Workers’ compensation is supposed to protect you when you get injured in an accident at work, but how much do you really know about what’s covered and what isn’t? If you throw your back out lifting something heavy, someone driving your work truck accidentally runs over your foot, or you get a concussion after something falls on your head, you expect New York workers compensation to cover the expenses for your medical care, and to reimburse you for the days you’ve missed at work. But not all workers are covered, and neither are all injuries!
Most employers in NY are required to buy New York workers compensation insurance, but workers’ comp doesn’t necessarily cover everyone on the job. Oftentimes, workers’ comp coverage excludes agricultural workers, domestic workers, and independent contractors, all of whom perform tasks with significant risks for injuries.
The term “employee” is often lost in a gray-area when it comes to technicalities. In order for someone to be covered by New York workers compensation, you have to be an employee, as it’s defined for tax purposes, who gets injured by accident while on the job, or get sick as a result of tasks you were required to perform, such as being exposed to asbestos on a construction site. Independent contractors and other types of workers who are not considered employees are often hired precisely because the business owner incurs less of a liability by having them work, because if they’re injured they will not be covered under the business owner’s workers’ compensation policy.
In addition to the strict definition of employee status, New York workers compensation also qualifies within strict guidelines relative to the injury that is sustained. In order for workers’ comp to cover the expenses related to the injury you sustain in the workplace, the injury has to have happened as a result of a task pertinent to your job. As such, if your boss’ girlfriend comes in to shoot him, but you get hit instead, your injury may not qualify for workers’ compensation. However, if another employee comes in to shoot your boss and shoots you by mistake, your injuries will probably be covered.
So what do you need to know, and what steps should you take to ensure that you’re able to get the workers’ compensation to which you’re entitled?
1. No matter how big or small, always report injuries/illnesses.
If you experience an injury or illness, and your doctor deems that it’s a result of your job, make sure that you report it. Even if it seems like it’s fairly insignificant, having a physical record of every incident is critical. You should fill out incident report paperwork after reporting your injury or illness to your company’s HR or risk-management department, and your company should contribute to your medical expenses. Be sure to follow up with your boss if you aren’t contacted by an insurance adjuster or get copies of your paperwork for your records, as that’s something to which you’re entitled.
2. Have your injuries evaluated and treated by the right medical professional.
If your injury is an emergency, you likely won’t have a say in where you’re taken for medical care, because the ambulance will take you wherever they’re instructed. However, if your injury isn’t an emergency, consult your employer before going to your regular general practitioner. Your employer’s New York workers compensation policy may require you to see their specific doctors, and if you don’t follow their protocol, you may not be eligible for cost reimbursement.
3. Make sure the medical providers know where you were injured.
The intake paperwork that you’ll have to fill out at the doctor’s office or hospital will ask you if you’ve been hurt on the job—make sure you check “yes.” The purpose for that question on your paperwork is to inform the doctor’s office that your medical bills should be sent either to your employer or to their New York workers compensation insurance provider, and not directly to you. The doctor’s office should contact your employer to find out where the bill should be sent.
4. Your injury should be well-documented.
Be sure to include when the injury/illness occurred, how it occurred, and what you were doing when it occurred, along with each body part that was affected by the injury or illness. If you neglect to include part of your body that was injured, it’s likely that the New York workers compensation provider will not pay to treat that body part, because it’s outside the scope of their responsibility.
5. Have your employer fully explain your workers’ comp coverage.
Insurance providers will usually give employers a stack of pamphlets that outline their coverage programs, indicating who and what is covered, and what you should do in case of injury. If you have any questions about your coverage or your participation if you’re injured, make sure you ask your employer for more information. You can also consult the insurance provider’s website for additional information, and call their customer service department if you still have more questions.
6. Remember that New York workers compensation is no-fault coverage.
This means that whether the accident that caused your injury was your fault or not, you’re still entitled to compensation. If your company tries to tell you that due to the accident being your fault, your injuries aren’t covered by their workers’ comp policy, there’s a really good chance they’re lying. If you slip and fall, your claim cannot be denied because your employer or the insurance provider believe you should’ve seen whatever you slip on. However, if you’re acting stupid and do something particularly risky and not required for your job performance, don’t expect your injury to be covered.
7. Let’s expand further on “don’t be stupid.”
You should only go to work sober. Always. If you show up to work high or drunk, and subsequently injure yourself while on the job, there’s a good chance you’ll be expected to pay your own bills. Oftentimes, employers will require a drug test after an accident, especially depending on the circumstances of the accident, and if you test positive, say “goodbye” to your workers’ compensation.
8. You can usually get what you’re owed without hiring an attorney.
New York workers compensation payouts abide by specific guidelines set by the state, and it’s according to those guidelines that your compensation will be determined. For example, New York State values a thumb at 75 weeks of pay, so if your thumb is deemed 10% disabled due to an injury sustained at work, you’re entitled to 7.5 weeks of disability pay. At minimum, if you hire a workers’ comp attorney, you’re looking at paying out at least 20% of what you’re given in your settlement, which can often be a decent chunk of change. Unless you’re worried that you’re being taken advantage of in a permanent disability suit, have a complex claim to settle, or were refused the coverage to which you were entitled, you should think long and hard before hiring an attorney.
9. Beware of payout limitations.
In New York State, the maximum weekly payout for workers’ compensation is $803.21. If you make less than that weekly, that’s not a problem, but many Americans make more than that a week, which may mean that you’ll struggle to make ends meet based on your financial obligations. In these circumstances, it’s sometimes worth seeking legal assistance, to try to get your payout in one lump sum so that you can properly appropriate it, but remember to consider how much that will cost when all is said and done.
10. If you cheat, you’re really likely to get caught.
Malingering is the term used for cheating workers’ compensation coverage, which exists due to the frequency of it happening in the first place. There are also fraud divisions specifically responsible for identifying people who try to scam workers’ comp providers. Insurance companies don’t make their money by closing their eyes and giving it all away for free; oftentimes you will have insurers paying you a visit at home to see how you’re doing. Additionally, you may receive home visits from your employer as well, to make sure that you’re okay. As much as I’m sure they care about your well-being, they’re also making sure that you’re not cheating the system.