If you were injured on the job in Staten Island or anywhere in New York, Minchew & Santner, LLP can help. Our workers’ compensation lawyers have been representing injured workers for over 38 years. We guide you through the entire claims process — from filing to settlement — and handle both your Workers’ Compensation claim and any personal injury lawsuit against the property owner or general contractor. Free consultations, no fee unless we win.
Navigating Worker’s Compensation Claims in New York: Your Path to Fair Compensation
Suffering a workplace injury can have significant consequences, affecting not only your physical well-being but also your financial stability. In New York, the worker’s compensation system is designed to provide medical benefits and compensation to employees injured on the job. This page will guide you through the process of filing a worker’s compensation claim in New York and highlight the importance of seeking professional assistance to ensure fair compensation for your injuries.
Understanding Worker’s Compensation in New York
Worker’s compensation laws in New York are designed to protect both employees and employers. It provides medical benefits and disability benefits to workers who suffer job-related injuries or illnesses without having to sue the employer. Workers do not have to prove fault against their employer in Court. Instead, they receive benefits immediately.
The only thing a worker needs to prove is that an accident occurred, notice to the employer within 30 days, and a causal relationship between the accident and the injuries claimed. Rather than bringing the claim in New York Supreme Court, claims are handled by administrative judges before the Compensation Board. Unlike Supreme Court, there is a presumption in the favor of the injured worker that the case is compensable.
Worker’s Compensation also limits employer’s liability for accidents occurring on the job. NY Worker’s Compensation Law § 29 So employers will not be liable for claims for pain and suffering.
Speed of Establishing Case
Another benefit for the claimant is the speed of dispositions. When an injured party is out of work and not collecting compensation, they will get an expedited hearing within 45 days. 12 NYCRR 300.34. Cases in Supreme Court take years to resolve.
Reporting the Injury and Filing a Claim
Promptly reporting your injury to your employer is crucial. New York requires injured workers to notify their employers within 30 days of an accident or the emergence of a work-related illness. Filing a claim involves completing specific forms and submitting them to the New York Worker’s Compensation Board. Seeking the guidance of a knowledgeable worker’s compensation attorney can ensure that all necessary paperwork is properly filled out and submitted within the designated timeframes.
Evaluating Your Claim and Obtaining Fair Compensation
Worker’s compensation claims can be complex, involving medical evaluations and negotiation with insurance companies. Working with an experienced worker’s compensation attorney can help evaluate the true extent of your injuries, gather evidence, and advocate for fair compensation on your behalf.
Medical Benefits
Medical bills must be submitted by the provider within 45 days from the date of service. Providers are now required to submit all medical bills and records electronically over the internet. Disputes about billing are handled between the compensation carrier and the medical provider. Charges for services are governed by the Compensation fee schedule. (This is the same fee schedule that insurance companies use for no-fault claims arising out of motor vehicle accidents.) Thus, an initial consultation by an orthopedic doctor has a different rate than a visit to an internist.
The schedule referenced in the prior paragraph is only a partial list of fee schedules. Each individual medical specialty has to purchase the master list of all fees allowed for the specialty from an outside vendor called RefMed.
Besides a set fee schedule, Compensation also has a system in place for Medical Treatment Guidelines. These Guidelines allow only approved modalities of treatment for each injury. It is up to the individual medical provider to follow approved modalities of treatment for a diagnosed injury. In the event that the medical provider wishes to prescribe a different medication or modality of treatment (like surgery) that is not allowed under the Medical Treatment Guidelines, then it is up to the medical provider to request a variance of treatment.
If the medical provider and carrier do not agree on a treatment modality (the variance of treatment is not allowed), it is up to the provider to request a medical arbitration from the Compensation Board to decide if the prescribed treatment will be paid by the carrier.
Lost Wage Benefits
The formula for lost wage benefits under Workers Compensation is determined in two parts. The first part of the formula determines what a person’s average weekly wage is. For most workers who have five day work weeks, the average weekly wage is defined as the average earnings over the preceding 52 weeks prior to the date of the injury. Worker’s Compensation Law § 14. For those workers who have been at a job less than a year, generally, the employer must provide the average weekly wage of a similarly situated employee. Employers generally must supply the compensation board and the injured worker with the necessary payroll information to make these calculations.
