New York Workers’ Compensation Benefits Process

New York workers' compensation benefits process

All workers’ compensation claims get processed at the state level. For injured New York employees, knowing how the workers’ compensation process works can help avoid confusion and lost time when filing your own claim. We’ve included a brief overview of the steps needed to apply for New York workers’ compensation benefits. You’ll also find a chart outlining the New York program’s five-year statistical history below.



Steps to Complete the New York Workers’ Compensation Process

The New York State Workers’ Compensation Board stipulates that virtually all New York employers must provide workers’ compensation coverage and post visible notice thereof in the workplace. Of course, there are some exceptions, including those covered by federal workers’ compensation laws, volunteers, members of the clergy, those who work at religious, charitable or educational institutions, independent contractors and sole proprietors. New York workers’ compensation insurance helps protect both employees and employers in the event that a workplace injury or illness does occur. When you’re ready to file your own New York workers’ compensation claim, follow these steps:

  1. Seek medical treatment immediately and then inform your supervisor in writing as soon as possible that you were injured and how the incident occurred. This notice should be made within 30 days of your accident.
  2. Submit an Employee Claim C-3 form to the New York Workers’ Compensation Board (this can be done online or in person, but online is the fastest option).
  3. If you cannot submit a C-3 form on your own, call 1-866-396-8314 and a Board representative will complete it on your behalf using information that you provide.
  4. Your employer’s insurance provider must provide you with a written statement of your legal rights within 14 days of your accident (usually included with your first workers’ compensation check). If you’re obligated to use a doctor within the insurer’s network, they must also give you that healthcare provider’s contact information.
  5. An insurance representative must accept or deny your claim within 18 days and inform you of that decision. Your employer and the Workers’ Compensation Board must also be notified of your claim’s approval or the insurer’s intent to dispute your request for benefits.
  6. Should your claim be disputed and you’re missing work as well as income, you may apply for disability benefits.
  7. If your claim’s approved, you’ll receive biweekly lost wage payments and all medical bills are paid directly to each provider. You’ll owe no copayments or out-of-pocket fees, though services that cost over $1,000 require prior authorization from the insurance provider first.
  8. Your physician must submit medical progress reports to the Board as well as your employer’s insurance provider every two weeks until you’re released from treatment.
  9. If your claim is denied, the insurance provider must explain why to the Board. A New York Workers’ Compensation Judge will then hold a pre-hearing conference or hearing to resolve any disputed claims.
  10. If you disagree with the Judge’s decision, you may submit an Application for Board Review form explaining why you’re disputing that denial within 30 days.
  11. Finally, if the Board rejects your claim after conducting its review, you can still file another appeal within 30 days to the Supreme Court’s Appellate Division, Third Department. You may owe legal fees for filing this last appeal, as this step falls outside of the New York workers’ compensation system.

Bear in mind that each workers’ compensation claim is unique, which means your own filing experience may vary. To get a more comprehensive understanding of this process, check out the Employee’s Guide to Workers’ Compensation in New York State.

New York Workers’ Compensation Statistics

The Bureau of Labor Statistics (BLS) releases an annual statistical report on the majority of workers’ compensation programs by state. There, you’ll see the total number of cases filed by state, how many employees missed work, transferred jobs, or were given restrictions, and workers’ comp claims filed in service-providing industries. See the chart below detailing how New York workers’ compensation program statistics looked between 2011 and 2015.

Like most states across the U.S., the New York workers’ compensation program has been relatively stable in the past five years. The biggest changed happened between 2011 and 2012, when all claims statistics saw a 5-9% drop overall. Since 2012, reported workers’ compensation claims have remained steady from year to year. Fewer claims may lead to shorter wait times and expedited approval for claimants now and in the future.

Can A Workers’ Compensation Attorney Help?

If you’ve been injured on the job, you may find it helpful to seek legal assistance regarding your claim. If your illness or injury makes filing your claim confusing or you’re planning to appeal an unfavorable decision, an attorney can help you. We can connect you with experienced workers’ compensation attorneys that can help you gather necessary medical paperwork supporting your claim, communicate and negotiate with your employers’ insurer on your behalf, and handle your appeals in case your claim’s denied. Contingency-based representation means your attorney won’t get paid unless you’re awarded benefits. If you need legal assistance but cannot pay out-of-pocket fees, this option may help you.

To see if you may qualify for legal assistance from an attorney in your area, click the button below to start your free workers’ compensation evaluation now.

Get Your Free Benefits Evaluation