If you are injured at work in the state of New York, you must typically file a workers’ compensation claim to pay for your medical treatment and to cover some of your lost wages while you recover. In order to ensure that you receive the maximum amount of compensation available to you, you must comply with all of the necessary deadlines and other requirements of the workers’ compensation claims process. Below is an overview of the workers’ compensation claims process from start to finish.
Notifications are Key
Immediately after an accident occurs, you should tell your supervisor about the accident that caused your injury. Be sure to describe the events leading up to the accident in detail. You should also seek medical treatment at this time to ensure that you have the best chance of recovering quickly.
Within 30 days of the accident, you must also inform your employer of the event in writing. Although you have 30 days to complete this step, you should do it as soon as possible after your accident occurs.
Obtaining the Preliminary Medical Report
Within 48 hours of your accident, your doctor should complete Form C-4 (Doctor’s Initial Report). This form must be mailed to the appropriate district office of the Workers’ Compensation Board. Your doctor must also mail copies of this form to you and to your employer.
Employer’s Report of Work-Related Injury
Once the employer has informed the insurer and the Workers’ Compensation Board of the accident, you should receive a written statement that details your rights as an injured employee.
Filing a Claim
Next, you must file a claim with the Workers’ Compensation Board. To file a claim, complete Form C-3. This form should be mailed to the appropriate district office as soon as possible. However, the form must be submitted within two years of the accident OR within two years after the time you found out the injury was related to your job.
If you have lost more than seven days at work because of your injury, the insurer should begin the payment of workers’ compensation benefits. Once payments begin, the insurer is required to notify the Workers’ Compensation Board that payment has begun. However, if the insurer is disputing your claim, you may not receive payment immediately. In such cases, the insurer is required to inform you and the Workers’ Compensation Board of the dispute and the reasoning behind it.
If Your Claim is Approved
Once your payments have begun, you should continue to receive a check once every two weeks until you are able to return to work or the insurer stops making payments for a different reason. Payments for temporary total disability are calculated as two-thirds of the average weekly wage you received during the year directly before your accident.
If payments are stopped or modified for any reason, the insurer is required to notify the Workers’ Compensation Board. While you are receiving payments, your doctor will also be required to submit a formal report regarding your progress every 45 days. After you have received payments for 12 weeks, the insurer will consider the possibility that you need rehabilitation treatment.
If Your Claim is Disputed
If the insurer disputes your claim, a hearing will be scheduled. At this hearing, a Workers’ Compensation Law Judge will review the evidence submitted by all parties. The judge may also listen to testimony from the parties involved. Once the judge has all of the information he or she needs, he or she will determine whether the claim will be paid.
If the Workers’ Compensation Law Judge ultimately denies your claim, you can appeal the decision by applying for a Board review within 30 days. If your application is approved, your case will be reviewed by three members of the Workers’ Compensation Board, and another decision will be made. Keep in mind that the insurer also has the right to appeal the judge’s decision if he or she approves your claim during the initial hearing. As a result, workers’ compensation disputes can become lengthy and complicated.
Seeking Legal Assistance
The New York workers’ compensation claims process can be complicated. In addition, if you fail to adhere to the Workers’ Compensation Board’s guidelines, you may lose your right to compensation. For this reason, many injured workers choose to seek assistance from an attorney who has experience with these claims. Likewise, if your claim is in dispute, seeking legal representation is highly recommended. Contact Paul Giannetti, Attorney at Law, today to schedule a consultation.