Workers Comp Guide_eBook

Workers’ Compensation NY A Complete Guide

POLSKY, SHOULDICE & ROSEN P.C.The WORKERS Attorneys

If you live or work in New York and you’re hurt on your job,

you are covered by workers’ compensation insurance. Also

known as workers’ comp, this benefit system is designed to

help injured and disabled employees cover medical expenses,

make up for lost wages and more.

By law, the majority of New York employees are protected by

workers’ comp insurance, at no cost to them.

However, the specifics vary from case to case. It’s important

to understand the system. Here’s your handy guide to workers

comp in NY.

TABLE OF CONTENTS

What is workers’ comp?

Who’s covered?

Who’s not covered?

Employer responsibilities

Employee responsibilities: - An overview- After the claim process begins

What’s covered under workers’ comp?- Health issues commonly covered- Health isssues not covered

Payments and benefits- Medical benefits - Financial benefits

What to do if you’re injured

Workers’ Compensation NY A Complete Guide

www.workerscompny.com

Mark Polsky Donald Shouldice Adam Rosen

Workers’ Compensation NY What is workers’ comp?


Simply put, it’s a state-mandated program that requires most em-

ployers to purchase specific insurance to help pay for employees’

work-related injuries, illnesses and disabilities. Workers’ comp may

also pay benefits to the survivors of employees who were fatally

injured on the job.

Usually under the program, injured workers are compensated

regardless of whose “fault” an injury is — and as a result, workers

are prevented from suing their employers for those injuries. This

helps prevent payment delays and uncertainties, and protects both

employees and companies from timely, expensive lawsuits.

Each state has its own workers’ comp rules. In 1914, New York

became the first state to set up a compensation program, after a

historic agreement between employers and employees.

Compensation is designed to cover both “incidents” (unplanned,

unwanted events that interfere with work, but could have possibly

been prevented) and “accidents” (unforeseen events that seem to

have happened “by chance”).

Workers’ Compensation NY Who’s covered?


All New York State employees are protected by the system, including:

• Workers in ALL for-profit businesses (including full-and part time

workers in health care, construction, manufacturing or any other business.

• All corporate officers in companies with more than 2 officers and/or 2 stockholders

• Officers of 1-2 person companies if there are other employees

• Domestic employees (such as caregivers and live-in maids) who work at least 40 hours weekly for the same employer

• Public school teachers, except those employed by New York City

• New York state employees, including some volunteers

• County and municipality employees who work in jobs defined as “hazardous”

• Farm workers employed by an individual or business who paid at least $1,200 for farm labor in the previous calendar year

• Most non-profit volunteer workers

Workers’ Compensation NY Who’s NOT covered?


Although most New York workers are part of the state workers’ comp system, some are excluded, such as:

• Federal government employees

• Certain foreign-government workers

• Sole proprietors

• Corporate officers at 1-or 2-person companies with no employees

• NYC firefighters, police officers and sanitation workers

• Clergy members and employees for religious orders (although religious groups may voluntarily cover their workers)

• Workers at charitable or educational organizations that teach or provide non-manual labor (similarly, coverage is voluntary here)

• Interstate railroad workers

• Certain real-estate salespeople who sign up to be independent contractors

• Casual yard workers at a one-family, owner-occupied home (where work is only occasional, and doesn’t involve a minor using power machinery)

Workers’ Compensation NY Employer responsibilities


A company’s responsibilities include:

• Posting a notice about coverage and worker rights in

a visible spot

• Not discriminating against a job applicant or hired worker for filing a workers’ comp claim

• Participating in safety consultations, if required by the state

• Allowing the Workers’ Compensation Board access to company records and payroll, as requested by the state

• Generally, reporting worker injuries to the Workers’ Compensa-tion Board and insurance provider within 10 days of the issue

• Reporting an injured or disabled worker’s pay (and any relevant

pay changes) to the state board

Beyond these responsibilities, covered companies have specific rights. These include:

• Attending claim hearings

• Requesting that an insurance provider contest a workers’ comp

claim (for instance, if an employer suspects fraud)

• Reporting suspected fraud to state authorities

Generally, employers are required to have

current workers’ comp insurance or meet

state-specific self-insurance guidelines.

Each company has to pay its insurance

premiums without charging a cent

to employees.

Employers can sign up for coverage through

an insurance carrier. There can be no lapse in

coverage, even when a company switches

providers.

Workers’ Compensation NY Employee responsibilitiesAn overview


An employee’s obligations:

• If a company has a preferred medical provider for claims, then

injured workers must get initial treatment from that provider.

• Workers should tell medical providers that they’ve suffered a

job-related injury, so that doctors can file necessary paperwork

with the state board.

• In writing, workers must tell their employers when, where and

how they were hurt, within 30 days of being injured.

• After informing the employer, workers must file paperwork to

tell the New York state board about the injury (on a C-2 form) and

register an employee claim (C-3 form).

• Workers should NOT pay doctors or hospitals directly. Unless a

comp claim is denied, bills are paid by insurance providers.

