Navigating New York’s Workers Comp System

By | 2017-08-15T13:53:33+00:00 December 17th, 2014|Work Injury|

Since 1917, most workers in New York State have been covered by workers compensation insurance. If you get hurt at work, you have the right to file a claim for insurance benefits.

And while that might sound simple enough, in reality, it’s far more complicated.

social security benefits and compensation

How Does Workers Comp Work?

Workers Compensation is a “no-fault” system, similar to many auto insurance policies in New York. If your claim is approved, that decision does not take responsibility into account. The Workers’ Comp Board doesn’t care if your employer caused the accident, if another worker contributed to your injury, or if it was your fault in the first place.

Instead, it determines that:

  1. Your injury is serious enough to require medical treatment and time off work.
  2. Your injury occurred in the workplace, during the “scope” of your employment. You were doing your job when you got hurt.
  3. You gave adequate notice of the injury to your employer.

You have to tell your boss about the accident as soon as possible. New York State’s Workers Compensation Law gives employees thirty (30) days after the date of an accident to provide an employer with written notice.

How Do I Apply For Compensation?

The Workers Comp Board will not consider your claim unless you have a medical report that attributes your injury, illness or disease to a workplace accident or environmental conditions within the workplace. So the first step is to see a doctor, describe your accident and symptoms, and get checked out.

Some employers have signed on to a Preferred Provider Organization (PPO) program. Essentially, your boss will have an approved doctor, and you have to see them. If this is true in your own case, your boss has to provide you written notice explaining the PPO program. If not, see your own doctor.

After notifying your employer, and receiving a medical report that explicitly links your injury to a workplace accident, you can file a claim for workers comp. Find the form, Employee Claim (C-3), here.

Now it’s up to New York State’s Workers Compensation Board to review your application and either approve or deny benefits. According to the US Department of Labor, the majority of claims are denied. While a denial can be appealed, that process generally requires an attorney.

What Benefits Does Workers Comp Offer?

  1. Medical treatment – any therapy, procedure, appointments, and prescriptions recommended by your doctor for the treatment of a workplace injury will be paid by the insurance carrier.
  2. Lost wages – if you are forced by your injury to stay away from work, the insurance will cover a portion of what you would have earned. The most you can get is two-thirds of your average weekly wage.
  3. Loss of earning potential – if you become partially disabled, and are unable to earn as much as you did before your injury, workers comp may cover a portion of those lost earnings. Workers who are totally disabled can receive compensation through Social Security.

What Will It Not Cover?

Workers comp fails to account for many of the most acute hardships of a workplace accident.

  1. Pain and suffering – pain hurts, and while the economic cost of discomfort is hard to calculate, no one would argue that it won’t cost you anything. You may lose a measure of happiness, be unable to do the things you love, and find it hard to continue relationships. Workers comp doesn’t cover any of these “abstract,” but real, results of injury.
  2. Emotional distress – Most injuries affect the mind just as much as the body. Damages for fear, anxiety, and even loss of sleep may be awarded in a personal injury lawsuit, but never in workers comp.
  3. Loss of consortium – When we get hurt, we’re not the only ones who lose out. Think of all the time and energy your spouse will have to expend caring for you, not to mention their own emotional distress.
  4. Punitive damages – Workers comp was designed to remove punishment from the equation. But what if your boss was truly negligent, and what if they’re still endangering other lives?

Should I Speak To A Lawyer?

While workers comp restricts you from suing an employer, it does not prohibit you from suing other people on the jobsite. If the negligence of a property owner, architect, engineer, contractor or sub-contractor contributed to your accident, you may be able to hold them accountable in a personal injury lawsuit.

To discuss your case with an experienced injury attorney, call us at (917) 551-6690 or fill out our contact form. You’ll speak with a lawyer for free within 24 hours.

New York is also home to some of the nation’s most progressive labor laws, especially when it comes to construction. In fact, certain accidents, like those involving ladders and scaffolding, require the State to hold your employer accountable. To learn more about New York’s “Ladder Law” and how it protects workers everyday, check out our infographic.

How Did Workers Comp Begin?

Before 1917, injured employees were forced to sue their employers for negligence, or pay for an injury out-of-pocket. There was no other way.

But during the early 20th century, inspired by Germany’s example, a select group of states began considering a bargain: in exchange for guaranteed insurance coverage, employees would sacrifice their right to sue.

Maryland passed their first state-wide workers comp law in 1902, and others quickly followed. But in most places, insurance for workers was still voluntary; the State could not force an employer to purchase coverage. Opponents of the law considered it a violation of the Constitution’s 14th Amendment.

The Amendment’s “due process” clause requires the determination of a lawful judgment before personal property can be redistributed. In essence, no one, including a governmental agency, can take what you have until your right to a trial has been appropriately exhausted. Notably, the Amendment’s “due process” clause was proposed by delegates from New York in 1788; no other state had thought about it.

Employers argued that, because they were paying for the insurance, all of that money was still their personal property. So if benefits were paid out without a determination of negligence, or the violation of a law, their right to “due process” was not being respected. Employees, on the other hand, said that the Law would restrict their own Constitutional right to “due process,” by prohibiting them from filing lawsuits.

In a sense, the discussion began and ended in New York. Just as New York had introduced the very due process clause that was giving workers comp trouble, the law’s Constitutionality was decided in a Supreme Court case between the New York Central Railway Co. and an injured worker.

The Court found that New York’s Workers’ Compensation Law did not violate anyone’s rights. Why?

  1. States were free to change legal doctrines like negligence if they provided just alternatives.
  2. Moreover, workers comp solved a huge problem. Before the system was in place, workers were forced to bear the lion’s share of their losses after a workplace accident, and the Court felt that was not just.
  3. The common law system, borrowed from Britain’s legal history, which recommended the negligence / court trial process, was simply not enough to ensure fair outcomes in the sphere of employment.

So the matter was decided, and in the very same year, New York State’s Workers Compensation program was made mandatory for most employers. Oddly enough, this program did not cover railroad workers, like the man instrumental to the Supreme Court’s decision. Instead, Congress enacted the Federal Employers’ Liability Act (FELA) in 1908, which specifically allowed railroad workers to sue their employers for negligence.

About the Author:

Laurence P. Banville is the managing partner of Banville Law. As an experienced personal injury attorney, Mr. Banville helps clients recover compensation from those responsible for his clients' injuries. Our firm is located in New York City, serving clients from the five boroughs: Manhattan, Brooklyn, Queens, The Bronx, and Staten Island.

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