I’ve Been Hurt on the Job: Who Pays?

The state of New York has a set of laws known as Workers’ Compensation that provides employees with medical coverage and financial compensation while they recover from injuries received from employment. In most cases, the insurance carrier pays for the injuries as long as there’s no denial or dispute over the cause of the injury. But what happens if your injury is going to keep you out of work long after workers’ compensation benefits have run out? You may be eligible to apply for SSDI and secure income going forward. Here’s what you need to know about filing for workers’ compensation in the state of New York.

The Basics of Workers’ Compensation in New York State

Workers’ compensation is a set of laws that lay out the actions employers and employees have to take before, during, and after a claim. Employers are required by the state to carry workers’ compensation insurance that pays out when a claim is made and approved. The laws lay out the procedure for filing a claim and getting medical treatment for the injury along with a cash benefit that maxes out according to the most recent schedule of benefits.

Workers’ compensation in New York state is known as no fault which means an employee can’t bring a personal injury lawsuit against the employer. But an employer can also deny the claim while the employee can file an appeal to overturn the denial. An employee has the right to retain NYC workers’ comp lawyers to assist with appealing the claim and obtaining benefits. 

What an Employee Needs to do After Injury on the Job

The law states that you need to first take care of all injuries as soon as possible. If you have a non-life threatening injury, you have to seek treatment from a health care provider that’s been approved by the Workers’ Compensation Board. The only time this requirement is waived is during an emergency situation. When an employer is authorized to participate in an Alternate Dispute Resolution (ADR) or Preferred Provider Organization (PPO), there may be a requirement to get medical care from a provider in either of these networks. If the case does not get disputed, the cost of medical care is covered by the employer or by the insurance company. 

The employee also has to notify a supervisor about the injury in writing within 30 days after the date of injury. If the injury is the result of occupational disease, the employee has up to two years to notify the employer. Finally, the employee has to fill out Form C-3 and mail it to the closest location of the Workers’ Compensation Board. If the form isn’t filed within two years of the date of injury, the employee may lose their rights to claim benefits. The employer and treating physician also have forms to file and the employer has to provide a written statement of worker’s compensation rights to the employee.  

Getting Compensated for Lost Wages and Injuries

Benefits aren’t disbursed for the first week of injury unless it lasts longer than 14 days. If the injury lasts for two weeks or more, the employee can get compensation from the first day they were off work. Someone who has received injuries that result in partial or total disability and can’t work for more than seven days can receive benefits starting from the first day of injury without going through a waiting period. 

The state of New York uses a formula of 2/3 x average weekly wage x percentage of disability = weekly benefit. The important part of the formula is a percentage of disability. Someone who has a 20 percent disability gets less in compensation while someone who has a 100 percent disability gets the maximum amount of compensation available to them. 

Necessary medical services are paid by the insurance company that handles the workers’ compensation policy as long as the claim has not been disputed. Health care providers are barred from collecting from the injured employee unless the claim is disallowed by the Workers’ Compensation Board or the employee fails to pursue the claim. 

What Happens When Workers’ Compensation is Terminated?

There is no defined time limit for workers’ compensation in the state of New York. A physician has to submit a progress report every 45 days to the Workers’ Compensation Board and the insurer can review the case for ongoing care after 12 weeks, but the termination of benefits depends on the recovery of the employee. If it becomes apparent that the employee is unable to return to their preferred line of work, the employee can take advantage of vocational rehabilitation offered by the board. 

Someone who is unable to return to work in any meaningful capacity after going through physical therapy and/or rehabilitation will want to look into Social Security disability benefits (SSDI) as a source of income when it’s apparent that workers’ compensation will no longer be an option. When it’s known that the employee will be permanently disabled for longer than 12 months, he can apply for SSDI while receiving workers’ compensation benefits. If the employee is successful in getting into SSDI, he can receive both SSDI and workers’ compensation benefits. SSDI will offset the benefits it pays out. 

SSDI pays up to 80 percent of the amount an individual earned while employed. If an applicant is accepted and receiving workers’ compensation benefits, SSDI offsets the amount it pays in order to maintain the 80 percent payout. 

Workers’ compensation is designed to cover all medical bills and replace a portion of working income while you’re recovering from work-related injuries. The law recognizes that the employee put their body at risk of injury on behalf of an employer and requires that an employer carry insurance to provide financial compensation and medical coverage for the employee. As long as the claim doesn’t get disputed, the employee will not have to pay for their medical care nor will they have to go without pay while they recover from their injuries