New York Workers’ Compensation Attorneys

If you or a loved one is injured in a workplace accident, you will likely be able to file for workers’ compensation. In New York State, employers are required to carry workers’ compensation insurance for their full-time employees. This insurance provides benefits for employees who become sick or injured while performing their duties, regardless of whether or not they’re at fault for their injuries.

With few exceptions, having workers’ compensation insurance means that you cannot sue your employer, a legal principle known as the exclusive remedy doctrine. But it’s still important to hire a good attorney when pursuing a workers’ compensation claim, and, in certain circumstances, it may be possible to pursue a claim for your injuries against another person or entity who is not your employer.

While this no-fault system of workers’ compensation insurance may sound simple, workers are often surprised by the challenges that come up when they attempt to pursue a workers’ compensation claim. Many insurers look for reasons to deny these claims, and you may even find that your employer puts obstacles in your path. A good workers’ compensation attorney can oversee your interactions with insurance providers and your employer, making sure you receive the benefits you are legally entitled to. Learn more about pursuing workers’ compensation claims and how a skilled attorney can help you.

Need to Know:

• It’s important to make sure your workplace injury was reported to the Workers’ Compensation Board and to the insurance provider. If your employer did not make this report, you will need to file a report yourself.
• When filling out necessary medical questionnaires, you should be completely honest about how your injury has affected you, and you must be careful to report prior accidents.
• If you have grounds for a third-party lawsuit, a successful workers’ compensation claim will be an asset to your third-party case.

In This Article:

• Has My Workplace Injury Been Reported?
• What to Know About Interacting With an Insurance Provider
• The Role of Workers’ Compensation in Third-Party Cases
• How a Successful Workers’ Compensation Claim Bolstered a Challenging Third-Party Lawsuit

Has My Workplace Injury Been Reported?

The rules governing a workers’ compensation claim in New York State are fairly straightforward. If you have work injuries which will cause you to miss more than one day of work, or which will require medical treatment beyond ordinary first aid, you need to notify your employer within 10 days, and file an employee claim form to the Workers’ Compensation Board within two years. Your employer is also required to file a report with the New York State Workers’ Compensation Board, as well as with the workers’ compensation insurance provider for your company, within 10 days. Normally, you will be prompted to file your employee claim after your employer reports your injury.

Some employers, however, fail to file a claim. Reports of workplace injury can drive insurance premiums up and may even trigger worksite safety investigations. This means that, even though employers are legally required to report employee injuries, many are hesitant to do so. They may try to avoid interacting with insurance providers by handling things themselves — for example, by offering to cover initial medical expenses or by telling injured employees to take some time off to recover, hoping the injury will improve on its own and they won’t be held accountable. Workers who are immigrants — documented and otherwise — or who speak limited English are particularly vulnerable to this type of abuse from employers they trust.

If you were injured in a workplace accident and have reported the injury to your employer, that employer should send you a workers’ compensation claim number within a few business days. If you don’t receive this claim number, it may be a red flag that your employer failed to report your injury to the insurance company.

If you find that your employer did not report your injury, you still need to file an employee claim with the Workers’ Compensation Board. Filing this claim will require you to fill out a C-3 form, explaining details such as the date of your accident, the nature of your injury, and the effects it has had on you.

When completing this form, it’s important to be completely straightforward. If you downplay or exaggerate your injury, or otherwise get details of the incident wrong, the insurance carrier could use those discrepancies to contest your claim.

When you have filed the C-3 form, the Workers’ Compensation Board will contact your employers’ insurance carrier, telling them to open a claim and investigate the case. At this point, the insurance carrier will conduct an investigation and may accept your claim or contest it.

What to Know About Interacting With an Insurance Provider

Any interaction with the insurance providers involved in your workers’ compensation claim should be done with the utmost care, and your attorney should be involved in the conversation as often as possible. When making a workers’ compensation claim, be aware of what information you’re obligated to provide as part of the process — and where you should set boundaries.

Medical Examination and Questionnaires

As part of their investigation, the insurance company will give you an independent medical examination with their own doctor. At this point, you will be asked to fill out questionnaires about prior injuries. Like the C-3 form, these questionnaires must be filled out accurately to protect your claim. The insurance company will seize hold of anything they can cite as dishonest or fraudulent. This includes honest mistakes.

To name one example of a common mistake, we find that many construction workers take a lot of physical wear and tear over the course of a long career in construction. They may fail to report prior injuries accurately, not because they are dishonest, but because they do not remember those injuries clearly, or at all. Before you fill out these questionnaires, you should consult with your attorney, speak to your doctor, and make an effort to obtain past medical records so that you can report prior treatments with complete accuracy.

