Workers’ Compensation is the system set up by the state to provide injured workers with payment for their medical care and treatment and a percentage of their wages so they are not destitute if they are off the job because of the workplace injury. The Workers’ Compensation Board is a state agency that processes the claims and determines, through a judicial proceeding, whether a worker will receive benefits and/or medical care, and how much he/she will receive. A claim is paid if the employer or insurance carrier agrees that the injury or illness is work-related. If the employer or insurance carrier disputes the claim, no cash benefits are paid until the Workers’ Compensation Law Judge decides who is right. If a worker is not receiving benefits because the employer or insurance carrier is arguing that the injury is not job-related, he/she may be eligible for Disability Benefits in the meantime. Any payments made under the Disability Program, however, will be subtracted from future Workers’ Compensation awards.

Generally yes, however, when there is an intentional act such as self-injury, a fight with a co-worker, or if there is intoxication or drug use, Workers’ Compensation may not cover the claim; but even in these cases there are some exceptions.

The Workers’ Compensation system was created so that the worker would not have to go to the trouble and expense of suing their employer to get the benefits to which they were entitled. Almost 100 years ago when the system was initiated, the worker’s right to sue the employer was taken away, so generally an injured worker cannot sue their employer. Even if your employer’s or a co-worker’s negligence causes your accident, you cannot sue them.

The most important action is to inform your supervisor or employer about exactly how you were hurt and give a written statement. Another important action is to tell the doctor or medical professional providing the medical treatment how the injury occurred, because every Workers’ Compensation claim is based on medical evidence that links your condition to your work accident.

After giving a written statement to your employer that the injury happened and how it occurred and after seeking appropriate medical treatment you should then file a claim with the Workers’ Compensation board, which is the state agency administering Workers’ Compensation claims.

After seeking the medical treatment, giving notice to your employer and filing the claim, the report will be sent to the insurance company covering the claim and the clock begins to run. The insurance company is required to respond within a two- to three-week period with a check covering lost wages due to the disability and the medical costs or with an explanation of why the claim has been denied.

If you are making a claim or are on Workers’ Compensation it is essential that you continue to see a doctor to get periodic statements that you are still disabled. If you do not do this the benefits will cease, and it is very difficult to get them restarted.

Yes. The denial of benefits comes in the form of a “C-7” form or “Notice of Controversy,” and the Workers’ Compensation board will set up a file that results in a hearing. At the hearing there will be testimony from you (the injured worker) and possibly other witnesses including your employer, co-workers, and doctors or others that provided medical care. It is advisable to get a lawyer at this hearing phase, because these proceedings are in essence a trial for which you will need experienced legal counsel. If you do not have an attorney you will be at the mercy of the insurance company, which will be represented by experienced counsel. Call BMCQ 866.979.BMCQ (2627) for a FREE consultation.

If a two- to three-week period has passed after you filed a claim and you have not received payment, you might get a call or a notification from the insurance company handling the Workers’ Compensation claim. The insurance company will say that they represent your employer and want to question you and take a statement to get more details about how the accident happened. When an insurance company contacts you to ask questions, their purpose is to try to find reasons to deny your claim. At this point it makes sense to consult an attorney to protect your claim. You should seek counsel to protect your rights and make sure you file any paperwork properly. Call BMCQ 866.979.BMCQ (2627) for a FREE consultation.

When approached by the insurance company, you should not sign anything or answer any questions until you consult an attorney. Without an attorney you could make a mistake by signing a statement that is not accurate, or is misleading or subject to a different interpretation. This statement could be used against you to deny your claim on the grounds that you made a material statement that could be considered a fraud by a court.

There are a number of hearing points throughout the state, and cases are heard at a location closest to the claimant’s home. Hearings for Albany, Schenectady, Rensselaer, parts of Montgomery, Schoharie and Saratoga counties are held in Menands (Albany); hearings for Columbia, Greene and Ulster counties are held in Hudson; the hearing point for Warren, Washington, and parts of Saratoga, Schoharie and Montgomery counties is in Queensbury.

The litigation can take from six months to a year for a controverted case to get through the system and then be appealed.