Understanding The Workers' Compensation Claims Process

The group of lawyers at Gilbert, Blaszcyk & Milburn has years of experience providing clients across Long Island and New York with workers' compensation cases.There are a lot of ins and outs in filing for a workers comp claim, which is why we are here to help. By getting in touch with one of our four offices, you will receive a free consultation to go over whatever sort of legal action you need or require. It it very helpful to understand the claims process, as there are a few courses of action required in the state of New York.

How To First Act

Upon immediately injuring yourself at work, you must obtain the necessary medical treatment and notify your supervisor about the accident. Detail how it happened. And within 30 days you must notify the employer of the accident in writing. Sooner rather than later, if we are being honest. Then, the employee must file a claim with the Board on Form Employee Claim (C-3). To do so, you must mail that form to the appropriate office, an office we can help you locate. This must be done within two years of the accident or within two years you knew it was an injury related to your job.

Within two days of your accident, the doctor must have completed a preliminary medical report on Form Doctor's Initial Report (C-4). This form then needs to be mailed to the appropriate District Office. Make a few copies of this form, as it must also be sent to a few different parties, such as the employer and/or their insurance carrier, whomever represents you, and one for yourself as well. 

Employer's Role In Workers' Comp Cases

There are a few actions the employer must do in a timely manner for everything to happen smoothly. Within ten days of being notified of the accident, the employer must report the injury to the insurance company. Then, within two weeks upon receiving the injury form from you, the employer, the insurer then provides you with a written statement about your rights and the law. On top of that, the insurer may require claimants to use a previously contracted network to obtain any diagnostic tests. You must receive the information to be able to get in touch with the network if need be. It is within your rights to know about how this is handled.

Workers' Compensation Payments

Within 18 days upon receiving the work injury form, the insurer then begins the payment of benefits if the time lost at work exceeds seven days. However, if the workers' compensation claim is disputed, then the insurer has to let the Workers' Compensation Board know about it. The insurer is also responsible for letting the claimant and the his or her representative about the dispute. 

There are a few reasons why the payment may not be received after the claim is put forth. One of them is if the lost time or the duration of the injury is less than the seven day waiting period. In this case, it is likely no payments will be made. If there is any reason why the claim will not be paid, the insurer will notify all of the involved parties. The Board gets notified by the insurer and indicates two outcomes:

  1. The payment has begun
  2. The reasons why the payments have not started

And if you, the employee, does not notify your employer, then this notice can be filed within ten days of learning of the accident. If the payments are being received, then the insurer will continue to make payments every two weeks to the injured employee. The Board is notified by the carrier when compensation for the injury needs to be stopped or changed. 

To continue receiving payment benefits for the injury, the doctor must submit progress reports every 45 days to the Board. This will ensure the payments keep getting received by the benefactor. If there are still payments after 12 weeks, then the insurer can consider if rehab is needed for the injured employee. If you have any questions or concerns about workers' compensation and the benefits you may receive from being injured on the job, please contact us today. We have offices in Patchogue, Riverhead, Melville and Garden City waiting for your call.