Workers’ compensation is a fundamental aspect of employment protection, providing essential benefits to workers who suffer job-related injuries or illnesses. In New York, the workers’ compensation system ensures that employees receive adequate compensation for lost wages when they are unable to work due to work-related accidents or occupational diseases. This compensation serves as a crucial lifeline, offering financial stability and relief during the recovery period and allowing injured workers to focus on their health and well-being without the added stress of lost income.
Sustaining a workplace injury can place a significant burden on you and your family, increasing stress due to escalating medical expenses and the potential decrease or loss of income. Fortunately, New York laws exist to ensure that these costs can be covered, lost wages can be recovered, and disability or other benefits may also be provided if a return to work is not feasible. At K L Sanchez Law Office, our experienced Queens workers’ compensation attorneys are dedicated to helping you and your family secure the benefits you deserve. Reach out to us at (646) 701-7990 to arrange a free consultation.
Workers’ Compensation in New York
To better comprehend the workers’ compensation system in New York, it is essential to understand the definition of workers’ compensation, the eligibility criteria, and the various benefits included in such compensation.
Workers’ compensation is a form of insurance that provides medical benefits and wage replacements to employees who become injured or ill due to work-related factors. This insurance system is designed to protect both employers and employees.
For employees, workers’ compensation helps them to receive medical treatment, recover a portion of their lost wages, and access vocational rehabilitation services, without having to bear these expenses independently.
For employers, workers’ compensation limits their liability for work-related injuries and illnesses, preventing them from facing potential lawsuits from employees who might seek higher compensation for their suffering. It ensures that the employers are only responsible for providing necessary benefits to the affected workers, and not for their entire life-care expenses.
Who Is Eligible for Workers’ Compensation Benefits in New York?
Employees in New York are eligible for workers’ compensation benefits if they suffer a job-related injury or illness. Coverage applies to full-time, part-time, seasonal, and some undocumented workers. Independent contractors and certain volunteers may not qualify. Employers must provide coverage unless legally exempt.
Eligibility for Workers’ Compensation
To be eligible for workers’ compensation in New York, an individual must meet specific criteria, which include:
- Employment Status: The person must be an employee as workers’ compensation covers employees, not independent contractors. However, some exceptions apply to certain industries, such as construction and domestic workers.
- Work-Related Injury or Illness: The injury or illness must have occurred while the individual was performing their job duties or as a consequence of their employment. It is not limited to physical injuries, as it could also cover mental and emotional stress-related illnesses caused by work-related factors.
- Timely Reporting and Filing: To be eligible for workers’ compensation benefits, the employee must notify their employer within 30 days of the injury or illness. They must also file a claim with the New York State Workers’ Compensation Board (WCB) within two years of the incident.
- Employer Coverage: The employee’s employer must have workers’ compensation insurance or be an approved self-insured employer in New York State.
It’s worth noting that employees are eligible for workers’ compensation benefits regardless of who is at fault for the work-related injury or illness.
| Eligibility Criteria for Workers’ Compensation in New York | Description |
|---|---|
| Employment Status | The person must be an employee, not an independent contractor. Exceptions apply in certain industries. |
| Work-Related Injury/Illness | The injury or illness must occur while performing job duties or as a consequence of employment. |
| Timely Reporting and Filing | The employee must notify the employer within 30 days and file a claim with the WCB within two years. |
| Employer Coverage | The employer must have workers’ compensation insurance or be an approved self-insured employer. |
What Happens if You Don’t Agree with the Insurance Company’s Doctor?
Unfortunately, there are times when your own doctor’s assessment of your disability is not in line with the insurance company’s doctor. In the past, you would be entitled to a hearing. Today, hearings are rarely held, but when there is a substantial difference in the opinion between your doctor and the insurance company’s doctor, it can be reviewed and decided by the Workers’ Compensation Board.
Types of Benefits Included in Workers’ Compensation
Workers’ compensation benefits in New York can be divided into various categories, which include:
- Medical Benefits: All reasonable and necessary medical treatment related to the work-related injury or illness should be covered by workers’ compensation. This can include hospitalization, surgeries, prescriptions, and rehabilitation.
- Lost Wage Replacement: If an employee cannot work for more than seven days due to their work-related injury or illness, they may receive wage replacement benefits, which typically amount to two-thirds of their average weekly wage. The exact amount may vary depending on the worker’s degree of disability and other factors.
- Permanent Disability Benefits: Workers who suffer a permanent disability, either partial or total, due to their work-related injury or illness, may qualify for long-term disability benefits, which can include compensation for lost wages and medical treatment, depending on their degree of disability.