Other Attempts to Gain Information

In addition to the medical examination, workers’ compensation carriers have many ways of seeking out information on your case. They may attempt to contact you by phone or travel to your house to interview you. They may even assign an agent called a workers’ compensation nurse or a nurse case manager to your case. This agent will seek your authorization to speak to treating providers on your behalf — and, assuming this is standard practice, you may be tempted to give him or her that authorization.

It’s important, though, to realize that all representatives of the insurance provider — even those who may appear to be friendly and helpful — are looking for evidence that will help the insurance company to cut benefits in your case, or even to deny your claim. Even a brief phone call, which may appear harmless, will be recorded for future reference, and you never know how a statement you make might be used against you.

You should politely but firmly refuse to interact with these representatives from the insurance company without your attorney present. You should never allow them to be present for medical appointments, and you should never sign any forms they provide without your attorney’s advice.

The Role of Workers’ Compensation in Third-Party Cases

If your accident resulted from negligence by a third party — such as a contractor, a site owner, or any entity other than your employer — you may have grounds for a third-party lawsuit. To name one example, a slip and fall accident in the hallway of your office building could be grounds for a premises liability case against the owner of the building, assuming that owner is not your employer. If your slip occurred because a cleaning crew contracted by the building owner failed to put up appropriate signage to indicate a wet floor, that cleaning company might be an additional third party.

Filing a workers’ compensation claim doesn’t mean that you shouldn’t pursue a third-party lawsuit, and vice-versa. In the first place, getting results from a third-party lawsuit can take years. Unless it’s contested, a workers’ compensation claim is more likely to be quickly resolved, since it doesn’t require proof of negligence. For many of our clients in third-party lawsuits who are no longer able to work, or whose ability to work has been limited, workers’ compensation ensures that they and their families receive some amount of compensation until the third-party lawsuit is resolved by a judgment after trial or a settlement.

Secondly, workers’ compensation is limited in what it covers. For example, it only pays a portion of lost wages, and it does not account for traditional damages categories such as pain and suffering. A third-party claim can address those aspects of your case.

Thirdly, in cases where workers’ compensation is contested, establishing a right to that compensation can solidify your third-party case. The greater the value of a workers’ compensation claim, the more likely it is to be contested.

Case Study: How We Navigated a Hotly-Contested Workers’ Compensation Claim

Partner Pawel Wierzbicki handled a workers’ compensation claim that was hotly-contested. His client, a 56-year-old electrician, had been called to repair a lighting fixture at a commercial store in Manhattan. During the repair, he received an electric shock, which resulted in him falling to the ground from the ladder he was standing on.

Like many of our construction accident clients, Wierzbicki’s client was a mentally and physically tough man, unused to accepting help. Refusing an ambulance, he packed up his tools and drove his company van back to his employer’s yard. That evening, he began to feel unwell and called his employer to tell him that he might not be able to come to work the next day. Within 36 hours of the accident, he was found unconscious by his partner, experiencing symptoms of a stroke.

Our client was hospitalized and diagnosed with a chronic artery blockage due to uncontrolled hypertension and untreated cholesterol, along with traumatic brain injury resulting from the stroke. This brain injury had left him unemployable, and his life care plan indicated that his future medical expenses would cost millions of dollars.

It was unsurprising, therefore, that the worker’s compensation insurance company fought his claim. The insurance carrier cited the diagnosis of artery occlusion to argue that our client’s accident did not cause his stroke. They hired two independent medical consultants, both of whom confirmed the diagnosis.

Wierzbicki — who was handling our client’s workers’ compensation case in addition to the third-party lawsuit — fought harder. Obtaining our client’s CTA examination — a medical test which examines blood vessels — from hospital records, he hired an expert neuroradiologist to review it. Upon reviewing this file, Wierzbicki’s expert understood that our client had suffered an internal carotid artery dissection due to his fall from the ladder. In layman’s terms, trauma to his neck had caused the wall of his artery to tear, resulting in his stroke.

Wierzbicki brought the workers’ compensation case to trial. This required him to discredit all of the doctors associated with the defense, from the experts for the insurance company to the doctors at the hospital who had made the initial diagnosis. He deposed and cross-examined each of these doctors, and, with the help of his own medical experts, was able to win the case, securing the life care plan for his client.

This conclusion — which confirmed beyond a doubt that our client’s injury was caused by the fall he took — gave our client firm grounds for a third-party lawsuit against the commercial store, and ensured that his medical expenses would be paid in the meantime.

Contact Block O’Toole & Murphy

If you or a loved one has been injured in a workplace accident, the attorneys at Block O’Toole & Murphy are here to help. We serve all five boroughs of New York City and the entire New York State. Contact Block O’Toole & Murphy to receive a free legal consultation by calling 212-736-5300, or by filling out our online contact form.