Workers' Compensation Benefits in New York

Protect Your Right to Benefits After a Work-Related Injury or Illness

Workers' compensation is a form of insurance providing wage replacement and medical benefits to employees injured in the course of employment. In New York, workers' compensation benefits are comprehensive, and are designed to support workers during their recovery, allow them to maintain financial obligations when they’re unable to work, and help them return to work when possible.

At the Harris Firm, LLC, our award-winning workers’ compensation team helps workers across Queens and New York City following all types of work accidents and injuries. From filing a workers’ compensation claim to appealing a denial, the work we do is intended to help clients secure these vital benefits.

We encourage any injured worker with questions about New York workers’ compensation benefits to reach out to our team for a FREE consultation. We can help you better understand the available benefits in New York and what benefits you may be eligible to receive. Call (718) 487-8669 or contact us online to get started.

What is Covered by New York State Workers’ Compensation?

All for-profit businesses and most nonprofits with employees are required by New York law to carry workers’ compensation insurance. Regardless of what insurance company an employer uses to purchase this insurance, it will provide workers’ compensation benefits that can help cover:

• Medical benefits for emergency care, testing, and treatment related to the work injury or illness.
• Lost wage benefits if you are totally or partially disabled and unable to work for more than 7 days.
• Benefits for reduced earnings caused by a work injury’s impact on your employment.
• Survivor weekly cash benefits (in cases of fatal work injuries or illnesses) and funeral or memorial expenses.
• Vocational rehabilitation.

Medical Benefits Under Workers’ Compensation

Workers who suffer injuries in the course of their employment are entitled to benefits that provide coverage for all medical treatment required to cure or relieve the effects of the injury or illness.

In New York, workers’ compensation medical benefits can cover:

• Emergency care, emergency transport, and hospitalization
• Testing, lab services, and other treatment and therapies
• Surgery, chiropractic care, and physical therapy / rehabilitation
• Dental care and optometry
• Prescription medications and medical / assistive devices

While being able to obtain medical care is vital to helping workers recover and repair their lives, there are some important limitations and things to keep in mind. For example:

• Authorized Providers Only. Except for emergency care, all treatment obtained in connection to a work-related injury or illness must be provided by a health care professional who is authorized by the NY Workers’ Compensation Board to treat injured workers. If you have a specific doctor or specialist you have used and liked in the past, you must use the Workers’ Compensation Board’s Health Care Provider and IME Search tool to ensure that they are authorized to provide covered care, otherwise any treatment you obtain will be at your own expense. In some cases, injured workers may be able to obtain care from providers who are part of their employer’s
  Preferred Provider Organization (PPO) program.
• Reasonable and Necessary. Workers’ compensation only covers care that is considered “reasonable and necessary” for the treatment of a worker’s injury and symptoms. Sometimes, workers’ compensation insurers will argue that certain care was not reasonable or necessary to avoid paying for those services or to pay only for an undisputed portion of a medical bill.
• Travel Expenses. Workers who incur costs to travel to medical appointments may seek reimbursement for mileage, public transportation, and other related expenses. If you incur these types of expenses when treating a work injury, be sure to save all receipts so that you can submit them to the workers’ compensation insurer.

Workers’ Comp Benefits For Lost Wages

If you were injured on the job, you are entitled to benefits that cover a portion of your lost wages when either (or both) apply:

1. The work injury prevents you from working for more than seven days.
2. Your income is reduced because your injury has forced you to work fewer hours or do other work.

While medical care benefits are available regardless of how short or long your injury keeps you out of work, you must have a total or partial disability that prevents you from working for more than seven days to receive lost wage benefits.

Here are some important details about lost wage benefits:

• You cannot collect lost wage benefits if your employer continues to pay you while you are out of work due to your injury.
• Lost wage benefits are not paid for the first 7 days of disability unless the disability extends beyond 14 days. If your disability lasts longer than 14 days, you can then receive lost wage benefits from the first workday you missed.
• If the workers’ compensation insurer approved your claim, payments will begin within 18 days of the date you were injured, or within 10 days of the date your employer learned of your injury, whichever is later.
• If the workers’ comp insurer disputes your claim, you will need to wait for a judge to review the matter and direct the insurer to pay benefits. While you are waiting for a decision, you can collect disability benefits that will be deducted from any award for lost wages you later receive.
• If you work for more than one employer (known as dual or concurrent employment), you may be able to include salaries from all jobs when calculating your average weekly rate.
• If your work injury prevents you from earning the same income you earned prior to the injury, you may be entitled to benefits that cover two-thirds of the difference between your current and pre-injury average weekly wage.

How Your Degree of Disability Affects Wage Benefits

Workers’ compensation benefits for lost wages depend on factors unique to your case, including the level or “degree” of disability that you have suffered.

