If you sustain an injury or illness while performing your job duties, you might be eligible for benefits through workers’ compensation. Fusco, Brandenstein & Rada, P.C. can help you file a claim and ensure you receive the payments you need to cover your medical care and lost wages. We’ll work hard to protect your right to the maximum compensation available.
Our compassionate and experienced legal team cares about the clients that hire us. We’ll listen to your needs and make your case a priority from start to finish. We can handle every legal aspect of the workers’ compensation claims and appeals process. We know how to hold employers and insurers accountable for the injuries you’ve suffered.
You can depend on us to remain by your side and help you through this challenging time in your life. Call us at 516-496-0400 today to speak with one of our New York workers’ compensation attorneys.
Occupations and Injuries Involved in Workers’ Compensation Claims
There are some industries that are more likely to result in injuries and fatalities to workers. When someone gets hurt on the job, they need to file a workers’ comp claim for benefits. The occupations that are at greater risk of injuries include:
- Construction workers
- Law enforcement and emergency services
- Industrial workers
- Healthcare professionals
- Manufacturing workers
- Agriculture, fishing, forestry, and hunting
Although the industries above involve more dangerous conditions than other job types, accidents can happen anywhere. Even if you work at a desk all day, you could still suffer injuries, such as carpal tunnel syndrome, which will require medical attention.
The most common injuries that qualify for workers’ compensation benefits include:
- Repetitive stress injuries
- Hospital workplace injuries
- Occupational spinal injuries
- Occupational diseases
- Spinal cord injuries
- Back injuries
- Lifting injuries
- Preexisting injuries
- Shoulder and knee injuries
Any of the injuries listed above could happen as the result of an accident. Whether you get hurt from dangerous working conditions or suffer harm from toxic chemicals, you could end up needing expensive treatment or develop a permanent disability. Some examples of situations that could lead to injuries, illnesses, or fatalities at work include:
- Slip/trip and fall
- Repetitive tasks
- Falling objects
- Defective tools, equipment, and machinery
- Overexertion injury
- Toxic substance exposure
- Fall from heights
- Malfunctioning safety equipment
- Explosions and fires
- Vehicle collisions
- Stuck between or under heavy machinery
- Hazards on the job site
9/11 & Zadroga Claims
As a natural extension of the work we have done with victims and responders of the September 11, 2001 World Trade Center attacks, our firm also handles compensation claims through the James Zadroga World Trade Center Victims’ Compensation Act.
The Zadroga Act allows for victims, responders, volunteers, and other members of the public who were harmed and injured as a result of the attacks to claim compensation for their injuries regardless of whether they were part of the prior incarnations of the Victims’ Compensation Fund or various class action lawsuits pertaining to the attacks. Our skilled attorneys can evaluate your claims and injuries to determine whether you are covered under the Zadroga Act, and then represent you before the Department of Justice in order to maximize your compensation
How to Handle an Occupational Injury or Illness
If you suffer an injury or illness at work or that’s caused by your working conditions, you might qualify for workers’ compensation benefits through your employer’s insurance coverage. New York laws require all businesses to provide employees with workers’ comp insurance. To begin the claims process, follow the steps below:
Step 1: Notify your employer of the accident within 30 days. It would be best to put it in writing, so there’s a record that you let them know about your workplace injury. Include the date and time of the incident, how it happened, and the injury you suffered as a result.
Step 2: Complete the application your employer provides. They will notify their insurer to begin the process. If they don’t give you a form, you can visit the New York Workers’ Compensation Board website to complete it yourself.
Step 3: Contact your employer’s insurance representative and request a copy of the policy. It will contain vital information, such as deadlines, qualifying medical conditions, and other details associated with your claim.
Step 4: Undergo an initial medical evaluation. The doctor will perform an examination to determine your diagnosis. They might refer you for additional treatment with other providers. Make sure you follow their orders and continue showing up for regularly scheduled appointments until all of your doctors release you from their care.
Step 5: Maintain records of everything that has to do with your accident, injury, and workers’ compensation claim. Evidence is crucial in any legal case and could help prove that you got hurt while performing your job duties.
Step 6: Obtain a statement from your doctor to submit with your application. It should include details about how you sustained an injury or illness, what you were doing at the time of the incident, and why it prevents you from returning to work.
Step 7: Hire an experienced New York workers’ compensation attorney. If you choose not to seek legal representation, you’ll likely end up with minimal benefits. An experienced attorney can ensure you receive the maximum payments you deserve.
How Do I Know If I’m Eligible for Workers’ Compensation?
Workers eligible for coverage in New York include:
- Anyone in a for-profit business, including family members, volunteers, and employees that are part-time, borrowed, or leased.
