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An A-Z Guide to Understanding Workers’ Comp

An A-Z Guide to Understanding Workers’ Comp

Steven Schwartzapfel, the founding member of Schwartzapfel Lawyers P.C., has been one of New York’s most prominent personal injury attorneys.
Steven Schwartzapfel, the founding member of Schwartzapfel Lawyers P.C., has been one of New York’s most prominent personal injury attorneys.
Steven Schwartzapfel -Founding Partner Mar 8, 2021

For more than 35 years, Steven Schwartzapfel, the founding member of Schwartzapfel Lawyers P.C., has been one of New York’s most prominent personal injury attorneys. Steve represents clients in all types of personal injury cases. His experience, skill, and dedication have enabled Schwartzapfel Lawyers P.C. to recover hundreds of millions of dollars for their clients.

Did you know that out of 100 full-time workers, 2.8 report injuries on the job every year?

While accidents are often unexpected, they can happen at any time while on the job—and workers’ comp plays an important role in recovery.

Whether it’s something as simple as a sprained ankle, or an injury that has caused long-term physical rehabilitation, it’s essential that you take the appropriate steps when you’ve been hurt at work. You might wonder what these next steps may be, like if your incident is worth reporting, who you should report it to, and how serious the claim will get.

Although workers’ comp is there to protect you and the company, there can be times when workers’ comp is denied or insufficient. In these instances, filing and winning a lawsuit can still be a challenge, but can help you acquire the resources you need to recover.

The good news is that this guide will tell you much of what you need to know about workers’ comp law, like how to file a claim and what to expect while going through the process.

Understanding Workers’ Comp Law in New York

Workers’ compensation, also known as workers’ comp, is a form of no-fault insurance that can protect employers and their employees in the event of an accident or injury in the workplace. The employer purchases workers’ comp insurance to provide wage replacement and medical benefits to employees who get injured on the job.

Workers’ comp is considered insurance because it helps guarantee the employee won’t go into severe medical debt due to a workplace accident. It also protects the company because workers’ comp is given to the employee in exchange for relinquishing the right to sue the employer for tort of negligence.

You should file a workers’ comp claim if:

  • You were injured while at work
  • You became sick because of work
  • You were injured due to work-related duties

However, you must file a claim within your state’s statute of limitations. A statute of limitations is a state-enforced maximum time limit for a person to legally file a claim successfully. According to New York law, workers must report their injuries within 30 days of the accident and up to two years if an injury has caused other damages.

What Does Workers’ Comp Cover?

Workers’ compensation laws vary depending on the company, state, and insurance coverage. Generally, it covers essential medical and wage benefits for the employee, like:

  • Wages when the employee is sick
  • Medical expenses for rehabilitation
  • Payments as income replacement
  • Lump sums to compensate for permanent impairment
  • Allowances for travel expenses incurred as a result of medical treatment
  • Funeral costs (if necessary)

What Doesn’t Workers’ Comp Cover?

Unfortunately, not every workplace injury may be eligible for workers’ comp. While it differs by state and company, here are some examples of incidents where you would not be eligible for coverage:

  • Injuries from a fight or horseplay with another employee
  • Injuries while intoxicated or inebriated in the workplace
  • Injuries while commuting to or from work
  • Injuries received at out-of-office recreational activities
  • Emotional injuries with no physical symptoms
  • Intentional injuries

What Kinds of Benefits Can You Receive?

After your claim has been approved, you might be eligible for any of these benefits:

  • Temporary Disability Benefits: These benefits are temporary and are only paid when you are away from work because you are still recovering from an injury. A good example would be healing from a broken leg that prevents you from doing your job.
  • Permanent Disability Benefits: These benefits are permanent and are reserved for lasting physical impairments caused by the injury. For example, you might receive permanent disability benefits if you had to get a body part amputated.
  • Medical Treatment: Workers’ comp benefits may cover medical treatment for medically necessary reasons. This could include medical debt accumulated through surgeries, follow-up visits, prescriptions, and physical therapy.
  • Vocational Rehabilitation: Some injuries are so severe that they require several months away from work. Vocational rehabilitation may assist in the costs that come with job retraining or, depending on the circumstances, help with finding a job within new work restrictions.
  • Mileage: Mileage is a basic type of workers’ compensation benefit covering the mileage used to travel to and from your doctor’s office and other workers’ comp-related travel. This might include to and from rehab centers, job training, follow-up visits, or surgeries.