This disability level may be determined by your treating doctor or by an independent medical examiner who evaluated you and your case for the workers’ compensation insurer. If the medical examiner and provider have different opinions about your disability, you may be able to negotiate with the insurer (with the help of a lawyer) or request a hearing to determine the correct rating.

Generally, disabilities are classified as either Total or Partial. They are also classified by their duration. In New York, workers’ compensation disability classifications are as follows:

• Temporary Total Disability (TTD). When an employee is unable to work at all due to a workplace injury or illness, but only on a temporary basis, they may receive Total Temporary Disability benefits.
• Temporary Partial Disability (TPD). If an employee can work but must take on lighter duties at a lower pay rate than normal due to their injury, Partial Temporary Disability benefits may be awarded to make up a portion of the difference in wages. A partial disability is anything under 100% total disability (i.e. 25%, 50%, 75%, etc.).
• Permanent Total Disability (PTD). When a work injury or illness prevents a person from performing any type of gainful employment, they can collect Permanent Total Disability benefits. These benefits have no limit on the number of weeks payable and claimants may still be able to engage in some work if their wages combined with their weekly benefit remains under the maximum weekly amount.
• Permanent Partial Disability (PPD). This classification of disability covers workers who have permanently lost some of their wage-earning capacity. Depending on the severity of the disability (which is determined when a worker has reached maximum medical improvement or MMI), a worker with a PPD rating may be entitled to Schedule Loss of Use (SLU) benefits or Non-Schedule Loss benefits.

How Much is My Workers’ Comp Weekly Benefit?

The amount of lost wage benefits you’ll receive will depend on your disability degree and your average weekly wage for the previous year.

In New York, the calculation used to determine a worker’s weekly benefit is:

• 2/3 × (average weekly wage) × (% of disability based on medical evidence) = weekly benefit

As an example, a worker who earned $1,000 per week and became partially disabled (50%) would receive $330 as their weekly benefit. A worker earning $1,000/week with a 100% total disability would receive $660.

As of January 2024, the minimum benefit for work-related injuries that occurred on or after January 2024 is $275 per week.

FAQs About Workers' Comp Benefits

Who is eligible for workers' compensation benefits?

In general, employees who are injured or become ill as a result of their work are eligible for workers' compensation benefits. This includes full-time, part-time, and temporary workers.

What types of injuries are covered by workers' compensation?

Workers' compensation typically covers injuries that occur while performing job-related duties, including accidents, repetitive strain injuries, and occupational diseases contracted as a result of work conditions.

Do I need to prove fault to receive workers' compensation benefits?

No, workers' compensation is a no-fault system, meaning that employees are generally entitled to benefits regardless of who caused the injury or illness, as long as it occurred in the course of employment.

What benefits are provided under workers' compensation?

Workers' compensation benefits typically include medical expenses related to the injury or illness, wage replacement payments for time missed from work, vocational rehabilitation, and disability benefits.

How long do workers' compensation benefits last?

The duration of workers' compensation benefits varies depending on the severity of the injury or illness. Benefits may be provided for a temporary period until the employee is able to return to work, or for a permanent disability if the injury or illness is severe.

Can I choose my own doctor for treatment under workers' compensation?

The rules regarding choice of doctor vary by jurisdiction. In some cases, employers may have a list of approved healthcare providers, while in others, employees may have the freedom to choose their own doctor.

What should I do if my workers' compensation claim is denied?

If your workers' compensation claim is denied, you have the right to appeal the decision. This usually involves filing an appeal with the workers' compensation board or commission in your state and presenting evidence to support your claim.

Will I lose my job if I file a workers' compensation claim?

It is illegal for employers to retaliate against employees for filing workers' compensation claims. However, if your employment is terminated for reasons unrelated to your injury or illness, you may still be eligible for workers' compensation benefits.

Can I receive workers' compensation benefits if my injury was caused by my own negligence?

Workers' compensation generally covers injuries and illnesses regardless of fault, including those caused by the employee's own negligence. However, there are some exceptions, such as injuries resulting from drug or alcohol use or intentional self-harm.

Can I receive workers' compensation benefits if I aggravate a pre-existing injury or condition at work?

Yes, workers' compensation benefits may be available if a work-related incident aggravates a pre-existing injury or medical condition. However, determining the extent of the aggravation and eligibility for benefits may require medical evaluation and legal guidance.

Questions About Workers’ Comp Benefits? Harris Firm, LLC Can Help!

It's vital for workers in New York to understand their rights and the benefits they're entitled to under the state's workers' compensation laws. Injuries and illnesses can have a significant impact on one's ability to work and earn an income, and these benefits offer crucial financial and medical support during recovery.

At the Harris Firm, LLC, our attorneys know that workers and their families come to us in difficult times. It’s why we leverage our decades of experience to help them navigate every step of the New York workers’ compensation claim process and seek the benefits they need.

If you have questions about benefits after a work injury or illness, we’re happy to discuss them during a FREE consultation. Call (718) 487-8669 or contact us online to speak with an attorney.