New York Workers’ Compensation Benefits Process

New York workers' compensation benefits process

State law determines the process to apply, qualify for and receive workers’ compensation benefits. For injured New York employees, knowing what to expect can make the application process go smoother. Below, we’ve outlined the steps you must follow to file your own New York workers’ compensation claim. You’ll also find a chart outlining the New York program’s five-year statistical history from 2013-2017 below.



Which Employers Must Have New York Workers’ Compensation Insurance?

The New York State Workers’ Compensation Board says virtually all employers must provide New York workers’ compensation coverage. Of course, there are some exceptions, including:

  • Federal employees
  • Volunteers
  • Members of the clergy
  • Independent contractors
  • Sole proprietors
  • Employees who work for religious, charitable or educational institutions

How to Apply for New York Workers’ Compensation Benefits

Follow these steps to file your New York workers’ compensation claim:

  1. Seek medical treatment immediately, then inform your supervisor about your injury. You must provide written notice within 30 days.
  2. Submit an Employee Claim C-3 Form to the New York Workers’ Compensation Board. You can do this online or in person; online’s faster. If you can’t manage either option, call 1-866-396-8314 and a Board representative can help you by phone.
  3. Your employer’s insurer must provide a written statement within 14 days about your legal rights. If you must see a doctor in the insurer’s provider network, they must also provide that physician’s contact info.
  4. A claims adjuster must accept or deny your claim within 18 days. They must notify you, your employer and the Board about their decision in writing.
  5. If approved, you’ll receive biweekly lost wages and full medical benefits. However, any services that cost over $1,000 require the insurer’s prior authorization. Your physician must submit medical progress reports to the Board and your employer’s insurer biweekly until you’re released.
  6. If your claim’s denied, the insurer must explain why to the Board. A New York Workers’ Compensation Judge then holds a pre-hearing conference or hearing to resolve your dispute.
  7. You have 30 days to dispute the judge’s denial, if that happens. Submit an Application for Board Review form explaining why you wish to appeal.
  8. If the Board denies your claim, you have another 30 days to appeal. You must do this through the Supreme Court’s Appellate Division, Third Department. Since this last step falls outside the system, you may owe legal fees.

Every New York workers’ compensation claim is unique, so your experience may vary. To learn more, read the Employee’s Guide to Workers’ Compensation in New York State.

New York Workers’ Compensation Statistics, 2013-2017

The Bureau of Labor Statistics (BLS) releases an annual statistical report on workers’ compensation programs in most states. There, you’ll see total cases filed, how many employees missed work, transferred jobs, or were given restrictions, and claims by job sector. Below, our interactive chart shows New York workers’ compensation program statistics from 2013-2017.

Total claims rose 2.5% from 2013-2014, but that’s the only notable increase in any category during this five-year period. After that, total New York workers’ compensation claims fell 6% between 2014 and 2016. It’s easy to see why: Service-industry workers filed 6% fewer injury claims during that two-year period. Each year, service-industry employees file about 58% of all claims for New York workers’ compensation benefits. Interestingly, that’s about the same percentage each year that miss enough work to qualify for lost wage payments (56%-59%). The only significant change in how many people missed work due to injury or illness happened from 2015-2016. That year, employees who missed work, received job restrictions or changed positions fell by 6%.

You May Qualify for Legal Assistance

If you get hurt or sick while on the job, you may benefit from talking to an experienced workers’ compensation attorney. People with preexisting health conditions are often denied New York workers’ compensation benefits. If you’re hurt bad enough to need hospitalization, a New York workers’ compensation attorney can handle everything related to your claim. This includes gathering necessary medical paperwork to support your claim, communicating and negotiating with your employers’ insurer on your behalf, and appealing your denied claim, if necessary. Contingency-based representation means you’ll pay any New York workers’ compensation lawyer nothing unless your claim’s approved. And if your case does win, you’ll only pay a small, one-time fee.

Ready to see if you may qualify? Click the button below to start your free workers’ compensation evaluation online now!

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