What Are Common Injuries from Workers’ Comp Cases?

When you file for a workers’ comp claim, you want to ensure that you have a valid case onhand. And with every case, there has to be an injury. Some of the most common injuries that workers file workers’ compensation are for:

  • Lacerations
  • Sprains and strains
  • Contusions
  • Burns
  • Eye injuries
  • Fractures

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Of course, some types of work are more hazardous than others, which may result in more severe types of injuries. The Occupational Safety and Health Administration (OSHA) says that manufacturing, construction, transportation, and warehousing are among the most dangerous fields in the United States. Because of this, OSHA identifies common injuries in these industries as The Fatal Four, which are injuries that are caused by slips and falls, being caught in between objects, being struck by an object, and electrocution.

Are New York Companies Required to Have Workers’ Comp Insurance?

Under New York law, all businesses must have a workers’ compensation insurance policy for their employees. This includes full-time employees, part-time employees, day laborers, borrowed employees, unpaid volunteers, and all family members employed by the company.

Businesses can buy coverage from several resources, like private insurers, NYSIF, and opting for self-insurance:

  • Private Insurers: Like health insurance, your employer can purchase workers’ compensation insurance through private companies available in New York.
  • The New York State Insurance Fund: Some businesses decide to get workers’ comp insurance through the New York State Insurance Fund. When a business is insured by the NYSIF, injured employees are offered cash benefits that are ⅔ of their average weekly wage (up to a maximum), plus travel expenses to and from healthcare appointments.
  • Self-Insurance: Also known as a self-funded plan, self-insurance is where the employer assumes the financial risk for providing workers’ comp to their employees.

However, not everybody is covered. There are exemptions from workers’ comp law, like:

  • Sole proprietors
  • A partnership under the laws of New York State
  • A one- or two-person owned company where those individuals possess all the stock and hold offices of the corporation

If you were injured while working in New York state, then your employer legally needs to have workers’ compensation insurance to help cover your medical costs. However, not every case is guaranteed: Depending on the details of the injury, it can be an uphill battle against insurance companies. But that’s not to say that they’re impossible to win.

Are Workers’ Comp Lawsuits Hard to Win?

Sometimes, employees don’t want to file a workers’ comp lawsuit because they’re afraid that they won’t win.

This fear is understandable: Going through the hardships of filing a claim and going to war with another party’s lawyers is enough to steer most people away from reporting their incident. Sometimes, even if an employee does report their incident, it’s easier for them to settle for much less than they deserve so that they could just be finished with the problem.

So, it’s natural to wonder whether or not workers’ comp lawsuits are hard to win. The first thing you should know is that your case matters and should be treated as important as any other injury case. Plus, the numbers speak for themselves: In New York, recent statistics show that 9 thousand out of 15 thousand reported workers’ comp cases received some compensation, totaling about $526 million.

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How to Tell If You Have a Winning Case

First, you need to have a legitimate case. That means that your injury needs to have happened at work or during work-related activity while you were on the clock. However, things get tricky when you’re off the clock, like if you were injured during your lunch break on-premises.

Secondly, your injury must be a result of a work-related error. Maybe the sidewalk wasn’t properly salted after an icy snowstorm, causing a painful fall and back injury. Perhaps your superiors didn’t perform routine inspections on a machine you use every day, and a malfunction injured your hand or arm.

Whatever the cause, it needs to be traced back to something that is not directly your fault. In other words, your work-related injury shouldn’t be because you were being negligent. Interestingly, even if you were being negligent, companies may still have a sliver of liability.

Thirdly, you need to verify your story. When you report your injury, make sure that you are as specific and straightforward as possible. When you begin adding details later on, it’s normal for lawyers to become skeptical about the circumstances of your injury. Obtaining witnesses and coworkers’ accounts or getting any potential recorded footage is a great way to prove how your injury occurred.