- Vocational Rehabilitation: If the injured or ill employee cannot return to their previous job, workers’ compensation may provide training, job placement assistance, and other services to help them find suitable employment.
- Death Benefits: Should a work-related injury or illness result in an employee’s death, their surviving dependents, such as spouse and children, may receive death benefits, which can include funeral expenses and a portion of the deceased worker’s wages.
Understanding workers’ compensation in New York is crucial for both employers and employees to ensure that they are aware of their rights and responsibilities under the law. Knowing who is eligible, what benefits are included, and how the system operates can help all parties manage the process efficiently and effectively.
| Benefit Type | Description |
|---|---|
| Medical Benefits | Covers all reasonable and necessary medical treatment related to the work-related injury or illness, including hospitalization, surgeries, prescriptions, and rehabilitation. |
| Lost Wage Replacement | Provides wage replacement benefits if an employee cannot work for more than seven days due to their injury or illness, typically amounting to two-thirds of their average weekly wage. |
| Permanent Disability Benefits | Offers long-term disability benefits for workers who suffer a permanent disability, including compensation for lost wages and medical treatment, based on the degree of disability. |
| Vocational Rehabilitation | Provides training, job placement assistance, and other services to help injured or ill employees find suitable employment if they cannot return to their previous job. |
| Death Benefits | Provides benefits to surviving dependents, such as spouse and children, in case of a work-related death, including funeral expenses and a portion of the deceased worker’s wages. |
When Do Workers’ Compensation Benefits Begin in New York?
If an employee is totally or partially disabled and unable to work for more than seven days, they become eligible for lost wage benefits. However, it’s important to note that these benefits do not cover the first seven days of disability unless the disability lasts longer than fourteen days. In cases where the disability extends beyond two weeks, lost wage benefits will be retroactively paid, starting from the first day the employee was unable to work.
Once a workers’ compensation claim is approved, the timeline for receiving these payments is also defined by specific guidelines. If the insurer accepts the claim, the initial payment is due within 18 days of the injury or within 10 days after the employer has been notified of the injury, depending on which is later. This ensures that injured workers receive timely financial support, allowing them to concentrate on recovery.
Employees should also be aware of the necessary steps to file their claim and the importance of timely notification to their employer to avoid delays in receiving their benefits. Consulting with a Queens workers’ compensation attorney can help employees through the claims process efficiently and address any challenges that may arise.
What Are the Maximum Workers’ Compensation Benefits in NY?
The maximum workers’ compensation benefit in New York is based on two-thirds of the worker’s average weekly wage, subject to a state-imposed cap. The benefit amount changes annually and is adjusted according to the state’s average weekly wage.
In New York, workers’ compensation benefits are designed to support employees who suffer injuries or illnesses on the job. The maximum weekly compensation an injured worker can receive is closely tied to the state’s average weekly wage and adjusts annually.
Every year on July 1st, the New York State Workers’ Compensation Board updates these benefit amounts to reflect changes reported by the Commissioner of Labor to the Superintendent of Insurance. This adjustment helps benefits align with economic changes and cost of living increases.
For the period from July 1, 2024, to June 30, 2025, the maximum weekly benefit rate is set at $1,171.46, a slight increase from the previous year’s $1,145.43. This rate applies equally to both total and partial disability claims.
It’s important to note that the benefit amount an injured worker is eligible for is determined by the date of the accident. This means that any increases in the maximum benefit rates that occur after the injury will not affect the amount the injured worker receives. This policy ensures consistency and clarity in the calculation and distribution of benefits.
Understanding these figures and their updates can help workers and employers manage the challenges of workers’ compensation claims in New York. Consulting a skilled workers’ compensation attorney can be invaluable, guiding you through the process to secure the full benefits you’re entitled to under New York law. Contact us to learn how we can assist you in obtaining your rightful compensation efficiently and effectively.
Calculating Lost Wages Under Workers’ Compensation
Lost wages, an essential component of workers’ compensation benefits, is the money that injured workers would have earned if they were able to continue working as usual.
Lost wages are the earnings that an injured worker misses out on due to their inability to work after an occupational injury or illness. When an employee sustains a work-related injury or illness that results in lost time from work, workers’ compensation benefits come into play to help compensate for the lost income. Payments for lost wages typically depend on the severity of the injury and the worker’s average earnings before the injury.
Factors Affecting Lost Wage Calculation
Calculating lost wages under workers’ compensation involves several factors that determine the amount and duration of the benefits that an eligible worker receives. Some of the key factors considered in lost wage calculations include the worker’s average weekly wage and the percentage of disability resulting from the injury.
