Workers’ Compensation: Frequently Asked Questions

Workers’ Compensation Basics

What is workers’ compensation?

Workers’ compensation is a program, often run by the state, that provides benefits to workers who have been injured while performing their job duties. Injured workers must file a claim to receive benefits, which typically cover the worker’s medical expenses and lost wages while they are unable to work. In certain cases, the benefits can expand to provide coverage for disability if the worker is temporarily or permanently disabled because of their injuries.

Who qualifies for workers’ comp benefits?

Three things need to be true for a worker to qualify for benefits:

1. The worker must be an employee (not an independent contractor or freelancer). It should be noted that an employee includes someone who is paid in cash and any undocumented workers.
2. The worker must have been injured while completing job-related tasks. What qualifies as a “job-related task” can sometimes be unclear, but for the most part, if you were carrying out work tasks and were on the clock when you were injured, you can likely file a workers’ compensation claim.
3. Your employer must have workers’ compensation insurance. Most states require employers to have this kind of insurance. It protects the employer from lawsuits that employees injured on the job might file, because it allows all employees to receive benefits even if the accident that caused their injuries was the fault of the injured worker.

To clarify the last point, workers’ compensation is a no-fault system. That means that a worker who was injured on the job can file to receive benefits regardless of who was at fault for the accident. Whether the worker caused the accident or their employer did, the injured worker can obtain benefits through workers’ compensation.

What to Do if You’ve Been Injured

What should I do if I’m injured on the job?

If you have been injured on the job, the two most important things to do are report the accident to your employer, and seek medical treatment if the circumstances warrant it. Reporting the accident to your employer ensures that there is a record of the incident immediately, which is helpful when you are filing the workers’ compensation claim or if you end up filing a third-party personal injury lawsuit. This way, no one can dispute that your accident occurred when and how you said it did. Of course, seeking medical attention for your injuries can also be important, although there may be some limitations on which doctors you can see based on your state’s workers’ compensation program (see below for more information on doctors).

If you have been injured on the job, seeking medical treatment and filing a workers’ compensation claim are your legal rights. It is important to note that your employer should never try to convince you not to seek medical attention, or tell you not to file a workers’ compensation claim if you intend to. They also should never use your injury as an excuse to fire you, pay you less, or otherwise harass you. If you find yourself in any of these situations, you can report your employer to your state’s workers’ compensation board, and may want to contact a workers’ compensation attorney to assist you with your case.

How do I file a workers’ compensation claim?

To file a claim, you must first report the accident to your employer. Once you have done that, you need to fill out and submit the necessary paperwork to your state’s workers’ compensation board to officially file the claim. The form(s) and methods for submitting them will vary for each state, but possibilities include filling them out online and emailing them, printing them out or asking your employer for the forms and mailing them, or going to your state’s workers’ compensation office and asking them to help you file a claim. A workers’ compensation attorney can also help you file a claim, as the process can be overwhelming to complete on your own.

How long do I have to file a claim?

In New York, an injured worker only has 30 days before they may lose their right to file a claim. If you do not notify your employer within 30 days, you may never be able to file a claim. This is also why it is so important to report the accident to your employer as soon as it happens; your ability to receive benefits may depend on that report. Once you have reported the accident to your employer, you technically have two years to file the claim itself. However, it is best to do it as soon as possible after the accident occurs.

Can I see my own doctor for medical treatment if I am filing a claim?

This depends on the state you are filing your claim in, as every state has different rules. Many states will ask that injured workers see a doctor they have already approved. This is the case in New York; injured workers must choose a doctor from a list of providers who have been authorized by the state’s workers’ compensation board (except in the case of emergencies; if your injuries are severe or life-threatening and you need immediate medical attention, you will not be penalized for going to the emergency room and receiving treatment from an unauthorized provider). You may be able to see your doctor if they happen to be approved by your state’s workers’ compensation board, but otherwise, you must see an approved provider. If you are dissatisfied with the quality of care given by the authorized doctor, it is possible you can change providers, but the new doctor will likely still need to be approved by the workers’ compensation board. If you are struggling with or have questions about this, a work accident attorney can help.

Workers’ Compensation Benefits

What kind of benefits can I receive from workers’ compensation?

Typically, workers’ compensation benefits cover:

• Cost of all medical expenses related to your injuries, including transportation to and from appointments
• Wages lost while you are unable to work
• Disability benefits if you are unable to return to work or must return at a reduced earning capacity
• Survivor benefits, including coverage of funeral costs, for the family if the worker dies from their injuries

Some states will also sometimes pay for the worker’s rehabilitation costs or for additional training if it helps them return to work.

How much money can I receive from workers’ compensation?

This will vary based on your situation and the laws in your state. However, in most states, workers receive approximately two-thirds of their average weekly wages while they are temporarily disabled from work. In New York, the formula for calculating how much an injured worker will receive weekly is:

Two-thirds x the worker’s average weekly wage x the percentage representing the severity of their disability

Note that no matter what this number is, it cannot exceed the maximum weekly amount that is set by state law.  

