What Does Workers Compensation Cover in New York?

Under worker’s compensation, NY employees are able to get benefits to help them recover from work-related illnesses or injuries. The state requires most employers to carry this coverage and it’s the responsibility of the business owner to meet the requirements and have coverage. 

What Is Covered?

There are a number of different benefits, no matter where a business owner chooses to get coverage in the state. 

Medical Expenses: This includes expenses for both injured and sick employees who become hurt or ill on the job. 

Repetitive Stress Injuries: These injuries include tendonitis and carpal tunnel. 

Lost Wages: If an employee misses work from a work-related illness or injury then this covers the wages they need to be paid. 

Funeral Costs: If an employee dies from a work-related accident or from an illness caused by work, workers compensation can cover funeral costs. 

Disability Benefits: This kicks in if a work-related illness or injury causes either temporary or permanent disability and an employee isn’t able to return to work. 

Who Needs to Have Workers Compensation Insurance?

The state requires every for-profit business and most non-profit ones to carry workers compensation insurance. An employee is considered any person who performs under the direction or supervision or control of an employer, either off or on the premises. This includes any full-time or part-time workers, as well as workers who are seasonal, unpaid, leased, or temporary. 

There are some situations where a for-profit business may have a workers compensation insurance exemption. This includes any sole proprietors, a partnership under the laws of the state, or a one- or two-person owned company where the individuals own all the stock. There can’t be any employees, including workers who are unpaid volunteers, independent contractors, part-time, or borrowed. There are some exceptions for non-profit businesses as well. These include people engaged in a teaching capacity for a non-profit business, a person receiving aid from a charitable institution, clergy, compensated executive officers for non-profit corporations, and members of supervised amateur athletic activities that are operated as a non-profit. 

Workers Compensation Benefits to Employees

As an employee, if you get injured on the job then you could be entitled to the workers comp benefit. There are two common types of benefits an injured worker may receive. These include medical treatment and cash benefits. 

Cash Benefits

Under the workers compensation system, cash benefits help supplement income when an employee isn’t able to work because of the injury or illness. The amount of benefits an employee may receive depends on earnings before the injury or accident. An injured employee may receive a weekly cash benefit that is equal to two-thirds of the average weekly rate. The weekly benefit isn’t able to exceed the maximum benefit under the law and the maximum benefits are adjusted every year on July 1^st. An injured employee may receive the maximum allowed benefit if he or she isn’t able to return to work, but if he or she can work then they may get partial cash benefits. 

Medical Benefits

Injured workers also get access to necessary and reasonable medical care for any work-related injuries or illnesses covered by worker’s compensation. The healthcare provider that performs the treatment must be approved by the worker’s compensation board, except in the case of any emergency care related to the injury. There is no charge for treatment if the workers comp employer approves the claim. The employee may also be entitled to get reimbursement for mileage for travel to doctor’s appointments. 

Other Benefits to Workers Compensation

In some cases, there are other benefits available besides just medical and cash benefits. 

Death Benefits

Surviving spouses or minor children may be entitled to death benefits if an employee dies because of the job-related injury or illness. The dependents could be entitled to weekly compensation in addition to money for funeral expenses. If there aren’t any surviving heirs then the worker’s estate could be entitled to a lump sum payment. 

Rehab Programs

Employees who have disabilities because of job-related accidents can also get help with rehabilitation programs. These programs help workers get back to work if possible or learn to cope with the restrictions on daily life caused by the disability. These services include medical rehabilitation, vocational rehabilitation, social services, or selective placement. Participation in these rehab programs doesn’t cut off cash benefits and, in most cases, participation in the programs is voluntary.

Permanent Disability Benefits

If an employee ends up permanently disabled because of a job-related illness or injury then the employee may get disability benefits. There isn’t a limit on the number of weeks an employee can receive these disability benefits. Those who experience a partial disability receive benefits based on the severity and type of disability. The severity is measured when the patient reaches Maximum Medical Improvement. This is assumed to happen no more than two years after the injury date.   

Getting Workers Comp Benefits

The system should be straightforward and you should be able to file a claim and receive benefits. However, these cases are not always straightforward. Both insurance companies and employers deny many claims or attempt to undervalue disability claims, reduce benefits, or restrict medical treatment. Employees do have the right to work with a workers compensation lawyer to help with a claim or to pursue a third-party negligence claim if it applies to the case. 

If you have been injured on the job or have suffered a work-related illness, working with a NYC workers comp law firm can help you get the benefits that you deserve. It’s especially important to speak with a lawyer if your employer or the insurance company is trying to deny your workers comp benefits.