might I be eligible to receive?
Depending on the nature of your claim, you may be entitled to one or more of the following benefits:
- Cash Benefits: benefits paid to an injured worker after missing more than seven days of work due to the injury. A claimant who is totally or partially disabled will be capable to receive these benefits and will receive an amount as two-thirds of the worker's average weekly wage multiplied by his/her percent of disability. These benefits are paid in situations where the injured workers is typically unable to return to work. If the claimant is able to return back to work, the benefits may terminate. However, another possibility is that the claimant is able to return to work but at a decreased capacity; in this case
- Supplemental Benefits: Benefits available to a limited class of individuals New York State believes to be most affected by rising costs. Most claimants who qualify for supplemental benefits were injured prior to January 1, 1979.
- Medical Benefits: If your case is not disputed and your employer's insurance provider accepts liability, the insurance provider may contract with your treating physician, diagnostic network, and pharmacies to cover the expenses of medical care related to your injury.
- Social Security Benefits: If you are temporarily or permanently disable for a continued period of no less than twelve (12) months, you may qualify for monthly Social Security payments.
- Death benefits: If you die as a result of a work-related injury or illness, your surviving spouse and/or minor children could be entitled to weekly cash benefits. This amount is roughly two-thirds of your average weekly wage prior to your accident. If you leave no dependents, your surviving estate may receive a lump sum of approximately $50,000. These benefits may also include up to $6,000 for funeral expenses.
5. How much time do I have to file my claim? What are the stages of the claims process? What should I expect?
To best ensure you receive benefits, you should file your claim within two (2) years of the date or your injury or when you reasonably would have known your illness was work-related.
To begin the claims process, you must complete an Employee Claim (C-3) form and submit it to the New York Workers' Compensation Board. Your employer is then expected to file a Form Employer's Report of Work-Related Injury/Illness (C-2) within 10 days of receiving notice of your accident, submitting it to the employer's insurance provider. The insurance provider will then review the nature of the injury and/or claim and determines whether the employer will accept liability. This determination must be made within fourteen (14) days of receiving the C-2 form. Depending on whether the insurance provider accepts liability or not, you may begin to receive benefits payments eighteen (18) days after the insurance provider receive the C-2 form. However, this can differ from case to case.
The Workers' Compensation Board may hold hearings, where a Workers' Compensation Judge resides over the case. The Judge will then make a decision about the amount of benefits owed and the period they are owed for. The decision is appealable by both parties within thirty (30) days of the Judge's decision. The party requests the appeal by applying to the Board in writing. The appeal consists of three Board members reviewing the case whereby they can choose to affirm, modify, rescind the Judge's decision. If the Board is not unanimous, either party may request a full-Board review. The full-Board may make the same decisions- to affirm, rescind, or modify the decisions.
6. If I am not happy with the determination, how do I appeal?
Within 30 days of the Board appeals panel, either party may pursue an appeal in the appellate division of the Supreme Court of New York. A decision of the Supreme Court of New York is then appealable to the Court of Appeals.