Keys to a Strong Workers’ Comp Case

When you’re injured on the job, the best thing you can do is file your claim immediately, obtain witness statements, seek medical treatment, and work with a worker’s comp lawyer. Here’s a compiled list of the best keys to a strong workers’ comp case:

  • Hire a workers’ compensation lawyer who is experienced with New York City lawReport your injury right away
  • Get prompt medical treatment
  • Change your doctors, especially if you go through a doctor chosen by your employer’s insurance company
  • Be prepared for medical exams by Independent Medical Examination (IME), constant surveillance, private investigators, which means that you should also be careful about what you do on social media
  • Keep your medical records and attend all doctors’ appointments, including follow-ups
  • Attend all legal proceedings, hearings, and appointments

How to File a Workers’ Comp Claim

No matter what your job is, it’s wise to know how to file a workers’ comp claim in the state of New York.

Knowing the steps ahead of time is one of the best ways to protect yourself in case of an incident, especially since your employer won’t want to admit fault or take responsibility until an investigation has begun.

Here are your steps to filing a workers’ comp claim—and what to expect during each step along the way.

Step #1: Report Your Injury to Your Employer

Before you receive medical attention, the very first thing you should do following your injury is to report it to your employer. This part is crucial because it not only documents your injury, but also highlights the urgency of the situation and ensures that you don’t get left behind in the statute of limitations.

After you fill out your company’s injury claim, they will submit it to their workers’ comp insurance company for review. Once this is submitted, your case is officially opened, and investigation may begin.

Step #2: Get Medical Attention Immediately

Some workplace injuries call for immediate medical attention. In incidents like the previous example, it’s essential to go to the hospital right away so that doctors can check your head, neck, and spine. These injuries can cause concussions or lifelong issues like back pain, neck pain, and even paralysis.

If you don’t go to the doctor immediately following your injury, then your employer’s insurance company will find out and use this against your claim. In their eyes, they’ll see that your damages were not severe enough to receive medical attention, and therefore your company should not have to pay for any expenses.

When you plan to file for a workers’ comp claim, leaving a paper trail of evidence is key to your case. Be sure to keep any medical records, like bills, prescriptions, notes, and anything else that might be relevant, like photos of the scene and of your injury.

Step #3: Insurance Will Conduct an Investigation

Embarking on your workers’ comp claim may not be an easy process. When you file, your employer’s insurance company or lawyers may conduct an investigation. This investigation aims to eliminate the possibility of fraud by answering important questions like:

  • Is your injury the cause of a workplace incident?
  • Is your injury a pre-existing condition that flared up?
  • Did the injury happen by your fault, or was it indeed the company’s negligence?
  • Did your injury actually occur on work premises?

The insurance company will investigate just about everything related to you and your injury. They will review any footage, witness testimonies, as well as your medical history. If there is the slightest indication that you are falsifying the incident or that this was not a work-related injury, your claim may be denied, and you won’t receive any worker’s comp.

Step #4: Hire a Workers’ Comp Attorney

Remember that the insurance company will do anything to minimize your injuries so that your employer doesn’t have to pay your medical expenses or work wages.

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At this point, your best option is to hire an experienced workers’ comp attorney. Doing so can greatly increase your chances of winning your case—even if you’ve been previously denied. In fact, nearly 67% of retried cases received compensation of some type.

Conclusion

Workers’ comp is a type of insurance that protects the company and the employee in case of an injury from a work-related accident. However, your employer’s insurance will try to diminish your injuries’ severity to avoid a high settlement or significant payout, which is why you should always consider working with an experienced workers’ comp attorney.

Your attorney can help increase your case’s chances by guiding you to the right steps after your injury, like accurate reporting, keeping records of your medical bills, and helping you stay prepared during the claim and settlement process. Ultimately, working with an experienced lawyer is your best option to getting the compensation you deserve.

Schwartzapfel Lawyers Fights For You

If you’ve been injured while at work in New York City, then it’s time to contact Schwartzapfel Lawyers. With more than 30 years of experience, Schwartzapfel Lawyers is one of New York City’s leading personal injury and workers’ compensation firms.

When our team takes your case, we always fight to ensure that you get the compensation you deserve. Even if you don’t think you have a legitimate case, you might be surprised to see what you’re eligible for. Contact us today for a free consult and case evaluation.

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