FILING A CLAIM

What is one of the most overlooked facts about

Workers’ Compensation in New York?

Most workers don’t know that filing an incident report is not

enough when they are injured on the job. There are further steps

that the injured worker must take. I repeat: Filing an incident

report is not the only thing an injured worker must do to file a

claim.

“Always document and keep records of the dates and

times you are injured at work.”

 THE TWO SINGLE MOST IMPORTANT THINGS TO

REMEMBER WHEN FILING FOR COMP:

1. Know your dates

The easiest way to screw up your case is to forget the correct

dates when events occurred. Let’s say you were injured at

work on May 6 and report it three weeks later but mistakenly

fill out an incident report stating that the accident occurred

on May 3. You may lose the case because the employer may

be able to prove that you weren’t even working when you

said you were injured.If you were injured on November 2 but erroneously file a

C-3 stating it occurred on November 3, you would cause a

lot of unnecessary headaches for yourself when you contact

the Board.

Always document and keep records of the dates and times

you are injured at work. Keep a diary when you are injured

so if you are asked dates at a later time you can provide the

correct information.

The carrier and the Board will not help you if you do not

know your dates.

You can easily lose your case if the date of the accident or

dates of medical treatment that you provide are not correct.

2. Choose your doctors and your lawyer wisely.

Choosing a doctor or a lawyer who is not familiar with

Workers’ Comp can derail your case quickly.

 CHOOSING HEALTH PROVIDERS

1. Choosing the wrong doctors in the beginning of a case can

wreak havoc on a Workers’ Comp case. In New York, there

are several rules to keep in mind when seeing doctors.

2. Injured workers have the legal right to choose their own

health providers.

3. Injured workers may not be charged directly by any Workers’

Compensation health provider.

Injured workers may see a variety of medical specialists for

the same accident if their injuries warrant it.

“Choosing the wrong doctors in the beginning of a case

can wreak havoc on a Workers’ Comp case.”

Example: Ruth suffers a slip and fall at work and injures her

right eye, face, head, neck, and left leg. It would be perfectly

fine for Ruth to consult with and receive treatment from an

ophthalmologist for her eye, a neurologist for her head, a

plastic surgeon for her face, a chiropractor for her neck, and

an orthopedist for her leg.

The only requirement is that Ruth—or any Workers’ Comp

claimant—may only see specialists who accept Workers’

Compensation. Experienced Workers’ Comp lawyers as

well as the WCB maintain lists of local health providers

who accept Workers’ Comp patients.

WORKERS’ COMPENSATION BOARD COMPARED TO THE CARRIER

Every new WC client who comes into my office gets a quick

lesson about the differences between the carrier and the Board.

It’s crucial that injured workers understand this concept.

“Board” is the term used to quickly refer to the New York State

Workers’ Compensation Board.

“Carrier” is the term most often used to describe the company

that acts on behalf of your employer. (In this book, I use the

term “carriers” to refer to self-insured employers, insurance

companies, and what are known as third party administrators,

which are claims handlers for employers.)

When you are injured at work, you will always be dealing with

and receiving correspondence from both the Board and the

carrier. They are completely different from each other. You need

to know which is which.

The carrier

• is on the side of the employer;

• actually pays out the benefits;

• can only be forced to pay a health provider or injured

worker if ordered to by the Board;

• is not on the side of the injured worker; and

• looks at each claim in monetary terms only and looks to pay

out as little as possible.

The decisions that the carrier makes are not final—they can be

overruled by the Board. When a carrier does something with

no order to do so by the Board, it is called a “voluntary” action;

it didn’t have to do it but did it on its own.

“The decisions that the carrier makes are not final.”

The Board

• is a New York State agency;

• acts as the court in WC cases;

• may hold hearings in the injured worker’s case;

• may determine not to hold hearings in the injured worker’s

case and instead to decide it on paper;

• acts as the “referee” between the injured employee and

employer;

• is impartial; and

• officially decides the injured worker’s case.

WORKERS’ COMPENSATION BOARD

Most people in New York don’t realize that the Workers’

Compensation Board even exists. For attorneys like myself,

the Board is where we make our living. It’s where I go almost

every day to represent injured workers. Its headquarters are in

Schenectady but the Board maintains district regional offices

across New York:

• Albany

• Binghamton

• Brooklyn

• Buffalo

• Long Island

• Manhattan

• Queens

• Rochester

• Syracuse

Simply put, the Board is the state agency in charge of workers’

compensation. It makes the official decisions about injured

workers’ cases.

Some facts you should know about the Board include the

following:

1. The Board has the legal power to decide if someone is an

employee or not.

2. The Board officially decides if an injury is or is not job related.

3. The Board is the agency that is in charge of both disability

benefits (off the job benefits) and Workers’ Compensation

benefits (on the job benefits) in the state of New York.

4. The Board has the legal power to penalize and fine employers

if they do not carry Workers’ Compensation insurance.

5. The Board not only decides Workers’ Compensation cases but

also regulates the attorneys who appear before it. Attorneys

for injured workers are never allowed to collect an attorney’s

fee unless the Workers’ Compensation Board approves the

fee. In fact, the Board decides the attorneys’ fees that are

payable; attorneys do not make these decisions.

6. The Board can be contacted through customer service toll

free at (877) 632-4996 Monday through Friday from 8:30

a.m. to 4:30 p.m. or by visiting http://www.wcb.ny.gov/

content/main/Contact.jsp.