No one heads to work thinking they will be injured on the job. But job-related injuries happen every day across New York City and Long Island. According to the New York State Workers’ Compensation Board, the Board assembled more than 174,000 claims in a single recent reporting year. That works out to roughly 726 claims per working day.
If you or someone in your family has been hurt at work or has developed a job-related illness, the questions come fast. How do you file a claim? Will your wages be replaced while you recover? What if your employer says the injury is not work-related? Can you see your own doctor? What happens if the injury turns out to be permanent?
These are not hypothetical concerns. They are the questions that injured workers across Nassau County, Suffolk County, and the five boroughs deal with every day. The answers depend on the specific facts of each situation, but the New York workers’ compensation system follows a defined process. Understanding that process is the difference between protecting your rights and losing benefits you are entitled to.
This article is an overview of how workers’ compensation works in New York—the types of injuries that are covered, who is eligible, how benefits are calculated, what happens when a claim is disputed, and when it makes sense to speak with an attorney. The goal is straightforward: if someone you love were injured on the job tomorrow, these are the most important things you would want them to know.
How the New York workers’ compensation system works
Workers’ compensation is a no-fault system. That means you do not have to prove that your employer did anything wrong. If you were injured in the course of your employment, you are entitled to benefits regardless of who caused the injury. Even if your own actions contributed to the accident—you were not paying attention, you missed a step—you are still covered. The only exceptions involve injuries that were deliberately self-inflicted or caused solely by the use of drugs or alcohol.
The system provides two categories of benefits. The first is medical care: payment of all reasonable and necessary medical expenses related to your injury, for the rest of your life if needed. The second is wage replacement: a weekly payment equal to two-thirds of your average weekly wage, up to the statutory maximum. For injuries occurring on or after July 1, 2023, the maximum weekly benefit is $1,145.43.
In exchange for these guaranteed benefits, workers generally cannot sue their employers for on-the-job injuries. This is known as the “exclusive remedy” doctrine. There are narrow exceptions. If a third party other than your employer contributed to your injury, you may have a separate legal claim against that third party while still collecting workers’ compensation benefits. And if your employer failed to carry workers’ compensation insurance as required by law, you have the option to file suit against them directly.
The system is administered by the New York State Workers’ Compensation Board. The Board processes claims, verifies their validity, holds hearings, and issues monetary awards. Disputed claims can be appealed through the Board’s own process.
Who is eligible
Almost all employers in New York are required to carry workers’ compensation coverage. Benefits begin on your first day of employment. Undocumented workers and employees who are paid off the books are also covered and entitled to benefits under New York law. That is worth repeating, because many workers do not know it: being paid off the books does not disqualify you from workers’ compensation.
Some categories of workers are covered by separate systems. Federal government employees, dockworkers, interstate railway workers, and seafarers fall under federal workers’ compensation laws. Teachers, police, fire, and sanitation workers employed by the City of New York are covered by other plans. Clergy and members of religious orders represent the primary exception to mandatory coverage.
One area that regularly produces disputes is employment status. Independent sub-contractors are considered self-employed and would not be eligible through the hiring company. But the question of whether a worker is truly independent or should be classified as an employee is not determined by a label. It is determined by facts: whether the employer controls or supervises the work, provides tools and equipment, determines the method of payment, and has the right to hire and fire. Do not assume that because your employer gave you a 1099, you are automatically a sub-contractor. The working relationship matters more than the paperwork.
Types of injuries covered
Most people think of workers’ compensation in terms of sudden accidents—a fall from a ladder, a hand caught in machinery, a vehicle collision while making a delivery. Those are covered. But the system also covers occupational diseases and repetitive stress injuries, and these are the claims that many workers do not realize they have.
Occupational diseases may develop after years of exposure to hazardous substances like silica or asbestos. Hearing loss from prolonged exposure to loud noise in a work environment may also qualify. Repetitive stress injuries occur when workers perform the same physical task day in and day out. Carpal tunnel syndrome. Chronic back pain. Shoulder and knee conditions that build over years of doing the same job. No one is required to work in pain.