Average Weekly Wage
To calculate lost wages, it’s essential to first establish the worker’s average weekly wage (AWW). AWW is typically determined by examining the worker’s earnings in the months leading up to the injury. Depending on the jurisdiction, this could include looking at the worker’s earnings over the past year or a different specific time frame. The AWW generally includes regular pay, overtime, bonuses, and other forms of compensation an employee receives.
Percentage of Disability
The percentage of disability refers to the extent to which the injury or illness has impaired the worker’s ability to perform their regular job duties. The percentage of disability, commonly determined by a medical professional, is an essential factor in calculating lost wage benefits. Injured workers may be classified as having a partial or total disability, and the resulting lost wage benefits are based on this classification.
It is also important to determine whether the worker is expected to recover their ability to work when calculating the benefits they are entitled to receive. Determining whether an injury or disability qualifies as temporary or permanent is crucial in the context of workers’ compensation in New York.
Temporary Disability Benefits
Temporary disability benefits are provided to employees who are unable to work temporarily due to their work-related injury or illness. These benefits are typically paid for as long as the employee is medically certified as unable to work, up to a certain maximum period specified by state law. Once the employee reaches maximum medical improvement (MMI) or is able to return to work, the temporary disability benefits will cease.
The injured employee needs to stay in touch with their treating physician and the workers’ compensation carrier to ensure they continue receiving their benefits for the appropriate duration of their recovery.
Permanent Disability Benefits
Permanent disability benefits are provided to employees who are unable to return to work permanently due to their work-related injury or illness. These benefits are intended to compensate the worker for their lost earning capacity and the impact on their quality of life.
Here are the main calculations available through workers’ compensation in New York:
- Temporary Total Disability (TTD): Temporary total disability benefits are provided to workers who are completely unable to work due to a work-related injury or illness. Workers are entitled to receive 100% of the wage benefit, subject to the maximum weekly benefit limit. TTD benefits are meant to cover the period during which the worker is recovering and unable to perform any work.
- Temporary Partial Disability (TPD): Temporary partial disability benefits are available to workers who can perform some work but have restrictions or limitations due to work-related injury or illness. TPD benefits are calculated as two-thirds (66.67%) of the difference between the worker’s average weekly wage before the injury and their current earnings while working with restrictions. These benefits help compensate for the wage loss caused by the reduced work capacity.
- Permanent Total Disability (PTD): Permanent total disability benefits are awarded to workers who have sustained a permanent impairment that prevents them from engaging in any gainful employment. PTD benefits are typically paid at the same rate as TTD benefits, the full amount of the wage benefit, subject to the maximum weekly benefit limit. These benefits are designed to provide ongoing financial support for workers with severe and permanent disabilities.
- Permanent Partial Disability (PPD): Permanent partial disability benefits are available to workers who have sustained a permanent impairment but can still perform some work. PPD benefits are determined based on a percentage of the worker’s loss of wage-earning capacity. The specific amount and duration of PPD benefits depend on the nature and severity of the impairment and are subject to certain statutory limits.
Accurately calculating lost wages under workers’ compensation requires taking into account individual jurisdictional rules, the worker’s average weekly wage, and the percentage of disability. Consulting with an experienced workers’ compensation attorney may be beneficial to ensure that all factors are considered and that the injured worker receives the appropriate compensation for their situation.
Frequency of Payments
The frequency of workers’ compensation payments for lost wages is generally based on the worker’s typical payment schedule. In most cases, the benefits are paid weekly or biweekly, which is similar to the regular pay schedule. This ensures that the injured employee continues receiving a steady source of income during their time off from work.
While the frequency of payments may vary depending on the state’s workers’ compensation laws and the specific insurance carrier, the employer or the insurance carrier must pay the lost wage benefits promptly and at regular intervals. Failure to do so may result in penalties for the employer or the insurance carrier, ensuring that injured employees receive their compensation within a reasonable timeframe.
Method of Payment
The method of payment for workers’ compensation varies depending on the carrier and the individual case. In many cases, the payments for lost wages are made through direct deposit to the worker’s bank account or are provided in the form of a check. The details regarding the payment method should be discussed with the insurance carrier or the employer to ensure a smooth and convenient process for receiving the compensation.
It is also possible in New York for an injured employee to receive a lump sum payment for their lost wages, which can be helpful if the employee has immediate financial needs or if they wish to receive their compensation in a single payment. However, it is important to carefully consider the pros and cons of a lump sum payment before choosing this option.
How Long Can You Collect Benefits?
