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As work injury lawyers in New York City, we can assist you in obtaining the compensation you deserve when you suffer from an injury in work. Damages arising from injuries in the workplace can be compensated by the insurance company under the Workmen's Compensation Act and a personal injury lawsuit.
Facing an insurance company after a work-related injury can be a daunting challenge. Insurance companies often prioritize their own financial interests over the well-being of injured workers, employing various tactics to minimize or deny claims. These tactics may include delaying the claims process, disputing the severity or work-relatedness of the injury, and offering low settlement amounts.
The Law Offices of Albert Goodwin is dedicated to helping New York laborers recover maximum benefits in workers' compensation cases. With extensive experience and an in-depth understanding of New York's workers' compensation laws and regulations, our firm has a proven track record of successfully obtaining maximum compensation for our clients. We provide personalized attention and guidance throughout the entire claims process, offering aggressive representation to counter insurance companies' tactics to protect our clients' rights. Additionally, our firm operates on a contingency fee basis, meaning there are no upfront costs for our clients.
Filing a Workers' Compensation Claim
New York's workers' compensation system operates on a no-fault basis. Injured workers are entitled to benefits regardless of who is at fault for the injury. There is no need to prove employer negligence or wrongdoing to receive benefits. For this reason, many employees pursue workers' compensation benefits to secure prompt financial support while concurrently exploring the possibility of filing a personal injury lawsuit against other negligent parties who may have contributed to their work-related injury.
Under New York's Workers' Compensation Law, once employees have claimed and received workers' compensation benefits, they generally cannot sue their employers for negligence anymore. However, an injured worker can still bring a lawsuit against other parties who contributed to the injury.
30-day deadline to notify employer of injury
In New York, injured workers must notify their employer within 30 days of the injury or the realization of a work-related illness. This notification can be given orally or in writing, but it is advisable to provide written notice to create a formal record. The notification should include the date, location, and description of the injury or illness, as well as the worker's name and contact information. Failure to meet the 30-day deadline may result in the forfeiture of workers’ compensation benefits.
Forms required
Form C-3 must be filed with the New York State Workers' Compensation Board within 2 years of the injury or illness. The form provides detailed information about the employee, employer, and the circumstances surrounding the injury or illness. Employees should keep a copy of the completed form for their records.
The treating doctor must complete and submit Form C-4 to the Workers' Compensation Board. The report should include a diagnosis, treatment plan, and the extent of any disability resulting from the work-related injury or illness. The doctor must be authorized by the New York State Workers' Compensation Board.
Employers must complete and submit Form C-2 to their insurance carrier and the Workers' Compensation Board within 10 days of receiving notice of the injury or illness. The form provides information about the employer, employee, and the details of the incident. Employers must also provide a copy of the completed form to the injured worker.
The insurance company has 18 days from receipt of Form C-2 to begin payment of benefits or notify all parties of denial. If approved, the insurer must make payments to the injured worker and their medical providers. The insurance company may contest the claim, leading to a hearing before a Workers' Compensation Law Judge.
Eligible benefits if claim is approved
If a claim is approved in New York, eligible benefits include medical treatment and expenses related to the work injury or illness, wage replacement benefits (up to two-thirds of the worker's average weekly wage), permanent disability benefits if the injury or illness results in permanent total or partial disability, supplemental benefits for severely disabled workers, death benefits for surviving family members if the injury or illness results in the worker's death, travel expenses for medical treatment or rehabilitation, and vocational rehabilitation services to help injured workers return to suitable employment.
Independent Medical Examination (IME)
The purpose of an Independent Medical Examination (IME) is to provide an objective medical assessment of the injured worker's condition, determine the extent of the work-related injury or illness and the necessary treatment, evaluate the worker's ability to return to work and any permanent restrictions or limitations, and assess the validity of the worker's claim to prevent fraudulent claims.
The employer or insurance company has the right to select the medical provider for the IME, who must be authorized by the New York State Workers' Compensation Board. The injured worker must attend the IME scheduled by the employer or insurance company, and failure to attend may result in the suspension of benefits.
