How Does Workers Comp Work?

If you fall ill or become injured on the job in New York or New Jersey, you are entitled to seek compensation for medical treatment and a portion of your wages through the workers compensation program. Through this no-fault system, the employee does not have to file a lawsuit or prove negligence in order to collect. In some cases, you may require the services of New York and New Jersey Workers Compensation Lawyers to explain your benefits to you, to represent your interests in a dispute, to litigate when the compensation is not sufficient, or to pursue a claim through the civil court system.

What Is An Eligible Workers Compensation Claim?

A workers compensation claim may include:

  • Occupational illnesses like asbestosis or hearing loss.
  • Industrial injuries like bone fractures, sprains, burns, cuts, or amputations.
  • Car accidents that occur while driving for employment.

Commuting to and from work or slip-and-falls in the parking lot are not typically covered by workers’ compensation because they occur outside the scope of doing your duty. If the injury is minor and does not require first aid care from a doctor, emergency treatment center, or hospital, then you may not need to file a claim.

How To Get The Compensation You Deserve

When you realize you’ve become sick or injured at work, you should:

  1. Report It: Report your injury or illness to a supervisor, manager, or HR department. They should give you a C-3 incident report to fill out and help you seek immediate medical treatment. Time limits for filing apply – as little as 30 days for a work-related injury, or up to two years for a work-related illness. Missing these windows can jeopardize your ability to collect compensation through the system.
  2. Seek Care: Visit the particular hospital, clinic, or doctor referred by your employer to ensure full coverage. If they do not indicate a preference, you may call (800) 781-2362 or visit http://www.wcb.ny.gov/ to make sure your care provider of choice is authorized.
  3. Document It: When you fill out paperwork at the medical center, be sure to check a box or document that the incident happened while you were working. This will ensure your medical bills get sent to the workers compensation insurance office or your employer, rather than to you.
  4. List Everything: Make sure your medical records include every ache, pain, symptom, and body part. Anything that isn’t listed will not be covered.
  5. Ask For Help: Your employer likely has a brochure explaining the workers compensation program. If not, you can check with the state workers compensation office website.
  6. Assume Nothing: There are limits to the “no-fault” system. While your employer can’t deny a slip-and-fall for “failing to see the banana peel on the ground,” they can deny your claim if you were involved in reckless horseplay with a coworker or if you sliced your finger because you were high at work.
  7. Lawyer Up: New York State’s maximum of 75 weeks of pay may be plenty for a minor injury. For instance, if your hand is 10 percent disabled in a workplace accident, you’ll receive 7.5 weeks of disability. However, if your injuries are permanent, complex, or outright denied it may be wise to work with workers compensation lawyers who can secure MAXIMUM compensation on your behalf. 

How Much Money Will You Receive For Workers Comp?

Valid claims should pay out immediately, with bills for your treatment paid by the workers compensation office. It could take a week to receive wage compensation. The amount you get depends upon how your injuries are classified and how severely you have been injured.

  • Temporary partial disability benefits will be given if you are deemed “partially disabled,” whether you are able to work or not. Partial temporary disability equals two-thirds of your average weekly wage, multiplied by the percentage of your disability, as determined by your medical care provider. So, if you require time off work and typically receive $900 a week and your doctor has given you a disability rating of 50%, you will receive $300 (two-thirds of $900 x 50%). If you return to light-duty work, you may be eligible to receive two-thirds of the difference in wages.
  • Temporary total disability benefits are awarded if you are determined 100% disabled and unable to come into work at all. Total temporary disability equals two-thirds of your average weekly wage, up to the maximum amount. The legal maximum amount you receive varies over time based on the state “average weekly wage,” but the 2020 cap has been set at $934.11 per week for New York State and $945 per week in New Jersey
  • Permanent partial disability benefits are awarded when you have sustained permanent injury to your eyes, ears, upper limbs, or lower limbs to some degree. You’ll receive two-thirds of your average weekly wage (up to the legal maximum) for the number of weeks listed in the state schedule, multiplied by the percentage of loss. For instance, New York state lists lost use of a hand at 244 weeks; if your disability rating was 50%, you would receive 122 weeks of payments in a lump sum or weekly. Non-listed body parts include the spine, head, organs, and other body parts, which pay out at two-thirds of the difference between your pre-injury average weekly wage and your current earning capacity, based on state guidelines. One example would be 500 weeks’ worth of benefits if you lost 91% earning capacity.
  • Permanent total disability benefits are given once your medical condition has stabilized without improvement. If you’re 100% disabled and unable to work, you’ll receive two-thirds of your average weekly wage indefinitely. Injuries that have left you with disfigurement to your face, head, or neck may be able to receive an additional award up to $20,000.
  • Additional benefits can also be paid for vocational training or job placement services when you’re too sick or hurt to return to your former job. Surviving spouses, children, and other dependents may receive death benefits and funeral expenses.

Know Your Rights

Workers do not receive compensation for ALL losses through the workers compensation system. That is the trade-off for a fast resolution, where you do not have to provide liability. Of course, you have the right to disagree with the decision by your medical provider, employer, or workers compensation carrier. An appeal can be made to the Workers Compensation Board in your state. If the decision is reversed by a law judge, three-member board panel, or Appellate Division Court of Appeals, you may receive additional funds.

There are also limited circumstances where you are able to sue outside the worker’s compensation system:

  • Product Liability Lawsuit – If you were injured by a defective product.
  • Toxic Tort Lawsuit – If you were injured by a toxic substance.
  • Personal Injury Lawsuit — If you were injured by your employer’s intentional negligence or conduct.
  • Insufficient Funds Lawsuit – If your employer does not carry sufficient workers comp insurance.

If you are considering an appeal or a lawsuit, you should contact New Jersey and New York Workers Compensation Lawyers for the best possible result. We offer free consultations and contingency-based representation with no upfront costs.