Workers’ Compensation Claims: The Top 5 Complaints

Workers’ compensation insurance provides medical care and/or cash benefits to those who have been injured or have become ill while on the job. The benefits are provided by insurance that is paid for by employers as directed by the Workers’ Compensation Board; a state agency that processes the claims. A claim is paid once the employer and insurance carrier come to the conclusion that the injury is, indeed, work-related.

Depending on the nature of the injury the process to get compensation can be tedious. Before we address the top 5 complaints made by those who file for workers’ compensation claimsthe following is how to go about filing a claim in New York State:

If you are injured on the job, you should complete the Board’s form Employee Claim (C-3) as soon as possible to ensure your benefits are not delayed or interrupted. You must also notify your employer in writing of when, where and how you were injured or became ill.

There are several ways to file the Employee Claim (C-3) form.

  • Complete the web version of the Employee Claim (C-3) form. Please Note: you must have Adobe Reader version 9 or greater installed on your computer to fill out and submit this form. If you use a browser other than IE (like Google Chrome or Firefox), or use a MAC computer, be sure to click on the relevant instructions before filling out the form or the form may fail to submit after you complete it.
  • Call 1-866-396-8314, and someone from the Board will help you fill out the form.
  • File a paper Employee Claim (C-3) form.

You will be notified by mail of any action regarding your claim.

You must file a claim within two years of the accident or within two years after you knew or should have known that a contracted disease was due to the nature of your employment.

Once the claim is filed, often, people are faced with some challenges. Here are 5 of the most common challenges they may incur:

  1. The claim was denied: This is one of the most prevailing issues. There are many reasons why a claim could be denied, from an employer denying the claim to not filing promptly. Insurance companies are under pressure to make sure costs are kept under control, and, as a result, often claims are denied for even small reasons. If you have credible evidence that your claim was denied as a result of fraud, administrative error, or other irregularity, you can contact your workers’ comp administrative office and request a complaint form. (Each state has a unique version of the form.) When you file a complaint, it goes through a review process. If your complaint has legal merit, it may support your case and influence the amount of your settlement.
  2. The claim process is taking too long: Straightforward claims usually do not take that long, but claims that require discovery and/or depositions can delay the process significantly. Contested claims can take up to two years to finalize.
  3. The settlement amount seems like too little. Workers’ compensation settlements are limited to partial wage reimbursement, medical bills, and in some cases, set amounts for permanent debilitation, limbs or sever loss. Also, the weekly cash benefit for temporary total disability is computed by taking two-thirds of the workers’ average weekly wage for one year immediately preceding the accident. It may not, however, exceed the legal maximum in effect on the date of the injury.
  4. Getting fired due to the inability (or ability) to work. Although an employer cannot legally fire a worker due to a workers’ compensation claim, they can if a doctor clears the employee to work and they refuse.
  5. A doctor deems a person as okay, and they are still suffering. A doctor may diagnose someone as reaching maximum medical improvement, and yet that person may disagree. Often people will seek another medical opinion. Sometimes the opinion is the same and sometimes it’s different depending on the situation.

Regardless of where you, or someone you know, may be in the workers’ compensation claim process, it is important to seek sound legal advice. Contact the law offices of Martin, Harding & Mazzotti, LLP at 1-800-LAW-1010 to get sound legal advice about workers’ compensation and how to navigate the process from start to finish.