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What is the NY Workers’ Comp Claims Process?

Friday, October 18, 2013

Most people don’t go into work and say “I think I will get injured today. Yeah that’s what I’ll do! At two thirty, I’ll be the victim of a horrible accident and spend months or even years undergoing a grueling and expensive recovery process“.   As such, many people are not prepared when serious work accidents do strike.  Recovery may take a very long time and result in a lot of financial stress and anxiety. That being said, it is important to understand the New York Workers’ Compensation claims process ahead of time so you are prepared.

To better understand these workers’ comp procedures, let’s use a   hypothetical New York construction site accident. This construction worker is “Steve”:

Workers' Compensation

Let’s say Steve (who is only hypothetical and not based on any particular real-life individual) is a construction worker.  He goes to his job site every day and works very hard.  Then one day Steve falls off this steel beam on the construction site landing on the ground 20 feet below:

His leg appears broken and he is in severe pain.  What’s the first thing Steve should do?

That’s right! He should obtain any necessary emergency medical attention immediately.  But what else should he do?  Steve should notify his supervisor of his injury and the circumstances surrounding it if he is not already aware. This should be done in writing within 30 days or as soon as possible.

Also, Steve should file a claim by filling out official New York State Workers’ Compensation Board  form C-3 as soon as possible but no longer than two years of the accident or within two years of when it became apparent that the injury or illness is work-related. This form should be sent to the NY Workers’ Compensation Board online or mailed to the appropriate WCB district office.

Within 48 hours of  falling off the steel beam, Steve’s Doctor should perform a preliminary medical exam and mail official WCB Form C-4 (Doctor’s initial report) to the WCB District Office, the employer and/or the employer’s insurance company, Steve, and Steve’s NY workers’ comp attorney.

The employer must also report the injury to the New York Worker’s Comp Board and his insurance company within ten days of the injury using official WCB Form C-2, Employers’ Report of Injury.

Within 18 days of receiving form C-2 and a proper medical report (C-4) and if the claim is not “controverted” (contested), Steve should begin receiving cash workers’ compensation benefits for his lost wages.  If the insurance company is not making payments, they would have to inform the NY Worker’s Compensation Board, as well as Steve and his NY workers’ comp lawyers Turley Redmond Rosasco & Rosasco, LLP.   The insurance company would also have to provide a good reason for disputing the claim if this was the case.

If the insurance company “accepts” the claim, Steve receives benefits every two weeks.  If these were to be stopped or modified, the insurance company would have to fill out form C-8.6 (Form Notice That Payment of Compensation Has Been Stopped or Modified) and send it to the Workers’ Compensation Board.   Every 45 days, Steve’s doctor will also submit progress reports to the Workers’ Compensation Board.

If Steve had not filed a claim or informed the employer of is on-the-job injury, he would have been giving up extremely valuable cash and medical benefits under the New York State Workers’ Compensation Law.  Fortunately, this was not the case. Good luck Steve! We’re all pulling for you!

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