Workers’ compensation provides important protection for employees in Niagara County and throughout New York. However, misconceptions about the program can cause injured workers to delay treatment, miss filing deadlines, or misunderstand the benefits that may be available. Below, we address several common misconceptions about New York workers’ compensation and explain the basic steps involved in filing a claim.
Misconception 1: Workers’ Compensation Is Only for Major Injuries
Workers’ compensation is not limited to catastrophic workplace accidents. Less severe injuries, including sprains and strains, may qualify when they arise out of and occur in the course of employment.
Coverage may also extend to repetitive-stress injuries and occupational illnesses that develop over time. An injured worker should report the condition and seek medical attention even when it initially appears minor. A seemingly minor injury can worsen or result in lasting limitations.
Available benefits depend on the facts of the claim. They may include payment for necessary medical treatment and partial wage-replacement benefits when a qualifying injury prevents an employee from working or reduces their earning capacity.
Misconception 2: Only Full-Time Employees Are Covered
Workers’ compensation coverage is not limited to full-time employees. Part-time, seasonal, and temporary employees may be eligible for benefits when they suffer a qualifying work-related injury or illness.
Independent contractors are generally not covered as employees merely because they perform services for a business. However, calling someone an independent contractor does not necessarily determine their legal status. The Workers’ Compensation Board may consider factors such as the degree of control exercised over the worker, how the work is performed, the method of payment, and the overall relationship between the parties.
A worker who has been labeled an independent contractor should not automatically assume that they are ineligible. An attorney can review the circumstances and help determine whether the worker may legally qualify as an employee.
Misconception 3: Workers’ Compensation Only Covers Accidents
Workers’ compensation can cover more than injuries caused by sudden accidents. It may also cover occupational diseases and conditions that develop because of a worker’s job duties or workplace exposure.
Examples can include repetitive-stress injuries, work-related hearing loss, and illnesses caused by exposure to hazardous substances. The worker will generally need medical evidence connecting the condition to their employment.
Misconception 4: You Must Prove That Your Employer Was Negligent
New York workers’ compensation is generally a no-fault system. An injured employee usually does not need to prove that the employer caused the injury through negligence to pursue benefits.
The worker must still establish that the injury or illness is connected to the employment and comply with applicable notice, medical-documentation, and filing requirements. An insurer may dispute whether an injury occurred at work, whether a medical condition is related to the employee’s duties, or the extent of the resulting disability.
Misconception 5: You Cannot Choose Your Own Medical Provider
In most cases, an injured worker may select any healthcare provider who is authorized by the New York State Workers’ Compensation Board and is accepting workers’ compensation patients. A personal physician may provide treatment if that physician is properly authorized by the Board.
Exceptions may apply when an employer or insurance carrier participates in an approved Preferred Provider Organization or an Alternative Dispute Resolution program. When a Preferred Provider Organization applies, the worker may be required to receive initial treatment within that network. After 30 days from the initial treatment, the worker may generally select another Board-authorized provider outside the network after notifying the insurer or self-insured employer in writing.
Emergency treatment may be obtained from any appropriate medical provider. The worker should tell the provider that the injury or illness is work-related.
Misconception 6: Reporting an Injury Promptly Is Unnecessary
Waiting to report a workplace injury can jeopardize a claim. An employee should notify the employer as soon as possible and provide written notice when practical. Under New York law, notice generally must be provided within 30 days of the accident.
An Employee Claim, Form C-3, should also be filed with the New York State Workers’ Compensation Board as soon as possible. The general filing deadline is two years from the accident. For an occupational disease, the deadline is generally measured from when the worker knew or should have known that the condition was related to the employment.
Exceptions and different rules may apply in particular circumstances, so an injured worker should not assume that a delayed claim is automatically lost without obtaining legal advice.
Misconception 7: Filing a Claim Guarantees Benefits
Filing a workers’ compensation claim does not guarantee that benefits will be awarded. The employer or insurance carrier may dispute the claim, request additional medical evidence, or contest the extent of the worker’s disability.
The Workers’ Compensation Board may hold hearings and review testimony, medical reports, employment records, and other evidence. An attorney can represent the injured worker when a claim is disputed or benefits are delayed or denied.
Steps to Take After a Workplace Injury in Niagara County
Obtain Medical Treatment
Seek necessary medical care promptly. Except in an emergency, make sure the treating provider is authorized by the New York State Workers’ Compensation Board. Tell the provider that the injury or illness is work-related and provide the employer’s insurance information when available.
Notify Your Employer
Tell your employer when, where, and how the injury occurred. Notice should be provided as soon as possible and, when practical, in writing. The general deadline is 30 days from the accident.
Document the Injury
Keep copies of medical reports, work restrictions, correspondence, accident reports, and communications with the employer or insurance carrier. Document missed work and any expenses connected to the injury.
File Form C-3
File an Employee Claim, Form C-3, with the New York State Workers’ Compensation Board. Do not rely exclusively on the employer to report the accident. Filing the employee’s own claim helps notify the Board and protect the worker’s rights.
Follow the Medical Provider’s Instructions
Attend medical appointments and follow reasonable treatment recommendations. Updated medical reports may be necessary to document an ongoing disability and continued eligibility for wage-replacement benefits.
Respond to Requests and Attend Hearings
The insurance carrier or Workers’ Compensation Board may request medical records, employment information, an independent medical examination, or attendance at a hearing. Missing a required examination or hearing can affect the claim.
Potential Workers’ Compensation Benefits
Depending on the circumstances, an eligible injured worker may receive payment for authorized medical treatment and wage-replacement benefits during a qualifying period of disability. Benefits may also be available for certain permanent impairments or reduced earning capacity.
The amount and duration of benefits depend on factors including the worker’s average weekly wage, the degree of disability, the medical evidence, and the ability to return to work.
Get Help With a Niagara County Workers’ Compensation Claim
Misconceptions about workers’ compensation can prevent injured employees from taking the steps necessary to protect their rights. Prompt reporting, appropriate medical care, accurate documentation, and timely filing can all play an important role in a claim.
If you were injured at work or are experiencing difficulties with a workers’ compensation claim, the attorneys at Cole, Sorrentino, Hurley, Hewner & Gambino, P.C., can review your situation and explain your available options.
Contact us to discuss your workers’ compensation matter. Injured workers in Niagara County can also learn about local assistance through the Cole Sorrentino Niagara Falls office.