If you become permanently disabled from work because of your injuries, you will likely be able to collect disability benefits. Again, this amount varies based on your specific situation, but in New York, there is no limit on the number of weeks a worker who has been permanently disabled can receive these benefits. However, just as with temporary disabilities, the amount cannot exceed the maximums set by state law.

What kind of injuries does worker’s compensation cover?

Workers’ compensation covers all injuries that a worker sustains on the job, regardless of negligence. The only exceptions to this rule would be if the accident happened while the worker was intoxicated, the worker intended to cause harm to himself, or if the worker was injured while committing a crime or violating a work policy.

Workers’ compensation also covers injuries or illnesses that did not result directly from an accident. For example, if a worker experiences chronic back pain and can prove that this chronic injury is directly connected to his job duties, he may be able to file a workers’ compensation claim and receive benefits. Another example is asbestos or carbon monoxide poisoning for workers who have been exposed to chemicals or other hazardous substances on the job.

How long will I receive benefits?

If you have been temporarily disabled, you will typically receive benefits until you are able to return to work at your normal earning capacity. If your injuries have reduced your ability to work and therefore lessened your wages as well, you may continue to receive some benefits to supplement your lost wages, even though you have returned to work.

If you are permanently disabled from work, depending on the severity of your disability, you may be able to receive benefits indefinitely, as long as the amount does not exceed the maximum weekly benefit amount set by the state.

Fault and Liability

Can I still receive benefits if I was injured in an accident on the job that was my fault?

Yes. Workers’ compensation programs do not take fault into account when evaluating claims, which means even if your negligence contributed to causing your accident, you can still receive benefits.

Can I sue my employer if the accident was their fault?

Almost always, the answer to this question is no. For the same reason that you can still receive benefits even if your negligence caused your injuries, you cannot sue your employer even if you believe that your injuries are your employer’s fault. Most employers are required by state law to have workers’ compensation insurance, which protects them from employee lawsuits since the insurance will help compensate employees for any injuries on the job.

Although you cannot sue your employer, it is possible to bring a personal injury lawsuit against a third party that contributed to causing your accident; more on that below.

Legal Help

What if the benefits I receive from workers’ compensation are not enough? Can I file for additional compensation?

Workers’ compensation is limited in the damages it covers. Although it does provide compensation for medical expenses and lost wages, sometimes workers may feel that this is not enough, depending on the severity of their injuries. If you feel this way, in some cases it is possible to file a personal injury lawsuit against a negligent third party who contributed to your injuries. Personal injury cases allow you to be compensated for a broader range of damages, including your pain and suffering and damage to your mental health. It is possible to file both a workers’ compensation claim and a personal injury claim at the same time; however, it is important to note that you cannot sue your employer in a personal injury case, only a negligent third party. For example, if you were using a defective saw that kicked back and struck you, causing serious injury, you could file a workers’ compensation claim because you were injured on the job. You also might be able to sue the manufacturer of the saw (a third party) and/or the contractor of your work site (another third party), who is supposed to ensure employees are working in a safe environment.

Do I need to hire an attorney to help file a workers’ compensation claim?

It is not necessary to retain legal help to file a workers’ compensation claim, but it can be extremely helpful. When you are injured and trying to recover, it can be overwhelming and stressful to deal with the deadlines and the paperwork necessary to file a claim. Additionally, if you are considering bringing a third-party personal injury claim, it is in your best interest to hire an attorney, as that process can be even more complex.

Expert Work Accident Attorneys Answering Your Questions

The personal injury attorneys at Block O’Toole & Murphy have extensive experience handling work accident cases, and are knowledgeable about all things related to work accidents and workers’ compensation cases. If you or a loved one has been injured in a work accident and you are unsure what to do next, don’t hesitate to call us to discuss your situation. Call 212-736-5300 or fill out our contact form today. We serve New York and New Jersey.

Our attorneys handle both third party work injury lawsuits and workers’ compensation cases. Noteworthy results we have obtained in work accident cases include:

• $15,000,000 settlement in a wrongful death case for the family of an HVAC worker who was crushed by a falling air chiller while at work
• $12,000,000 settlement for a union worker who fell 40 feet down a ventilation shaft at his work site and unfortunately became permanently disabled from work as a result of his injuries
• $11,500,000 settlement for a worker who suffered lacerated tendons after a defective saw he was using kicked back and struck his wrist
• $11,000,000 settlement for a masonry foreman who was seriously injured at his work site when he stepped on an unsecured hole cover, causing him to fall three stories
• $10,875,000 verdict for a union worker who sustained serious internal injuries after he fell on the job and was impaled by steel rebar
• $10,500,000 settlement in a wrongful death case for the surviving family of a worker who was tragically killed when he was struck in the neck by a defective saw

To speak with an attorney today, dial 212-736-5300.