Injuries do not have to occur at the employer’s physical location. If you were working on behalf of your employer when the injury occurred—at a client site, on the road, at a job site in another borough—you are generally covered.
Regardless of the type of injury, you must be treated by a doctor who is authorized by the Workers’ Compensation Board to handle these cases. That doctor will document how your condition is work-related and file the required medical forms. Be thorough and honest with your treating physician about every symptom and how the injury occurred. Medical records become evidence in a workers’ compensation case. If symptoms go unreported and then surface later, the insurance carrier may attribute them to a different, non-work-related incident. Consistency in the medical record matters from the first visit forward.
Filing a claim: deadlines and requirements
If you are injured on the job in New York, notify your employer within 30 days. Do it immediately. Do not wait to see if the injury gets better on its own. Many injuries that feel minor in the first week turn out to be far more serious. An injury that seems like a strained back can become a herniated disc requiring surgery. A sore wrist can become a permanent impairment. Report the injury, complete your employer’s written accident report, and keep a copy for your records.
In addition to notifying your employer, file a C-3 Employee’s Claim Form with the New York State Workers’ Compensation Board. The law allows up to two years to file this form, but file it now. The form is available at www.wcb.ny.gov. If you belong to a union, notify your union representative immediately. If the claim is due to an occupational illness, notify your employer as soon as your doctor tells you the condition is likely work-related.
Some employers will try to discourage you from filing. They may tell you that you only had 24 hours to report the injury. That is not true. Others will suggest you file the claim under your health insurance instead. Do not do this. A work-related injury belongs in the workers’ compensation system, and filing it elsewhere can create serious problems for your claim later.
Failure to notify your employer or to file the C-3 form can jeopardize your right to medical care and wage replacement. These are not formalities. They are procedural requirements that protect your claim.
How benefits are calculated
Weekly wage replacement is based on your average weekly wage, or AWW. The standard payment is two-thirds of your AWW, up to the statutory maximum. The AWW calculation includes regular wages, and it can also include tips, commissions, car allowances, and income from concurrent employment. For workers under age 25, the calculation may factor in wage increases the worker would have received had they not been injured.
Workers who are paid off the books often have difficulty proving their earnings. This can delay benefits or reduce the benefit amount. Workers paid on commission or who earn periodic overtime may face disputes about the AWW as well. Keep pay stubs. Keep bank records. Keep anything that documents what you earned. In a disputed claim, these records become the evidence that determines your benefit level.
If you are completely unable to work, benefits are classified as Temporary Total Disability, or TTD. If you can work reduced hours or at a different job, benefits fall under Temporary Partial Disability, or TPD, with the amount based on your level of disability as determined by your treating physician. Workers’ compensation benefits are not taxed.
Your first check for lost wages should arrive within 18 days of your disability or 10 days after your employer has been notified of your injury, whichever is later. If you miss one week or less of work, you will not be paid for lost wages. If you miss more than one week but less than two, you are paid only for the second week. If you miss more than two weeks, you are paid for all time lost, including the first week.
When injuries become permanent
At some point during treatment, your doctor may determine that you have reached Maximum Medical Improvement, or MMI. This means you have recovered as much as you are going to recover. Any remaining disability is expected to be permanent. Your doctor will complete a Form C-4.3 outlining your level of impairment.
If you are unable to do any type of work after reaching MMI—even part-time or limited duty—you will be classified as permanently, totally disabled. Payments continue for the rest of your life, along with ongoing medical care, transportation to doctor’s visits, and prescription medications.
If you can do some type of work but not your prior job, a permanent partial disability rating will be assigned. The Board considers three factors: the medical impairment rating from your treating physician, your functional loss (ability to walk, stand, drive, lift, and perform fine motor tasks), and vocational factors like education level and prior work experience. These factors together determine how much earning capacity you have lost.
For injuries occurring on or after March 13, 2007, permanent partial disability benefits are capped based on the degree of disability. The duration ranges from 225 weeks for losses of 15% or less, up to 525 weeks for losses greater than 95%. For injuries that occurred before that date, permanent partial disability payments may continue for life. This distinction matters, and it is the kind of detail that can significantly affect the value of a claim.
