Workplace Injury: All You Need to Know about New York Workers’ Compensation Packages

Insurance provides compensation for loss, damage, or anything that has been insured at a specific price called the premium. One of the insurance programs in New York City is the Workers’ compensation insurance. It takes care of the bills incurred from the medical treatment of occupational injuries and illnesses. They also provide cash aid to the employee during this period. The workers’ compensation is to be provided for the employees at no cost by the employer.

Work Safety

Work Safety

If an employee dies as a result of a workplace injury or illness, the spouse and/or other dependants of the deceased will be given some cash benefits weekly. The wages of the deceased weekly for one year before the onset of the illness are calculated. Then, two-thirds of it is given to his family. The money spent on the funeral ceremony is also covered.

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The affected employee will be paid some portions of his lost wages if the illness or disease causes him to work fewer hours, restricts him from doing his other jobs, or causes his being away from work for more than a week.

The New York Workers Compensation Board sees to the compensation of workers, protection of the employer’s interest as well as that of the employee, and ensuring adherence to the workers’ compensation law.

How can an employer access workers’ compensation insurance?

Through the state insurance fund or private companies providing insurance, the employer can obtain insurance. The employer may also obtain it through self-insurance.

An employer can obtain self-insurance after meeting the board’s rules and regulations and making security deposits as required.

While private insurance can be obtained from carriers, agents, or brokers, New York State insurance fund (NYSIF) offers a public insurance service. It also offers family leaves with pay services and disability benefits. It is the insurance provider for all employees of the state. It is a different body from the board and competes with the other insurance carriers in providing coverage. However, it is the number one insurance production body in New York. Other providers of this insurance include Travelers, AmTrust, Hartford, Chubb, and Berkshire among others.

Under the paid family leave insurance, an employee is paid when he is out of the office to attend to matters relating to his family. These include taking care of a loved one battling serious health issues and staying with one’s new child for bonding purposes. When an employee is sent outside the state for active military services, the insurance helps reduce the burden on his family. Deductions made from the payroll of employed workers are used to fund the paid family leave. This insurance is offered together with disability benefits.

Who qualifies for the plan?

The employees of profit-making organizations, governmental agencies, and some non-profit-making organizations should all be beneficiaries of the plan including family members that are employed and part-time workers. This helps to prevent lawsuits against the employer except in extreme cases like intentional injury caused by the employer. However, a lawsuit can be filed for a third-party-caused injury.

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Non-profit organizations may not be required to get coverage for some employees. These include people working for charitable organizations such as teachers teaching in recognized non-profit organizations and clergymen performing religious duties. Also, businesses where the owner has no employees or makes use of borrowed employees, may not need to get the compensation policy.

According to Michael F. Boland, Esq an attorney at Bronx Injury Lawyers The workers’ compensation law has some factors in place that help in determining if a worker is an employee. Some factors are put into consideration including these:

  • Payment method- When a laborer is paid wages for working for a company periodically, that person may be likened to an employed worker.
  • Control ability- When an organization directs the task being performed by a worker, then, such worker is an employed worker.
  • Provision of working equipment and facilities- An employer-employee relationship can be said to be taking place when the facilities the worker uses in carrying out tasks are being provided by the organization.
  • Nature of work- Consistency in similarities between the duties and services carried out by a person and the company that hired him shows that such person is employed.
  • Hiring or firing right- When workers can be hired or fired by an organization, such workers are regarded as employed.

How to access the workers’ compensation plan

To access the benefits of the workers’ compensation plan, some things need to be done.

As soon as an occupational injury occurs, the employee is required to inform the employer through writing within thirty days in New York. However, for illnesses that are noticed over time, an early report on detection is also needed. The employed worker is advised by the employer to seek immediate medical attention. This should be from healthcare providers approved by the workers’ compensation board except in emergency cases.

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The employee fills out a form describing the injury incidence, time, date, and location. The report from witnesses is also documented. The form and documents are submitted to the workers’ compensation insurance carrier by the employer. A medical report from the employee’s doctor is also submitted. The first report of injury form can also be filled out and submitted to the workers’ compensation board. Submission of forms to the board and insurer should be done by the employer within 10 days.

For minor injuries, the completed injury report is not sent to the insurer or workers’ compensation board but is kept in business files. These files may be reviewed by the board at any time. Injuries that caused work time loss of less than a day and injuries that require two or fewer treatments are considered minor.

The insurer, on receiving the claim form may either approve or reject the claim.

If the claim is approved, the insurer pays the employee with the employer’s knowledge. The insurer should write back to the employee on his/her legal rights when he receives his first check or within 14 days of receiving the claim from the employer. After receiving payments, the employee and their lawyer in charge of workers’ compensation (if any), may accept the payments or request higher amounts.