Injured workers receive plenty of protection

under the system, but in return, they have

certain obligations.

Workers’ Compensation NY Employee responsibilitiesAfter the claim process begins


Employees are also responsibile for:

• Attending necessary claim hearings and appointments

• Answering state board and insurance inquiries in a timely,

truthful manner

• Telling involved parties about address changes

• Keeping necessary records and receipts (including medical reports,

mileage to and from doctor appointments, proof of wages, etc.)

• Returning to work as soon as it’s safe (you might be assigned

lighter, transitional duties)

Employees cannot be fired or threatened for

filing a claim. Employers who violate that rule

can be reported. On the reverse side, workers’

must not file false or exaggerated claims.

In some cases when company recklessness leads

to an employee’s injury, the worker can sue the

company. However, if that happens, then the

employee waives his or her right to receive possi-

ble workers’ comp benefits.

Workers’ Compensation NY What’s covered under workers’ comp?Health issues commonly covered


Examples of commonly covered health issues are:

• Carpal tunnel syndrome and many “repetitive motion” disorders

• Broken bones

• Neck and back injuries

• Lung injuries

• Breathing disorders, such as “baker’s asthma” from ongoing flour exposure

• Asbestos poisoning

• Strokes

• Heart attacks

• Loss of limbs

• Vision loss

• Hearing loss, such as from noisy factories

• Work-related anxiety, depression or post-traumatic stress disorder (PTSD)

• Disfiguring cuts or scars

Many employee injuries, illnesses and disabilities

are covered. So are occupational diseases and

hearing loss — as long as they happen “in the

course of” employment.

Workers’ Compensation NY What’s covered under workers’ comp?Health issues not covered


Typically, employees will NOT be covered if:

• An injury was self-inflicted

• An accident happened during a commute

• The employee was under the influence of drugs or alcohol

• The employee was breaking company policy or committing a

crime when the issue occurred

• The employee started a fight, and then was hurt

• There’s no medical report to state that an injury or illness was

caused by a work-related factor

Determining whether injuries and illnesses are

a result of someone’s job can be complicated.

In general, employees may be entitled to com-

pensation if they were hurt as a result of regular

work duties. Even if an incident happened while

employees were engaged in horseplay on compa-

ny property, benefits might be issued.

Workers’ Compensation NY Payments & benefitsMedical benefits


Insurance benefits can help cover:

• Doctor visits and check-ups

• Necessary procedures and surgeries

• Chiropractor or specialist visits, if applicable

• Prescription costs

• Medical equipment costs (such as for knee braces,

splints, crutches or hearing aids)

• Mileage to and from necessary appointments (save your receipts!)

If a claim is approved, then employees are

entitled to a number of medical and financial

benefits. First, there’s medical compensation,

which doesn’t just mean the initial doctor bill.

Medical expenses might be covered short-term

(for instance, to help heal a sprained wrist) or

long-term (to cover ongoing ailments like spinal

injuries). Employees are not entitled to “pain and

suffering” expenses.

Workers’ Compensation NY Payments & benefitsFinancial benefits


Conditions eligible for wage replacement:

• An injury keeps the employee out of work for more than

7 days

• The employee earns less because of the injury

(from working fewer hours or being reassigned)

• A body part is permanently disabled

When it comes to the financial side, benefits are

usually modest, but they can still help provide

much-needed relief during recovery. Workers

might be eligible for wage replacement (usually

up to 2/3 of an individual’s average wage)

if at least one of the conditions on the right apply.

The exact figures for wage replacement are based

on an employee’s pay rate and his or her degree

of disability. Total disability means an employee

can’t do any work, but partial disability means

that he or she can do some work, even if it isn’t

the same work as before the injury. What might

account for a “total” disability in one occupation

might be only “partial” in another.

Workers’ Compensation NY What to do if you’re injured


As with any injury, the first priority is seeking proper medical care.

From then on, it’s important to stay as informed as

possible — both about the workers’ compensation NY

system and your specific case. It’s key to visit a doctor

regularly, keep relevant medical reports, track out-of-

pocket expenses (such as bandages and prescriptions)

and keep proof of earnings and taxes.

Talking to a lawyer can be helpful, especially if you’ve

suffered a serious injury. Workers’ comp lawyers are not

allowed to charge consultation fees and are only paid if

their clients receive a financial reward.

If you need advice, there’s no harm in asking. Our expert

legal team is on YOUR side, not the insurance company’s.

We are The WORKERS Attorneys.

If you’ve been injured and think you have a Workers

Compensation claim, you need a lawyer on YOUR side.

We’ll fight for you to get the maximum benefits you

deserve. Call us for a free attorney consultation.

(516) 594-0909www.workerscompny.com

Workers’ Compensation NY Contact Us


Stay up-to-date on Workers Comp news and information on in our blog!

http://blog.workerscompny.com/blog

We have offices in Long Island and New York City

POLSKY, SHOULDICE & ROSEN P.C.The WORKERS Attorneys

Documents

Workers Comp Guide_eBook