Workers' Compensation FAQ

Q. Are all disabilities covered under workers' compensation law?
A. No. Only those disabilities that are causally related to an injury or occupational disease "arising out of and in the course of the employment."

Q. What if the worker fails to file a claim for workers' compensation?
A. The worker may lose his/her right to benefits and medical care.

Q. Is it necessary for the worker to retain an attorney?
A: Although it is not required that you have an attorney, we do of course suggest you obtain representation, or at least consult with an attorney, to determine whether your case requires assistance. Attorney's fees are deducted from the claimant's award, as determined by a workers' compensation law judge. A claimant does not pay an attorney directly.

Q. How is the weekly cash benefit for temporary total disability determined?
A. The weekly cash benefit for temporary total disability is computed by taking two-thirds of the workers' average weekly wage for one year immediately preceding the accident. It may not, however, exceed the legal maximum in effect on the date of the injury. ( See maximum weekly benefits)

Q. Is medical care provided in the case of an accidental injury even when no claim is made for weekly cash benefits?
A. Yes. If medical care is necessary, it will be provided even though there has been no/minimal lost time from work.

Q. Are prescription drugs and medications covered under the law?
A. Yes.

Q. May a doctor proceed with care if the insurance carrier withholds authorization without reason?
A. Yes. When the authorization has been requested and withheld without reason, the doctor may proceed to render the services required for the claimant's welfare in an emergency situation.

Q. Must an injured worker submit to a medical examination when requested to do so by the employer or insurance carrier?
A. Yes. The employer or insurance carrier is entitled to have the worker examined by a qualified physician. Refusal to submit to an exam may affect the worker's claim.

Q. What happens when a claim is contested by the insurance carrier?
A. The insurance carrier contesting a claim must file a notice of controversy with the Board within 18 days after the disability begins or within 10 days of learning of the accident, whichever is greater. The carrier must give the reasons why the claim is not being paid. The issue is resolved by a workers' compensation law judge at a prehearing conference or a hearing.

Q. May an insurance carrier suspend or modify the cash benefits?
A. In a case where the carrier has made payment without waiting for a judge's decision, it may suspend or modify the payment based on payroll or medical evidence submitted to the Board.

Q. What can a worker do if he/she is not satisfied with the judge's decision?
A. The worker may file with the Board a written application for review within 30 days of filing of the notice of the judge's decision. The application must specify why the claimant disagrees with the decision.

Q. What can a worker do if he/she is not satisfied with the Board's
decision after an application for review?
A. The worker may appeal to the Appellate Division, Third Department, within 30 days after the decision has been served upon the parties.

Q. What is the penalty for making a false claim?
A. A person who willfully misrepresents the circumstances surrounding his or her case in order to obtain benefits is guilty of a felony.

More Information About New York Workers' Compensation

We offer a free initial consultation to answer your workers' comp questions. Call 718-285-6458 or contact us online to schedule a free initial consultation. We represent New York workers.