Understanding the procedures for filing a New York workers' compensation claim is crucial after suffering from a workplace injury or illness.
Reporting your work injury or illness and getting medical care
Initially, you must report your injury or illness to your employer in writing within 30 days. You must also see a doctor as soon as possible and inform them that your condition is linked to your job. Before you file your claim, you’ll need to get an official medical diagnosis that links your injury or illness to your job.
Filing your claim
You must then complete Form C-3 and submit it to the Workers’ Compensation Board within two years of learning about your work-related injury or illness. Accuracy on this form is critical, as errors could lead to claim denial or permanent disqualification from benefits.
Additionally, your employer will need to report the incident to the Workers’ Compensation Board by filing a Form C-2F within 10 days after they are notified of your condition. Your doctor must submit an initial medical report (Form C-4) to a board district office within 48 hours and ensure that copies are also forwarded to you, your employer, and the insurance company.
Collecting important documents
It's important to collect and organize all documentation related to your injury or illness. This includes:
- Detailed medical records and reports from your visits to healthcare providers.
- Receipts for any out-of-pocket expenses you have incurred as a result of your injury, such as medication, medical supplies, and travel expenses to medical appointments.
- A detailed journal of your symptoms and how they affect your daily activities.
- Correspondence with your employer or their insurance company regarding your injury.
Claim evaluation and benefits
Once your employer and healthcare provider have submitted the necessary documents, the insurance company will evaluate your claim to determine your eligibility for workers' compensation benefits. If your claim is accepted, you will start to receive benefits on a bi-weekly basis. This includes:
- The cost of current and future medical care relating to your work injury or illness.
- Cash benefits for more than seven missed work days.
- Rehabilitation and vocational retraining services.
Dealing with disputes and claim denials
In the event of disputes, you might need to engage in further procedures with the Workers' Compensation Board. That includes undergoing an independent medical examination (IME) as requested by the insurance company or attending hearings with the board.
If your claim gets disputed or denied, you should take the following actions:
- Request a written explanation for the denial from the insurance company.
- Gather additional evidence that supports your claim. This could include more detailed medical reports, expert opinions, or witness statements.
- File an appeal with the Workers' Compensation Board. This will likely involve a hearing where you can present your case.
If your first appeal does not rule in your favor, you have options to further contest the decision:
- File for a review with the Workers' Compensation Board's full panel. This involves a review by a larger panel of board members who will reconsider the initial decision.
- If the full panel decision is still unsatisfactory, you can appeal to the Appellate Division of the Supreme Court, Third Department. This is a higher judicial authority that reviews the legality and fairness of the board's decision.
- For cases involving significant legal or constitutional issues, you may be able to appeal to the New York State Court of Appeals, the highest court in the state.
Getting workers’ compensation benefits can be a complicated process without the help of an attorney. A lawyer can ensure that all forms are properly filed and you’re aware of your rights and options.