Big Changes in Workers Compensation
By Robert Grey, Esq.
Grey & Grey, LLP
Forget everything you thought you knew about workers’ compensation – there have been major changes to the system that you need to know about. Why? Because when someone gets hurt on the job, the workers’ compensation system is the first line of defense in our ever-shrinking social safety net.
Other benefits might be available (such as Social Security Disability or a disability pension), but they are almost always secondary to workers’ compensation.
There are three basic areas where the workers’ compensation system is changing. One is the law itself, in which large sections were re-written in March of 2007. The second is the regulations, which are the rules the Workers’ Compensation Board writes for itself. And the third is the way claims are actually handled.
This month’s column will talk about the basics of workers’ compensation. Next month, we will go over how the law has changed. A third column will go over the regulations and what is going on in real time.
What is Workers’ Compensation?
Workers’ compensation is a system that pays benefits to employees who are injured on the job, or who develop medical problems because of the kind of work that they do. A construction worker who falls from a ladder and breaks his leg has a workers’ compensation case. So does a nurse’s aide who lifts a patient and hurts her back. A data entry clerk who develops carpal tunnel syndrome from typing on a computer has a workers’ compensation claim, too.
A worker who files a workers’ compensation claim is called a claimant. The claim is filed against the worker’s employer. All employers must have workers’ compensation coverage, which they can get either by buying an insurance policy from a carrier (a private insurance company or the State Insurance Fund) or by being self-insured (like the City of New York). In this article, we will use the term “carrier” to refer to both insurance companies and self-insured employers.
If the carrier accepts the claim, it will usually pay for medical treatment for the injuries it agrees were caused by the accident. If the worker is out of work for more than one week, has medical proof of a disability, and the employer is not paying wages, the carrier should also send the worker payments for time out of work. The amount of the payment depends on the date of accident, how much the worker was earning before the accident, and how disabled the worker is.
If the carrier contests the claim, refuses to approve medical treatment, or reduces the worker’s payment rate, the worker must request a hearing. Hearings are held by the Workers’ Compensation Board. At the hearing, there will be a WCL Judge and the carrier will be represented by an attorney or trained hearing representative.
If there is a permanent injury, the worker may be entitled to an award in addition to payment for time out of work. The worker will probably have to request a hearing to get this type of award.
Because of the complex nature of the system, many workers retain an attorney to make sure that they get the benefits they are entitled to.
What Should An Injured Worker Do?
There are three things an injured worker must do as soon as possible after the accident.
First, the worker must notify the employer about the accident. All employers have different rules about being notified of an on-the-job accident, but the Workers’ Compensation Law gives the worker 30 days. Sooner is always better.
Second, the worker must file a C-3 form with the Workers’ Compensation Board. C-3 forms are available from the New York State Workers’ Compensation Board and from attorneys who handle workers’ compensation cases. If the employer gives the worker a Claimant Information Packet, it should also include a C-3 form.
Third, the worker must see a doctor who will file a C-4 form. The Workers’ Compensation Board will not process a claim or schedule a hearing unless it receives a medical report, and the C-4 form is the medical report used by the Board.