What you need to know about getting benefits after a workplace injury
If you were injured in a workplace accident in New York City or anywhere in New York state, you are eligible to receive workers’ compensation benefits. These benefits include coverage of medical expenses related to your injury. They also include weekly benefits to help compensate for lost wages while you can’t work.
The process begins when you complete and submit Form C-3, Employee’s Claim for Compensation, with the New York Workers’ Compensation Board. This form must be filed within two years from the date of your accident or diagnosis of disease – but it’s better to file as soon as possible.
How your weekly benefit is determined
If you are out of work due to your injury, the amount you receive each week is based on your average weekly wage (AWW) over the previous year. Gross earnings are used, not take-home pay. Overtime pay is included. If you have multiple jobs (concurrent employment), and you are out of work at both jobs, then your combined earnings should be included.
Your employer is required to complete and submit Form C-2401, Employer's Statement of Wage Earnings Preceding Date of Accident. If your employer is late in completing this form, a temporary benefit rate may be paid.
The formula for determining your weekly benefit is two-thirds of your average weekly wage. Here’s an example: A worker earned an average of $800 each week during the past year prior to being injured. The injured worker would receive $533.33 per week in benefits while they are unable to work.
There is a maximum weekly benefit amount that is set by the Workers’ Compensation Board based on the average weekly wage in the state during the previous year. There is also a seven-day waiting period before you can begin receiving benefits. If you are out of work for more than 14 days, then the first seven days will be retroactively compensated.
If you are able to return to work in a reduced capacity – for example, if you work reduced hours, a “light duty” role for less pay, or can return to one of your two jobs but not the other – then workers’ comp likewise pays two-thirds of the difference between your pre-injury income and current income.
How permanent disability benefits are calculated
If you suffered a permanent disability involving certain parts of the body, you are eligible to receive an additional cash benefit known as a Schedule Loss of Use Award. This applies when there is a permanent functional impairment to an arm, hand, finger, leg, foot, toe, eye, ear, or there is noticeable disfigurement in the face or neck.
The amount of this benefit is based on the part of the body affected, your average weekly wage, and your percentage of disability. For instance, a hand is worth 244 weeks of compensation under the schedule; if your injury caused you to lose 50% of use of one hand, then you would get two-thirds of your average weekly wage times 122 weeks. If you have permanent injuries to multiple parts of the body, then you get the combined schedule loss of use benefits for all injured parts.
You are also eligible to receive non-schedule benefits if you suffered a permanent disability involving the spine, pelvis, lungs, heart, or brain.
Permanent disability benefits will begin once a doctor has determined you have reached maximum medical improvement (MMI). You can receive these benefits in either weekly payments or a lump sum payment.
What else is covered by workers’ compensation in New York?
Workers’ compensation pays for the full cost of reasonable and necessary medical treatment for your work injury. You can also be reimbursed for certain expenses related to your medical appointments. This includes mileage reimbursement, co-pays, and the cost of parking. Form C-257, Claimant’s Record of Medical and Travel Expenses and Request for Reimbursement, needs to be completed and submitted.
Can I dispute a workers’ compensation decision?
If you disagree with how your benefits are calculated or another aspect of your claim, you can request a hearing with an administrative law judge (ALJ) by filing a “notice of controversy” with the Workers’ Compensation Board. There are multiple steps in this process, including a pre-hearing conference and a formal hearing with the ALJ. The ALJ’s decision can resolve disputes about your average weekly wage, disability status, percentage of impairment, and other factors in the calculation of your benefits, as well as any other substantive dispute about your workers’ compensation claim.
If you disagree with the ALJ’s decision, you can apply for review by the Workers’ Compensation Board. A panel consisting of three Board members will review the ALJ’s decision and either affirm it, modify it, or rescind it; if the three-member panel is not unanimous, you can also request a review by the full Board. Decisions by the Board can be further appealed to the Appellate Division of the New York Supreme Court, and from there to the New York Court of Appeals.
How can a worker’s compensation attorney help?
The workers’ compensation claims process in New York can be complicated. Your initial claim for benefits could be denied for a number of reasons, even for missing a deadline or filling out a form incorrectly. Insurance companies are very familiar with how the system works and will use that knowledge to their advantage.
That’s why you need an experienced New York workers’ compensation attorney who has experience dealing with the Workers’ Compensation Board and knows how to build strong cases that get results. An attorney can guide you through the claims process every step of the way. Your lawyer can:
- Ensure that all forms are filled out correctly and have accurate information
- Submit your claim to the correct office
- Ensure that doctors have all the information they need
- Negotiate with the insurance company on your behalf
- Represent you in hearings and appeals if necessary
Disputes involving workers’ compensation benefits are common, and the laws that apply to workers’ compensation claims are complex. That’s why it’s important to consult an experienced lawyer as soon as possible if you’ve been injured in a workplace accident. Most attorneys offer a free consultation.