- Public school teachers, with the exception of New York City employees and public school aides
- Municipality and county employees that perform hazardous work
- Individuals who work for the State of New York, including volunteers
- Employees of most nonprofit organizations
- Domestic workers employed by one employer and performs job duties at least forty hours per week, such as a live-in maid or babysitter
- Corporate officers within corporations that have more than two stockholders or officers
- One or two-person corporation officers
- Volunteer firefighters and ambulance workers qualify for some benefits under the Volunteer Firefighters’ Benefit Law and Volunteer Ambulance Workers’ Benefit Law
Workers’ compensation laws don’t cover the following people:
- Anyone who volunteers for a nonprofit organization without receiving compensation. Compensation includes room and board, stipends, and other benefits of monetary value
- People who teach for an educational, nonprofit religious, or charitable institution
- Anyone performing non-manual tasks for a nonprofit religious, educational, or charitable institution
- Those who receive charitable aide from a charitable or religious institution in exchange for performing work, but don’t have an express contract for hire
- Workers covered by other workers’ compensation laws, such as railroad employees, maritime workers, and federal government employees
- Media sales representatives that sign an independent contractor contract
- Sole proprietors, partners, and one or two-person corporate officers with no additional employees who provide services necessary for the business
- Adults and minors performing chores or yard work at one family’s residence or the property of a noncommercial, nonprofit organization
- Spouse and children under 18 years old of an employer who is a farmer but isn’t under an express contract of hire
- Nonprofit, supervised amateur athletic members that aren’t employed by anyone participating in the athletic activity
- Some employees of Native American Nations and foreign governments
- Christian Science readers, sextons, religious order members, and duly ordained, licensed, or commissioned priests, ministers, and rabbis
- New York City firefighters, police officers, and sanitation workers who have coverage under New York State General Municipal Law provisions
- Real estate salespeople that are independent contractors signed with a broker
- Insurance brokers and agents that sign contracts as independent contractors
Benefits Available to Injured Workers in New York
Anyone who gets hurt on the job ends up with damages. Damages are all the losses associated with an accident or injury. When it comes to workers’ compensation claims in New York, you could pursue two types of damages: medical treatment and income benefits.
Workers’ compensation will typically provide coverage for all necessary costs associated with medical treatment. These expenses include:
- Hospital and ER costs
- Physical therapy, surgery, and other necessary treatment
- Prescription medications
- Home healthcare
- Medical assistive devices
When you begin treatment, you’re only allowed to see someone on the authorized healthcare provider list. If you choose to see your own doctor that hasn’t been approved by the New York State Workers’ Compensation Board, you’ll have to pay for the appointment out of pocket.
If you don’t like the initial physician you saw, you can notify your employer and submit a request to change doctors to the insurance company for approval. Your first appointment must have been within the first thirty days of your workplace accident. The new doctor must also be on the State’s approved list.
Income benefits provide replacement wages when a worker can’t return to their job or can work but at a limited functional capacity. Your eligibility for specific types of disability benefits will depend on the type of injury you sustained, how serious it is, and how long you’re unable to maintain employment.
Temporary partial disability is for employees who:
- Can’t return to work at all due to the disabling injury or illness. The payments you will receive are two-thirds of your average weekly wages multiplied by your disability rating. The disability rating is a percentage that indicates the level of impairment or loss of bodily function. To calculate the amount of your benefit payments, multiply your disability rating by two-thirds of your weekly wages before the accident occurred. For example, if you earned $900 per week and your doctor provided you with a 50% disability rating, you would receive $300 payments.
- Can return to work but unable to complete all job-related tasks. You would be eligible for payments at two-thirds of the difference between your average weekly wages before and after the accident.
Temporary total disability is for individuals who have a 100% disability rating but temporarily. The payments you would receive are two-thirds of your pre-injury average weekly wages. You’re eligible for this coverage until you’re able to return to your job.
Permanent partial disability benefit payments will depend on the body part affected.
- Scheduled loss of use awards: New laws provide a schedule that determines the number of weeks an injured worker can collect benefits based on the body part they can no longer use. Your payments will be two-thirds of your average weekly wages before the accident occurred multiplied by the schedule associated with your injury. For example, if you have a 50% loss of use of your hands, you would receive payments for a maximum of 122 weeks.
- Nonscheduled awards: This is for anyone who suffered permanent disability to their head, spine, organ, or another body part that isn’t included on the scheduled list. Payments are at two-thirds of the difference between your pre and post-injury average weekly wages. The maximum number of weeks you can collect payments depends on the percentage of your lost earning capacity. For instance, the nonscheduled awards list states that someone with a 95% lost wage capacity is eligible for coverage up to 525 weeks.
