Quick Answers: Workers’ Compensation Claims, The Top 5 Complaints
Updated September 2022
Workers’ Compensation provides medical care and/or cash benefits to those who have been injured or have become ill while on the job. These benefits are provided by insurance that is paid for by employers as directed by the Workers’ Compensation Board, a state agency that processes employee claims and oversees the system. Benefits for a claim are paid once the insurance carrier, or the Board, concludes that the injury is, indeed, work-related.
Depending on the nature of the injury, the process of obtaining compensation can be tedious. Before we address the top five complaints made by those who file workers’ compensation claims, here is how to go about filing a claim in New York State:
How To File For Workers’ Compensation In New York State
Within 30 days, you must notify your employer in writing of when, where and how you were injured or became ill. You should then complete the Board’s Employee Claim Form (Form C -3) as soon as possible to ensure your benefits are not delayed or interrupted. The purpose of Form C-3 is to notify the Workers’ Compensation Board of your injury.
There are several ways to file the Employee Claim (C-3) form:
You will then 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 an occupational injury or disease was due to the nature of your employment.
Once the claim is filed, people are often faced with some challenges. Here are the quick answers to five of the most common challenges you may encounter:
Top 5 Most Common Workers’ Compensation Complaints
- The claim was denied: This is one of the most common 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, claims are often denied for even small reasons. However, if you have credible evidence that your claim was denied as a result of fraud, administrative error, or other irregularity, you can contact the State Inspector General and request a complaint form, or file one online. When you file a complaint, it goes through a review process. If your complaint has legal merit, it may result in your claim being reinstated.
- The claim process is taking too long: Straightforward claims usually do not take very long before benefits are paid but claims that require discovery and/or depositions can delay the process significantly. Contested, (also known as ‘controverted’), claims can take up to two years to finalize.
- The benefit amount seems too little. Workers’ compensation benefits are limited to partial wage reimbursement, medical bills, and in some cases, set amounts for permanent loss or disablement. 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.
- Getting fired due to the inability (or ability) to work. Although an employer cannot legally fire a worker for making a workers’ compensation claim, you can be terminated if your doctor clears you to return to work and you refuse.
- A doctor deems a person fit to return to work, yet they are still suffering. A doctor, often one hired by your employer’s insurance carrier, may decide you are able to return to work, but you may disagree. Often people want to know if they can seek another medical opinion. The answer is yes, you can, and if that opinion differs from the one already submitted, the Board may hold a hearing to decide which opinion carries more weight.
Get Help From a Workers’ Comp Lawyer
Regardless of where you or someone you know might be in the workers’ compensation claim process, it is important to seek competent, professional legal advice. Contact Martin, Harding & Mazzotti, LLP at 1-800-LAW-1010, 24 hours a day, 7 days a week, and take advantage of our decades of experience helping injured workers just like you. We’ll help you navigate the process from start to finish. Helping you is what we do. ℠