The length of time that you are eligible to collect workers’ compensation benefits will vary depending on the degree of the injury, illness, or disability that is determined by a healthcare provider. When a worker has been determined to have suffered from a permanent total disability, there will be no limit to how long they will be able to collect benefits.
Schedule Loss of Use (SLU) Awards
Schedule Loss of Use awards apply to permanent impairments affecting certain body parts specifically listed in the New York Workers’ Compensation Law. These include the arms, legs, hands, feet, eyes, and hearing. The calculation is based on:
- Average Weekly Wage (AWW): The injured worker’s average earnings before the accident.
- Body Part Schedule: Each body part is assigned a maximum number of compensable weeks. For example:
- Arm: 312 weeks
- Leg: 288 weeks
- Hand: 244 weeks
- Foot: 205 weeks
- Eye: 160 weeks
- Percentage of Loss: Determined by the medical evaluation.
Example Calculation:
If an injured worker has a 20% loss of use of an arm and their benefit rate is $600 per week:
312 weeks × 20% = 62.4 weeks
62.4 weeks × $600 = $37,440
This amount may be reduced based on any prior payments already received.
Before any determination is made regarding an injury or disability, there will be a medical evaluation to determine if the worker has reached maximum medical improvement and has recovered as much as possible from the injury.
An injured worker is required to see a doctor every six weeks to establish that there is still a disability. However, you or your doctor may disagree with the insurance doctor’s findings. This is when having an experienced personal injury lawyer is essential.
Non-Schedule Permanent Partial Disability (PPD) Benefits
Injuries not covered under SLU awards—such as those affecting the spine, brain, lungs, or other internal systems—are categorized as non-schedule permanent partial disabilities. These benefits are calculated based on the worker’s Loss of Wage-Earning Capacity (LWEC).
LWEC is assessed by considering:
- The medical impairment rating
- Functional limitations
- Vocational factors such as age, education, and work history
Two-thirds of the AWW is multiplied by the percentage of wage loss (which is 100% minus LWEC). For example, if the AWW is $900 and LWEC is determined to be 60%, the worker’s wage loss is 40%.
- $900 × 40% = $360
- $360 × 2/3 = $240 weekly benefit
The duration of benefits depends on the LWEC percentage. For example:
- 1–15% LWEC: 225 weeks
- 16–30% LWEC: 250 weeks
- 31–40% LWEC: 275 weeks
- 41–50% LWEC: 300 weeks; and so forth
Workers who are permanently and totally disabled and unable to return to any type of work may receive benefits for life. The weekly benefit is two-thirds of the AWW, up to the statutory maximum.
What is the Statute of Limitations for Workers’ Compensation in NY?
In New York, when an individual suffers an injury at work, it is important to be aware of the legal time limits for filing a workers’ compensation claim. The statute of limitations for these claims is two years, but understanding exactly when this period starts is key to ensuring you do not miss out on potential benefits.
The two-year limit begins from either the date of the actual workplace injury or from the date of the last compensation payment received, whichever is later. This rule is designed to provide some flexibility and ensure that workers can still file a claim if ongoing medical issues or continued payments are present that extend beyond the initial injury date.
Given this timeframe, it’s advisable not to delay in initiating the claim process. Waiting too long can complicate your case and potentially hinder your ability to claim workers’ compensation benefits. Early filing helps in smoother processing and quicker access to benefits, which can be crucial for medical care and financial support during recovery.
For those who have suffered a work-related injury, consulting with a knowledgeable Queens workers’ compensation attorney can make a significant difference in navigating the process of workers’ compensation claims. Contact K L Sanchez Law Office today to further grasp these timelines, helping you file your claim on time and obtain all the benefits you’re eligible for.
How a Skilled Queens Workers’ Compensation Attorney Can Help
Workers in Queens who have lost wages due to a workplace injury can benefit greatly from the assistance of a knowledgeable workers’ compensation attorney. These attorneys have a thorough grasp of New York’s workers’ compensation laws, allowing them to confidently handle the legal process. They assist injured workers by preparing and submitting all necessary paperwork accurately and on time. They also collect key evidence, such as medical records and employment documents, to strengthen their clients’ claims. In addition, they negotiate with insurance providers to secure compensation that fairly addresses lost wages. If disputes or denials arise, these attorneys provide strong legal representation during hearings or appeals to advocate for their clients’ rights.
At K L Sanchez Law Office, we are committed to helping injured workers obtain the benefits they are entitled to. Our Queens workers’ compensation attorneys work tirelessly to make the claims process straightforward while protecting your rights every step of the way. If you’ve been injured on the job, call us at (646) 701-7990 to schedule a free consultation and start pursuing the compensation you need.
