Anybody can get injured at work and may remain disabled for
a period of time. Workers’ compensation is an insurance
that provides cash benefits and/or medical care for workers
who are injured or become ill as a direct result of their job.
The New York State Workers’ Compensation Board is a state
agency that processes the claims and determines, through a judicial
proceeding, whether a worker will receive benefits and/or medical
care, and how much he/she will receive. In a worker’s
compensation case no one party is held accountable for the injury
caused. The amount that the injured worker receives is not decreased
by his/her carelessness, nor is it increased by the employer’s
fault. However a worker loses his/her worker’s compensation
if the accident is caused mainly by the worker by either intoxicating
himself/herself by drinking or taking some kind of drugs or
with an intention to harm oneself or somebody at work.
A claim is paid if the employer or insurance carrier agrees
that the injury or illness is work-related. If a worker is not
receiving benefits because the employer or insurance carrier
is arguing that the injury is not job-related, he/she may be
eligible for Disability Benefits in the meantime. Any payments
made under the Disability Program, however, will be subtracted
from future workers’ compensation awards.
This is very important for every individual to know how this
systems works.
You have been injured — What do you do, immediately...
| "Failure
to file a claim or give the employer notice may result in
the loss of rights to compensation." |
The worker obtains the necessary medical treatment and notifies
his/her supervisor about the accident and how it occurred.
The employee notifies the employer of the accident in writing,
as soon as possible within 30 days.
The employee files a claim with the Board (New York State Workers’
Compensation Board) on Form C-3 (Employee's Claim for Compensation)
by filing the form with the appropriate District office. This
must be done within two years of the accident, or within two
years after the employee knew or should have known, that the
injury was related to employment.
After you have been rushed to the Hospital you make sure that
the doctor completes a preliminary medical report on Form C-4
(Attending Doctor's Report) and mails it to the appropriate
District Office within 48 hours of the accident. A copy of the
Form C-4 should also be sent out to the employer or its insurance
carrier, the injured worker, and his/her representative, if
any.
Within 10 days of notification of the accident the employer
reports the injury to the Board and the insurance company on
Form C-2 (Employer's Report of Accident). The insurer
provides the injured worker with a written statement of his/her
rights under the law. This must be done within 14 days after
receipt of the form C-2 from the employer or with the first,
whichever is earlier.
Then the Doctor completes a 15 day report of the injury and
treatment of Form C-4 and mails it to the appropriate District
Office, within 15 days of initial treatment.
Within 18 days after the first day of disability or 10 days
after the employer first has knowledge of the alleged accident
or within 10 days after the carrier receives Form C2, (which
ever is greater), the insurer begins the payment of benefits
if lost time exceeds seven days.
If the claim is being disputed, the insurer must inform the
Worker’s Compensation Board, the claimant and his/her
representative if any. The insurer files Form C-669 (Notice
to Chair of Carrier's Action on Claim for Benefits) or
Form C-7 (Notice That Right to Compensation is Controverted)
with the Board indicating either that payment has begun or the
reasons why payments are not being made.
If the employee does not notify the employer timely, this notice
may be filed within 10 days of learning of the accident. A copy
of each form must be transmitted to the claimant and his/her
attorney or licensed representative, if any, simultaneously
with the filing with the Board.
When the Board notifies an employer or its insurance carrier
that a workers compensation case has been indexed against the
employer, and the employer or insurance carrier decides to controvert
the claim, a notice of controversy Form C-7 shall be filed with
the Board within 25 days from the date of mailing of the notice
of indexing. Failure to file the notice of controversy within
the prescribed 25-day time limit could bar the employer and
its carrier from pleading certain defenses to the claim.
If the rights to compensation is not controversial but payments
has not begun because no compensation is presently due, prescribed
Form C-699 shall be filed with the Board no later than 25 days
after the Board has transmitted a notice of indexing a case
to the employer or its insurance carrier.
Every two weeks the insurer continues to make payments of
benefits to the injured employee (if there are no disputes).
The carrier must notify the Board on Form C-8 (Notice That
Payment of Compensation Has Been Stopped or Modified) when
compensation is stopped or modified.
Every 45 days the doctor submits progress reports on Form C-4
to the Board.
After eight weeks, the insurer considers the necessity of rehabilitation
treatment for the injured employee.
Failure to file a claim or give the employer notice may result
in the loss of rights to compensation.
Common Questions That Arise During a Worker’s Compensation
Claim
Q. Are all disabilities covered under Worker’s Compensation
Law?
A. No. Only those disabilities that are causally related
to an accidental injury “arising out of and in the course
of the employment” or to occupational disease, are compensable.
Q. What if the worker fails to file a claim for worker’s
compensation?
A. The worker may lose his/her rights to benefits and medical
care.
Q. Is it necessary for a worker to retain an attorney?
A. No. Worker’s Compensation Law Judges may assist
a worker not represented by an attorney. If the case is complicated
it is better to have an attorney represent you.
Q. How expensive is it to hire an attorney?
A. Attorney’s fees are deducted from the claimant’s
award as determined by a Worker’s Compensation Law Judge.
A claimant must not pay an attorney directly.
Q. Are prescription drugs and medications covered under the
law?
A. Yes. The claimant should send a receipted bill and letter
from the attending physician to the insurance carrier, stating
that the purchase was necessary and in accordance with the
physician’s direction.
Q. Should an injured worker be subjected to a medical examination
when requested to do so by the employer or the insurance carrier?
A. Yes. The employer or the insurance carrier is entitled
to have worker examined by a qualified physician. Refusal
by the worker may affect the claim. Any person who willfully
misrepresents the circumstances surrounding his or her case
in order to obtain benefits is guilty of a felony and may
result in jail time and may be fined.
Important Telephone Numbers to Service Centers
Workers' Compensation Benefits
Brooklyn District (New York City)
Counties Serviced: Kings, Richmond
Edward M. Joyce, Jr., District Administrator
Tom Agostino, District Manager
1-800-877-1373 FAX-718-802-6642
111 Livingston Street Brooklyn, NY 11201
Manhattan District
Counties Serviced: Bronx, New York
Frank Vernuccio, District Administrator
Joann Shelton, District Manager
1 - 800-877-1373
215 W. 125th Street New York, NY 10027
Queens District
Counties Serviced: Queens
Wayne D. Allen, District Administrator
Carl Gabbidon, District Manager
1 -800 - 877 -1373 FAX - 718 291-7248
168-46 91st Avenue, Jamaica, NY 11432