Injured workers who have multiple jobs, have their average weekly wage computed by the sum of all of the wages from their various jobs.
The compensation rate is 2/3 of an injured workers average weekly wage. NYS Worker’s Compensation Law § 15. However there is a cap on the amount injured worker can recover based upon the date of the accident. For decades, the cap on benefits was fixed by statute. Since 2010, the benefits have been capped at an amount of New York State average weekly wage determined by the New York Commissioner of Labor. For accidents occurring after July 1, 2025 until June 30, 2026, the cap on wage benefits is $1,222.42.
Settlements
Because there is no claim for pain and suffering, there are no settlements like there is in a court case. Any settlement for an injured worker is determined by the lost wages that person will sustain in the future. There is a list of injuries found in the compensation law, which defines certain “scheduled” injuries. NYS Worker’s Compensation Law § 15(3). The schedule defines for certain body parts, the number of weeks of permanent disability that an injured claimant should be awarded. An injured worker who loses complete use of their arm would be awarded 312 weeks of compensation.
The “settlement” for a scheduled injury would be the number of weeks for the loss of use of a particular body part multiplied by the compensation rate. However, the compensation carrier is entitled to a credit (deduction from the settlement) for any compensation payments previously made.
If a person does not have a complete loss of use of an arm, say only 50% loss of use, then the settlement would be 156 weeks. The carrier would still be entitled to a credit for any compensation paid.
The injured party’s Medical Doctor evaluates permanent limitations for a schedule injury using the Worker’s Compensation guidelines. The compensation carrier’s doctor evaluates the injured party using those same guidelines. If the two doctors do not agree, then the Compensation judge would decide the loss of use of a particular body part.
Schedule awards are paid in lump sum.
Non-Schedule Settlements
Non-schedule injuries are those not listed in NYS Worker’s Compensation Law § 15(3). The most common non-schedule injury is to the neck and back.
The scheme to determine compensation for a non-schedule injury involves two calculations. One calculation determines Loss of Wage Earning Capacity (LWEC) under Workers’ Compensation Law § 15 [3] [w]. In simplest terms, the LWEC is normally the difference between wages prior to the accident and wages post accident. Compensation benefits are 2/3 of that difference in pay.
A second calculation is for Wage Earning Capacity (WEC) under Workers’ Compensation Law § 15 (5-a). The WEC is determined by claimant’s doctor and the insurance company doctor. If the two doctors do not agree on WEC, then the administrative judge decides that issue. The judge can find the claimant has a 0% WEC to 100% WEC. This percentage is important because it determines how long those awards will run. The benefit limits are determined by Workers’ Compensation Law § 15 [3] [w]. For those injuries with an over 95% WEC, the benefits run 525 weeks. But those claimants with 15% or less WEC, those benefits run 225 weeks.
No-schedule awards are paid out over time depending on the number of weeks they run.
Section 32 Settlements
Settlements that are neither schedule or non-schedule awards are governed by NYS Worker’s Compensation Law § 32. These cases can be non-schedule awards payable over time which are settled in a lump sum. Or some cases are just difficult and neither side, neither the employer nor claimant, wants to take a chance on an “all or nothing” result, so the case is settled. All such settlements under this section must be approved by an administrative judge. Once settled, the case may not be appealed.
Appealing a Denied Claim
Some worker’s compensation claims are denied initially. If your claim is denied, do not lose hope. In New York, you have the right to appeal the decision. A skilled worker’s compensation attorney can guide you through the appeals process. Because the attorney can gather additional evidence and present your case before the Appeals Council.
Worker’s Compensation claims in New York can be complex and overwhelming. Seeking professional guidance from a reputable worker’s compensation law firm can make a significant difference in your case. By understanding the process, reporting your injury promptly, and working with experienced attorneys, you can navigate the system with confidence and increase your chances of receiving fair compensation for your workplace injuries.
Contact us today for a free consultation.