Potential issues with insurance companies interpreting IME findings include using the findings to justify denying or reducing benefits, the IME report being biased in favor of the insurance company and minimizing the extent of the injury or illness, cherry-picking information from the IME report to support their position, and conflicting opinions between the treating doctor and the IME doctor leading to disputes and delays in benefits.
Injured workers have the right to choose their own doctor for ongoing treatment after the initial IME, and the chosen doctor must be certified by the New York State Workers' Compensation Board. Injured workers should inform their employer and the Workers' Compensation Board of their choice of doctor, who will provide treatment and submit progress reports to the Board. If the injured worker is not satisfied with their chosen doctor, they may request a change of doctor through the Workers' Compensation Board.
Appealing a Workers' Compensation Denial
Common reasons for denial by insurance companies include the injury or illness not being considered work-related, failure to report the injury or illness within the required time frame, insufficient medical evidence to support the claim, discrepancies between the accident report and medical records, pre-existing conditions not related to work, suspicion of fraud or misrepresentation, employer disputes the claim or provides contradictory evidence, failure to attend scheduled Independent Medical Examinations (IMEs), non-compliance with recommended medical treatment or rehabilitation, and engaging in activities inconsistent with the claimed injury or illness.
After receiving the claim notification, the injured worker has several options. If the claim is accepted, the injured worker will start receiving benefits. The insurance company will pay for medical treatment and a portion of lost wages. The injured worker must continue to follow the prescribed medical treatment and attend any required IMEs.
If the insurance company contests the entire claim, the injured worker must file an appeal with the Workers' Compensation Board, which will review the case. If the Board rules in favor of the injured worker, the insurance company must start paying benefits. If the insurance company contests specific parts of the claim, the worker may accept certain aspects while disputing others. In this situation, the injured worker may receive partial benefits while appealing the disputed portions of the claim. The Workers' Compensation Board will review the disputed issues and make a determination.
Injured workers have the right to request a review of their denied claim by the Workers' Compensation Board. The request for review must be filed within 30 days of receiving the claim denial notice. The Board will assign the case to a Workers' Compensation Law Judge (WCLJ), who will conduct a hearing, considering evidence and testimony from both the injured worker and the insurance company. The WCLJ will issue a written decision, either approving or denying the claim. If the claim is approved, the insurance company must start paying benefits as directed by the WCLJ. If the claim is denied, the injured worker may appeal to the Board Panel.
If the injured worker disagrees with the Board Panel's decision, they may appeal to the Appellate Division of the New York State Supreme Court. The appeal must be filed within 30 days of the Board Panel's decision. The Appellate Division will review the case record and the Board Panel's decision and may affirm, modify, or reverse the Board Panel's decision. If the court rules in favor of the injured worker, the insurance company must comply with the decision and pay benefits accordingly. The decision of the Appellate Division is generally final, although in rare cases, it may be appealed to the New York State Court of Appeals.
The complexity of the workers' compensation system in New York needs the assistance of an experienced attorney. Navigating the intricate legal framework of the New York State Workers' Compensation Law, understanding the numerous forms, deadlines, and procedural requirements, and dealing with insurance companies and their legal representatives who have extensive experience in workers' compensation cases can be overwhelming for an injured worker. The Law Offices of Albert Goodwin can help gather and present medical evidence to support the claim, including medical records, doctor's reports, and expert testimony, as well as appeal denied claims and represent the injured worker at hearings and legal proceedings. Our firm aggressively pursues maximum compensation and other payment sources for our clients, conducting thorough investigations of work-related injuries or illnesses to identify all potential avenues for compensation. We represent work injury victims throughout the state of New York, including all five boroughs of New York City (Manhattan, Brooklyn, Queens, The Bronx, and Staten Island), Long Island, and Upstate New York. Should you need legal representation, you can call us at 212-233-1233 or send us an email at [email protected]. We are located in Midtown, Manhattan.
About the Author
Albert Goodwin Esq. is a licenced New York attorney with over 17 years of courtroom experience. His extensive knowledge and expertise make him well-qualified to write authoritative articles on a wide range of legal topics. He can be reached at 212-233-1233 or [email protected].
