While some employers need not provide workers compensation coverage, they tend to be the exception rather than the rule in New York. Since 1941 employers have been mandated to provide this coverage. Worker’s compensation is designed to protect employees, but in reality, it also protects employers from significant financial losses in the event an employee is injured or killed on the job.
Keep in mind what the premise is behind workers compensation: Regardless of who is at fault for the accident or injury, workers compensation pays. Workers are reimbursed for medical bills and lost wages. However, in return, generally employees may not file a lawsuit against the employer. Employer’s insurance companies can, and sometimes do, deny claims but in most cases, they will lose an appeal of a legitimate claim.
Eligibility: Which Employers Must Cover Employees
Typically the only exclusions to workers compensation coverage include teachers employed by New York City and volunteers at a non-profit who are not receiving a stipend. Some of the persons who must be covered include:
- For profit business – For profit businesses must provide coverage for family members and volunteers, full and part time employees, “borrowed” or leased employees.
- Counties and Municipalities – Any employee who is employed in a task that is considered hazardous under New York laws must be covered by workers compensation.
- State of New York employees – Public school aids, all employees as well as some volunteer workers must be covered.
- Individual employer – If a homeowner hires a sitter, companion, live in maid or other domestic help for forty or more hours a week they must provide workers compensation.
- Farm labor – Any employer who pays more than $1,200 in wages in a calendar year must provide workers compensation coverage to their employees.
Keep in mind, employers are required by law to post in a prominent location the name and contact information for their worker’s compensation insurance company.
When a Claim May Be Filed
Workers who are injured on the job or who suffer an illness as a result of work-related activities may file a claim for workers compensation. It is important to understand that even if you are not going to miss time from work, there may be instances where you may be eligible to file a claim. In the event an employee loses their life on the job, spouses and dependent children may also be eligible to apply for benefits and may also receive payment for funeral and burial expenses. Some on the job injuries may include:
- Slip and fall accidents
- Repetitive stress injuries
- Back and neck injuries
- Broken bones and sprains
One of the important distinctions that must be noted however are car-accident related injuries. Workers are not entitled to workers compensation if they are injured traveling to and from work. Workers who have a position that requires them to travel are generally covered under New York’s “no fault” car insurance policies. In most cases, if you have suffered an auto-accident related injury pertaining to your job you should report the injury to your employer but you should also discuss this issue with a personal injury attorney who understands both workers compensation and auto accident rules.
Keep in mind, an employee has responsibilities under New York workers compensation laws including:
- Reporting – Accidents and illnesses must be reported to your employer as soon as possible. It is worth noting that New York does allow claims to be filed for up to two years after the date the injury occurred or the illness was diagnosed.
- Doctor’s care – It is common for your employer to require you to see a physician of their choosing. However, in most cases the injured worker has the right to see a physician of their choosing for ongoing treatment.
No Fault Coverage
In nearly all cases, workers compensation is considered no-fault. Unless an employee violated a company policy such as drinking on the job or being under the influence of drugs that may have contributed to their injury or illness they are entitled to compensation including cash payment in lieu of wages, medical bill coverage and more.
Length of Coverage
When you first file a claim, there will be a delay in receiving benefits. Workers who miss 14 days of work may be eligible to recover wages from the first seven lost days as well. If you have any questions about coverage, your employer or the insurer should be able to address them. If you are permanently or partially disabled, in some cases, the insurance company may offer a settlement after 12 months or may offer it sooner. In many cases, the settlement will be reduced by the amount of cash benefits you have already collected.
When a worker loses their life on the job, their spouse and dependent children may be entitled to collect weekly benefits as well as funeral and burial expenses. In these instances, it is generally a good idea to work with a workers compensation attorney to ensure their rights are protected.
Workers compensation requirements and eligibility can be very confusing. If you have been injured on the job, report the accident to your employer immediately and seek medical attention. Your employer should notify the insurance company as well as make other appropriate notifications of a workplace accident. If your legitimate workers compensation claim is denied by your employer or by their insurance company, you have the right to file an appeal for benefits. Should you find you need to file an appeal, it is best to work with a workers compensation lawyer who understands the laws in New York and understands the eligibility and reporting requirements for workplace injuries.