- Disfigurement: An additional payment up to $20,000 is available for someone who suffered an injury that caused a severe and permanent disfigurement of the head, face, or neck.
Permanent total disability benefits are available when the injured worker’s doctor places them at maximum medical improvement (MMI). MMI indicates that the patient’s condition won’t improve with further medical intervention. They will perform a thorough evaluation of the injury or illness to determine the disability rating appropriate for permanent limitations resulting from the accident. Payments are at two-thirds of your average weekly wages and will last as long as you’re unable to maintain any employment.
Additional benefits might be available under New York workers’ compensation laws, such as:
- Vocational rehabilitation: Services to help the disabled employee find a job that matches their abilities.
- Death benefits: Available to surviving family members if the worker died from their work-related injury or illness. Payments are at two-thirds of the deceased’s average weekly wages for the year before the fatal accident. Compensation of burial and funeral expenses might also be available.
Our New York workers’ compensation lawyers can help walk you through all of the benefits you may be eligible for!
Common Reasons for Denied Workers’ Compensation Claims
When you apply for workers’ compensation benefits, there are strict deadlines and procedures you must follow to receive coverage. If you make a mistake or miss a deadline, the insurance company might deny your claim. Sometimes, the reason for a denied claim is because the insurance company didn’t perform a thorough investigation or acted in bad faith.
The most common reasons for denials include the following:
- Failure to notify employer: You must notify your employer immediately after an accident occurs on the job. If you don’t or wait too long, you could ruin your eligibility to collect benefit payments.
- Lack of medical evidence: When you seek medical treatment, your doctor should include in their notes the type of injury you sustained, how it happened, and why it prevents you from returning to work. If there isn’t detailed information on your medical records, the insurance company won’t believe you have a disabling condition.
- Insurance bad faith: The insurance representative failed to perform an adequate investigation into the claim, unnecessarily delayed the process, or issued a denial without reviewing all available evidence.
- Gap in treatment: A gap in treatment refers to an injured worker who waits a while before seeking initial treatment or has a significant gap between each doctor’s appointment. You must see a doctor within days after the accident and show up for regularly scheduled appointments if you want to collect workers’ comp benefits.
- Conflicting employer statements: The insurance company will ask your employer to provide a statement about the accident that caused your disability. If they deny that you got hurt at work or provide details that don’t match your statement, that could result in a denied claim.
- Lack of witnesses: Eyewitness statements are crucial evidence in any insurance claim. If no one was around at the time of your workplace accident, it may not be easy to prove that it actually happened.
- Definition of disability: Every insurance policy has a definition that determines which injuries and illnesses qualify as a disability. If your employer’s workers’ compensation policy doesn’t consider your medical condition a disability, you won’t be eligible for benefits.
If you have been denied a workers’ comp claim in New York, our NYC workers’ compensation attorneys can walk you through the next step of the process, filing an appeal.
How to Appeal a Denied Claim
If you received a denial letter for your original workers’ compensation claim, you could appeal the decision through the following process:
- Hearing/trial: An administrative law judge will hear the reasons for an appeal and review evidence that shows you deserve benefits. They will either agree with the original decision to deny the claim or conclude that you’re eligible for insurance coverage.
- Appeal administrative denial: If the administrative judge denies your request at the hearing, you’ll have 30 days to file an appeal. You must submit the appeal in writing and submit it to the Workers’ Compensation Board. A three-member panel will review your request and determine if they should uphold, modify, or rescind the administrative judge’s decision.
- Appeal to state court: If the board continues to deny your request, you can file an appeal with the Appellate Division of the Supreme Court in New York.
Our attorneys have decades of experience handling workers comp appeals in New York. Contact us today to schedule a consultation to discuss your specific situation.
Contact an Experienced New York Workers’ Compensation Attorney
At Fusco, Brandenstein & Rada, P.C., we understand the stress of pursuing workers’ compensation benefits. When you’re injured and out of work, you face financial struggles while paying for medical treatment and other associated costs. You don’t know how you’re going to afford your daily living expenses and support your family. It’s an overwhelming experience, and you can depend on us to help. When you hire us, we’ll fight aggressively to protect your rights and ensure you receive the maximum benefits you deserve.
We have the experience, resources, and knowledge to file workers’ comp claims and appeal denied claims. Our legal team will treat you and your case as a priority. You can depend on us to be there when you need us and provide support and guidance throughout the process.
If you have a disabling medical condition keeping you from your job, call one of our New York workers’ compensation attorneys at 516-496-0400 to schedule a free consultation.