In cases where the insurer refuses the claim, the employee may ask for a reconsideration, or appeal formally through the State’s workers compensation board.

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The employee sends written notices to both the employer and insurer when he has recovered and can resume work. The insurance company may have to pay permanent disability benefits to the employee depending on the level of injury. Some employers also put programs in place to help the workers get back to work readily and be productive as soon as possible.

Injuries covered by the workers’ compensation plan

The plan covers injuries caused by accidents in the workplace. This includes breaking an arm, spraining an ankle, etc. The following scenarios are also covered by the plan:

  • Repetitive stress injuries. Muscles, tendons, and nerves can be damaged from motions carried out repeatedly. Hence, carpenters may experience tendonitis, while those that type a lot in an office setting may experience carpal tunnel syndrome.
  • When one’s work worsens a pre-existing condition, the person can access a workers’ compensation plan.
  • Occupational diseases. These are diseases that are developed as a result of one’s workplace. They include mesothelioma developed from working with asbestos, and occupational lung disorders among others.
  • Mental health conditions arising from work-related stress. There has to be substantial proof for this claim to be accepted. Maybe, traumatic events at work or mental distress induced by physical injury in the workplace.
  • Necessary medical drugs, dental care, surgery, medical care, and optometry are the medical benefits provided by the workers’ compensation plan.

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Injuries that workers’ compensation may not cover

  • Injuries one inflicted on himself or herself.
  • Injuries that occurred while going to work or while returning from work.
  • Fight-caused injuries.
  • Injuries incurred from violating the policies of companies.
  • Injuries from alcohol-influenced or drug-influenced crimes.

Penalties

A penalty of between $1000 to $5000 is imposed on the employer for not providing five or fewer employees with workers’ compensation insurance for 12 months. For more than five employees, the penalty is between $5,000 to $50,000. About $2000 for every 10 days of not providing coverage, can be meted out as punishment also. This may be more than $12,000 by the time the first notice of the penalty is issued to the employer.

However, there should be a request for penalty review sent to the workers’ compensation board by the employer within 30 days of receiving the penalty of non-coverage. In this notice, an explanation should be offered for the coverage lapse in the business, and a request made for a penalty reduction. After review, the penalty may be withdrawn, reduced, or maintained by the board.

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The importance of transparency of employers in matters related to workers’ compensation cannot be overemphasized. Some of the things that the employer should do include:

  • To ensure appropriate employee classification.
  • To see to it that injuries are classified accordingly.
  • Not swaying the diagnosis of the health care provider.
  • Not manipulating the treatment given to the injured employee by the health care provider.

How much does the compensation cost?

The cost of the compensation plan is dependent on so many factors. Employers pay $0.07 for every $100 in the payroll of the business for lowest-risk jobs. A higher amount is charged for the highest-risk jobs, which is $29.93 for every $100. The highest risk workers include pilots, steelworkers, and roofers. Other factors determining the cost of compensation include the location and payroll of the business, number of employees, industry type, and claim history.

Workers’ compensation claims and their effect on businesses

Effect on the productivity and payroll of a business- Getting an employee back to work as soon as possible after recovery can reduce the company’s expenses. The cost of hiring short-term employees, losses incurred from work interruption by regulators of industries, and paying employees higher amounts for extra hours at work can be reduced by early reinstatement of the injured worker.

Effect on premiums charged by workers’ compensation insurers- When a company is noted for frequent claim requests, it may lead to the insurer charging higher premiums. If the claim experience of a company is far higher than those of similar companies, higher premiums might result.

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Effect on the reputation of an organization- Frequent occupational accidents can damage the reputation of a company. Such an organization may experience difficulty in getting new employees, partners, or clients.

Effects on the cost of administration- Time is lost in trying to get claim papers ready for submission to the board and insurance company. Trying to get the company ready for inspection by regulators if need be, and repair equipment damaged from an accident may also affect the resources needed to run the organization negatively.

Hence, it is important to put structures in place to prevent workplace injuries. It is also necessary to educate the employees on workplace safety tips.

There is also a need for every company to educate its employees on the company’s compensation plan, their workers’ compensation benefits, and the importance of early reports of occupational injuries and illnesses for health optimization purposes.

Conclusion

The workers’ compensation plan covers medical care and cash benefits for occupational injuries and illnesses of employees in New York. It also takes care of the dependents of the employee in cases of work-related death. The workers’ compensation board serves as a regulatory body to protect the interests of both the employer and employee, and ensure conformity to the workers’ compensation law.

References

What Is the Workers’ Comp Claim Process for Employers? | Insureon

Brooklyn Injury Attorneys

New York Workers Compensation Insurance – Forbes Advisor

NYC Injury Attorneys

Violations of Workers’ Compensation Law (Liability and Penalties) (ny.gov)

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