How To File A Workers Comp Claim

How To File A Workers Comp Claim

If you’ve been injured at work, then you may be eligible to file a workers’ compensation claim. As part of the claim process, you are asked to seek medical treatment after obtaining necessary first aid and care.

Workers’ compensation is a type of insurance that will pay injured workers with cash benefits, while also providing medical care, if an injury or illness occurs because of their job responsibilities.

Employers are responsible to pay for this insurance. Employees do not contribute to the cost of this type of insurance policy. When authorized by the Workers’ Compensation Board, weekly cash benefits and medical care are paid by the insurance carrier which holds the policy for the affected employer.

If you are injured on the job in New York, there is a process for filing a Workers’ Comp claim that is overseen by The New York State Workers’ Compensation Board, which you must follow. The Board protects employees’ and employers’ rights by ensuring the proper delivery of benefits and promoting compliance with the law.

Workers Comp Claim Process and Timeline

The following are the steps and timeline that you must follow to file a workers’ comp claim to ensure it will be processed, evaluated, and approved to receive the benefits you are entitled to.

  1. Immediately after the injury occurs
    1. If you are injured on the job, the first and most crucial step is to immediately obtains any necessary medical treatment and notifies your supervisor or manager about the accident and how it occurred.
    2. Notify your employer of the accident in writing, as soon as possible, but within 30 days.
    3. File a claim with the Board on Form Employee Claim (C-3) by completing the form online or mailing the form to the appropriate Board District Office. Completing and returning this form must be done within two years of the accident or within two years after the employee knew or should have known that the injury was related to employment.
  2. Within 48 hours of the accident
    Have your Queens workers’ comp doctor completes a preliminary medical report on the Board’s Doctor’s Initial Report (C-4) form and mail it to the appropriate District Office. A copy must also be sent to the employer or its insurance carrier, the injured worker, and his/her representative if any.
  3. Within ten days of notification of the accident
    The employer must report the injury to the Board and their insurance company.
  4. Within 14 days of receipt of Form Employer’s Report of Work-Related Injury/Illness
    The insurer will provide the employee who has been injured with a written statement of their rights under New York Workers’ Comp law. This must be completed within 14 days after receipt of the Employer’s Report of Work-Related Injury/Illness from the employer or with the first check, whichever is earlier. In addition, if the insurer requires claimants to use a doctor or other health care provider within a network it has contracted with to obtain diagnostic tests, it must notify the claimant of the name and contact information for the network to be used at the same time it sends the written statement of their rights or immediately if that time has passed.
  5. Within 18 days of receipt of Form Employer’s Report of Work-Related Injury/Illness
    1. If lost time exceeds seven days, the insurer begins the payment of benefits. If the claim is being disputed, the insurer must inform the Workers’ Compensation Board (and the claimant and their representative, if any). If payment is not being made for specific reasons stated on the notice (e.g., that there is no lost time or that the duration of the disability is less than the 7-day waiting period), the insurer must also notify all the parties.
    2. The insurer notifies the Board that either payment has begun or why payments are not being made. If the employee does not inform the employer in a timely manner, this notice may be filed within ten days of learning of the accident.
  6. Every two weeks
    The insurer continues to make payments of benefits to the injured employee (if the case is not being disputed). The carrier must notify the Board when compensation is stopped or modified.
  7. Every 45 days
    The doctor submits progress reports on Form Doctor’s Progress Report (C-4.2) to the Board.
  8. After 12 weeks
    The insurer considers the necessity of rehabilitation treatment for the injured employee.

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