Workers’ compensation insurance is a crucial safety net for employees who suffer job-related injuries or illnesses. In New York, this system ensures that workers receive necessary medical care and wage replacement benefits, regardless of fault. Understanding the claims process, the types of payments available, and what happens in the unfortunate event of a workplace fatality is essential for both employees and employers.
The Workers’ Compensation Claims Process in New York
New York operates under a no-fault workers’ compensation system, meaning that injured employees can receive benefits regardless of who was responsible for the accident. However, to qualify, certain steps must be followed:
1. Reporting the Injury
Employees must report a workplace injury or illness to their employer as soon as possible, but no later than 30 days from the date of the incident. Prompt reporting helps avoid delays in medical treatment and benefits.
2. Seeking Medical Treatment
Workers should seek medical attention from a healthcare provider authorized by the New York Workers’ Compensation Board (WCB). The physician’s report will be critical in supporting the claim.
3. Filing the Claim
To officially begin the claims process, the injured worker must file Form C-3 (Employee Claim) with the WCB within two years of the injury. The form can be submitted online, via mail, or in person.
4. Employer’s Responsibilities
Once notified of the injury, the employer must inform their workers’ compensation insurance carrier and submit Form C-2F (Employer’s Report of Work-Related Injury/Illness) to the WCB.
5. Insurance Carrier Review
The insurance company will investigate the claim and determine whether to accept or dispute it. If approved, payments begin promptly. If disputed, the case may go to a WCB hearing for resolution.
6. Dispute Resolution
If there is a disagreement regarding benefits, the case is reviewed by a workers’ compensation law judge who hears evidence from both sides before making a determination.
Types of Workers’ Compensation Benefits in New York
Workers’ compensation provides several types of benefits, depending on the severity and impact of the injury or illness.
1. Medical Benefits
Workers are entitled to full coverage for all necessary medical treatments related to their work injury, including doctor visits, hospitalization, surgeries, rehabilitation, and medications.
2. Cash Benefits
If the worker is unable to work due to their injury, they may receive cash benefits based on their average weekly wage and the extent of their disability:
- Temporary Total Disability (TTD): When an injury prevents the worker from performing any work for a temporary period.
- Temporary Partial Disability (TPD): When the worker can perform some tasks but cannot earn the full wages they previously did.
- Permanent Total Disability (PTD): When the worker can no longer work in any capacity due to the injury.
- Permanent Partial Disability (PPD): When the worker sustains a permanent impairment but can still work in some capacity.
3. Scheduled Loss of Use (SLU) Awards
For permanent loss of function or amputation of specific body parts (e.g., limbs, vision, or hearing), workers may receive a one-time cash award based on a pre-determined schedule.
4. Vocational Rehabilitation
If an injury prevents a worker from returning to their previous job, they may qualify for vocational rehabilitation services to help them transition into new employment.
What Happens When a Worker Dies on the Job?
In the unfortunate event of a workplace fatality, the deceased worker’s dependents may be entitled to death benefits.
Death Benefits for Dependents
New York law provides financial compensation to surviving dependents, which may include:
- A surviving spouse
- Minor children
- Dependent parents, grandparents, or siblings (if financially reliant on the deceased worker)
The benefit amount is typically two-thirds of the deceased worker’s average weekly wage, subject to state-set maximums. Payments continue for the lifetime of the spouse (unless they remarry), and children receive benefits until they turn 18 (or 23 if they are full-time students).
Funeral Expenses
Workers’ compensation also provides coverage for funeral and burial expenses. As of current regulations:
- Up to $12,500 in New York City, Long Island, and select counties.
- Up to $10,500 in other areas of the state.
Filing a Death Claim
The surviving family must file Form C-62 (Claim for Compensation in Death Case) with the WCB within two years of the worker’s death.
BGES Group: Your Workers’ Compensation Insurance Specialists
Navigating workers’ compensation insurance can be challenging for businesses. Ensuring proper coverage and compliance with New York laws is essential to protecting both employees and company assets. That’s where BGES Group comes in.
With over 42 years of experience, BGES Group specializes in workers’ compensation insurance, particularly for businesses in high-risk industries like construction. Their team provides personalized guidance, ensuring employers get the best coverage options while minimizing costs.
Why Choose BGES Group?
- Industry Expertise: Deep knowledge of New York, New Jersey, and Connecticut workers’ compensation laws.
- Tailored Insurance Solutions: Customized policies to fit business needs and reduce risks.
- Dedicated Support: One-on-one assistance to help navigate claims and prevent costly disputes.
Contact BGES Group
For expert workers’ compensation insurance solutions, reach out to BGES Group:
- Contact Person: Gary Wallach
- Phone: (914) 806-5853
- Email: bgesgroup@gmail.com
- Website: bgesgroup.com
Whether you’re an employer looking for comprehensive workers’ compensation coverage or need guidance on managing claims, BGES Group is your trusted partner.