Guide to NY Worker’s Compensation process

If a person gets injured on the job, it should be reported immediately.  The injured party should give oral notice and follow up with written notice and should fill out any necessary workers’ compensation paperwork.  In New York notice of incident/injury must be given within 30 days. Once this is complete, the employer notifies the workers’ compensation insurance carrier, and a claim number is issued. An injured worker can start treatment right after the incident at a hospital or at an urgent care facility.  These bills as well as any future medical bills in connection with the injury will be paid by the workers’ compensation insurance carrier unless the case is controverted.  

The injured party can treat with a private practice doctor, but that doctor must accept NY workers’ compensation insurance. It is necessary to make sure that the injured party sees the doctor at least once every 90 days, especially if out of work due to his or her injury.  The doctor examining the injured party will give a medical opinion of degree of disability due to the injury.  This can range from 0% – 100%.  If the doctor finds the injured worker at 100%, the injured worker is unable to return to work.  If there is a less than 100% temporary disability found, it is possible the injured worker can return to his or her job. It is likely that if a treating doctor is giving `100% temporary disability the insurance carrier will send the injured party to an independent medical examiner (IME).  

Once the injured party is found to be unable to work due to injury, the employer may continue to pay salary or the workers’ compensation insurance carrier will start payments which are up to 2/3 of the injured person’s weekly wage up to a statutory maximum.  Most of the time this is paid biweekly.  It is important to know though, that an insurance carrier is not obligated to make any payments unless directed by a judge.  

NY State Workers’ Compensation Guidelines mandates that maximum medical improvement (no further medical treatment is necessary) cannot be reached until a minimum of 6 months past injury.  If, however, the injured party has surgery he or she must wait until one year post surgery.  A workers’ compensation case can be closed with a one lump sum payment for lost wages as well as medical or just for lost wages.  There are several different ways to “close” a case.  

If a case is closed due to doctors findings maximum medical improvement then the medical portion of the claim remains open and the injured party is entitled to maintenance visits. If at some point the injured worker’s condition worsens or surgery is needed the case can be reopened and treatment will be litigated.  If a case is closed out by agreement between the parties though the majority of time the case cannot be reopened and the injured party is liable for his or her medical treatment in connection with the injury.  

It is important to understand that the workers’ compensation process does not happen overnight and can take some time especially when the injured party is unable to return to work. 

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