A no-fault system with trade-offs
Workers compensation generally pays for medical care and part of lost wages when an injury or illness comes from the job, whether or not anyone was careless. The trade-off is that, in most situations, an injured worker cannot also sue the employer for the same injury, and the benefits do not include the kind of pain and suffering damages a lawsuit might. Illnesses that build up over time, such as hearing loss or conditions caused by repeated motion or chemical exposure, can be covered as well, although connecting them to the job often takes more medical support. In New York the system is overseen by the Workers' Compensation Board, and the employer's insurance carrier pays the benefits. Coverage questions come up often for people paid off the books, people labeled as contractors, and people hurt while traveling for work.
Where disagreements tend to arise
The carrier may accept a claim, accept part of it, or contest it, for example by questioning whether the injury happened at work or whether a condition was already there. Contested issues are heard by a Workers' Compensation Law Judge, and a decision can be reviewed further at the Board. The carrier can also send you to a doctor it chooses for an independent medical examination, and the difference between that report and your own doctor's opinion frequently becomes the real dispute. As treatment winds down, the extent of any lasting loss of earning capacity turns into a central question. In New York your providers generally need to be authorized by the Board to treat workers compensation patients, emergencies aside, so it is worth asking before you book an appointment.
What we look at first
We start with how and when your employer was told about the injury, because notice is expected within a short period and late notice hands the carrier an argument. Then we check whether a claim has been filed with the Board, what the carrier has said in writing, and whether any payments have started. If someone other than your employer contributed to what happened, such as a property owner, a contractor on a shared site, or a driver, a separate claim against that party may exist alongside the benefits. We also confirm whether your employer carried coverage at all, since that changes the route. Bring your medical records, recent pay stubs, any accident report, and every letter from the carrier or the Board.