Schedule loss of use awards and Section 32 agreements
If your injury resulted in permanent loss of use of a specific body part—an arm, leg, hand, foot, finger, toe, or loss of hearing or vision—you may be entitled to a Schedule Loss of Use Award. This is an additional cash payment on top of your regular benefits, and it is available even if you did not miss time from work or are already back at your job. Schedule Awards are not automatic. You must request a hearing after reaching MMI. The Board requires opinions from both your doctor and the insurance carrier’s physician regarding the percentage loss of use.
Head, neck, and back injuries are the most common permanent injuries that are not on the Schedule. These are handled through a separate framework called Non-Schedule Awards, which considers the impairment class, severity ranking, and your functional capacity to obtain gainful employment.
A Section 32 Agreement is a voluntary lump-sum settlement between the injured worker and the insurance company or employer. Once signed and approved by a Workers’ Compensation Law Judge, the case is closed. The agreement may also need Medicare approval to ensure the settlement covers expected future medical expenses. Do not accept a Section 32 Agreement without speaking to both your doctor and a workers’ compensation attorney. The insurance company has a lawyer protecting their interests at the negotiating table. You should have a lawyer protecting yours. A settlement that looks adequate today can leave you exposed to medical costs and lost wages that were not accounted for.
Third-party claims and liens
Workers’ compensation is the exclusive remedy against your employer. But a third party may also bear responsibility for your injury. A construction worker injured on a job site may have a claim against the property owner or general contractor for failing to provide a safe work environment. A worker hurt in a motor vehicle collision caused by another driver while on the job may have a claim against that driver. A worker injured by a malfunctioning piece of equipment may have a products liability claim against the manufacturer.
These claims exist alongside workers’ compensation. You can pursue a third-party lawsuit and still collect your workers’ compensation benefits. But there is an important wrinkle: your employer’s workers’ compensation carrier has a statutory lien on any third-party recovery. That means the carrier has the legal right to be reimbursed out of your settlement or verdict for the benefits they already paid on your behalf. Your attorney must account for this lien when evaluating any settlement offer. Failing to do so can leave you with far less than you expected.
When to speak with a workers’ compensation attorney
If your injury is relatively minor and you get back to work quickly without any permanent loss of use or disability, you probably do not need an attorney. But if there are disputes about your employment status, whether the injury is truly work-related, your ability to return to work and at what level, if you have a permanent disability or loss of use of a body part, if a Section 32 Agreement has been offered, or if a loved one was killed on the job—speak with an attorney.
The workers’ compensation system is designed to process standard claims efficiently. When a case is not standard, or when the system is not working the way it should, legal representation changes the dynamic. Attorney fees in workers’ compensation cases are set by the Workers’ Compensation Law Judge and are deducted from the benefits you are awarded when your case is resolved. There is no up-front payment.
Many injured workers in New York get discouraged by the obstacles they encounter and choose to let the matter drop. They do not get the medical care or the benefits they are entitled to. Do not let that happen to you.
How Schwartzapfel Holbrook handles workers’ compensation cases
At Schwartzapfel Holbrook, we review every workers’ compensation case with the understanding that the details determine the outcome. That review begins with the nature of the injury and the circumstances in which it occurred, and extends through the treating physicians’ independent clinical findings, the calculation of average weekly wage, the classification of disability, and the evaluation of any potential third-party claims.
We are selective about the cases we accept. When we take a case, we prepare it with the expectation that it may need to be proven at a hearing before a Workers’ Compensation Law Judge. That preparation includes reviewing the full medical record as it develops, monitoring the treating physicians’ findings for thoroughness and consistency, evaluating the insurance carrier’s Independent Medical Examination reports, and identifying any third-party liability that may expand the recovery available to our client.
If we do not accept a case, we encourage people to seek another opinion—because the answer one lawyer gives is not always the final answer. Consultations are free. There is no obligation.
Schwartzapfel Holbrook / Fighting For You