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.

• 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.
• 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.
• Within ten days of notification of the accident
  The employer must report the injury to the Board and their insurance company.
• 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.
• 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.
• 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.
• Every 45 days
  The doctor submits progress reports on Form Doctor’s Progress Report (C-4.2) to the Board.
• After 12 weeks
  The insurer considers the necessity of rehabilitation treatment for the injured employee.

Workers’ Comp Claim — FAQ

1. What is a Workers’ Comp Claim?
   A Workers’ Comp Claim is a request for benefits under your state’s workers’ compensation insurance program after you suffer a work‑related injury or illness.
2. Who is eligible to file a Workers’ Comp Claim?
   Almost all employees injured or diagnosed with an occupational illness on the job are eligible. Independent contractors may not be covered.
3. How do I file a Workers’ Comp Claim?
   Notify your employer as soon as possible, complete your state’s accident report forms, and submit any required paperwork to your employer or their insurance carrier.
4. What information is needed to file a Workers’ Comp Claim?
   You’ll need your personal details, employer information, date/time/location of injury, description of how it happened, and any witness names.
5. When should I file a Workers’ Comp Claim?
   Most states require you to report your injury to your employer within 30 days, though it’s best to notify them immediately.
6. Can I file a Workers’ Comp Claim if I’m part‑time or temporary?
   Yes. If you are classified as an employee—whether full‑time, part‑time, or seasonal—you generally qualify for workers’ compensation benefits.
7. What benefits are available through a Workers’ Comp Claim?
   Benefits typically include coverage for medical treatment, temporary disability payments, permanent disability awards, and vocational rehabilitation.
8. How long does a Workers’ Comp Claim take to process?
   Initial acceptance or denial often occurs within 14–21 days of your employer receiving the claim, though timelines vary by state.
9. What happens after I file a Workers’ Comp Claim?
   Your employer’s insurer reviews the claim, may request medical evaluations, and then either accepts (pays benefits) or denies (provides reasons) the claim.
10. Can I choose my doctor for a Workers’ Comp Claim?
    In many states, your employer or insurer designates a panel of doctors. Check your state’s rules—some allow you to see a second opinion or your own provider.
11. What if my Workers’ Comp Claim is denied?
    You can request a reconsideration or file an appeal with your state’s workers’ compensation board, providing additional evidence if necessary.
12. How do I appeal a denied Workers’ Comp Claim?
    Follow your state’s appeal procedure: submit a written request, attend hearings, and present medical records or expert testimony.
13. Does a Workers’ Comp Claim cover all medical expenses?
    Yes—approved claims cover treatment for your work‑related injury or illness, including hospital stays, doctor visits, prescriptions, and necessary therapy.
14. Does a Workers’ Comp Claim cover lost wages?
    If you miss work due to your injury, you may receive temporary total disability (TTD) or temporary partial disability (TPD) benefits, typically a percentage of your average weekly wage.
15. Can I return to work while my Workers’ Comp Claim is pending?
    If you can perform light or modified duties, your doctor may clear you for a gradual return, which can preserve your claim and benefits.
16. What is a temporary disability Workers’ Comp Claim?
    It provides wage replacement (TTD or TPD) while you recover if you cannot work or can only work reduced hours due to your injury.
17. What is a permanent disability Workers’ Comp Claim?
    If your injury causes lasting impairment, you may be eligible for permanent partial disability (PPD) or permanent total disability (PTD) benefits.
18. How does a Workers’ Comp Claim affect my future employment?
    Employers cannot retaliate for filing a claim. Your claim record generally does not affect your ability to work elsewhere once you’ve recovered.
19. Can I be fired after filing a Workers’ Comp Claim?
    No. Federal and state laws prohibit retaliation or termination solely because you filed a claim, though you must still meet performance standards.
20. Do I need an attorney for my Workers’ Comp Claim?
    Many workers navigate the process themselves, but an attorney can be invaluable if your claim is denied, benefits are disputed, or your injury is severe.