Compensation Claim Resolution Process for NY Workers

As a rule, the process of claiming for Brooklyn New York Workers Compensation benefits after an industrial injury or illness is relatively simple. However, there are several key steps in the process and there are various deadlines in place. The following is a step-by-step breakdown of the claims process, starting from the processing stage:

• Step 1 - Treatment

If an employee supports an injury, illness, or occupational disease, their first step should be to get any necessary first aid or medical attention immediately. Except in emergencies, the healthcare provider must be authorized or coded by the New York State Compensation Council for Workers.

In addition, if the employer is a member of a preferred provider organization (PPO) or alternative dispute resolution scheme (ADR), an employee may be required to receive medical care from affiliate health services.

The cost of any medical treatment is paid by either the employer or the employer's insurance company, assuming that the claim is not in dispute. This means that healthcare providers do not have to bill an employee directly for any treatment.

However, an employee may be required to sign Form A-9, which acknowledges that a patient may be required to pay for treatment in the event that an application for Brooklyn New York Workers Compensation not fully implemented, or in the event that the Council prohibits claims for any reason.

• Step 2 - Notifying the employer

The employee’s supervisor should be verbally notified of the accident or incident as soon as it becomes feasible. This should include information about what happened and how it happened. In addition to this verbal notice, the employer must be notified of the accident or incident more formally in writing. Again, this should be done as soon as possible, although not later than 30 days after the incident.

Failure to notify the employer in writing within 30 days may result in the employee losing their right to claim compensation. In the case of an occupational disease, rather than an injury, this notice period is extended to within two years after disability, or within two years the plaintiff found that the condition is related to work, depending on which date is later.

• Step 3 - Filing a workers Compensation Claim

In order to qualify for NY compensation payments to employees, the employee will have to fill out the "Employee Compensation Claim (P-3)" form and send it to the appropriate district office of the Workers Compensation Council.

Ideally, this requirement should be filed as soon as possible, but it should be filed within two years after the accident, or two years of training the employee that the injury was caused by the conditions of their work.

Brooklyn workers who are unable to file a claim within a two year period may lose their right to compensation.

The attending physician must complete the Doctoral Preliminary Report (C-4) form and send it to the appropriate county department within 48 hours after the accident. Copies of this report should also be sent to the employee, employer and insurance company. At the same time, the employer must report the injury to the Council and their insurance company within 10 days of the notification of the accident or incident.

• Step 4 - Confirmation of the rights of workers

After the insurer has received the required notice of an accident or incident from the employer, they must then provide the injured worker with a written statement stating the extent of their legal rights. Such notice must be provided within 14 days from the date of receipt of the notice from the employer, or sent from the first payment of benefits to the injured worker, depending on which of these dates is early.

In the event that the insurer requires the injured worker to use the network under the contract in order to receive his diagnostic tests, the employee must be notified of this fact at this stage in this process. The applicant must be provided with both name and contact information for this network at the same time.

• Step 5 - Starting Payments, or Dispute

Within 18 days from the receipt of the notice from the employer, the insurer must start paying benefits and notify the Commission that payments have become, assuming that the time lost from work exceeds seven days.

There are certain situations when the insurer cannot make a payment at this time, for example, if there were no loss of working time, or if the incapacity for work was less than seven days. If so, the insurer is obliged to notify the employee, employer and the Council of the reason for non-payment.

On the other hand, if the insurance carrier decides to challenge the claims, they must notify the New York State Workers Board of compensation in order to officially begin the dispute.

• Step 6 - Progress Reports and Rehabilitation Reports

Assuming that the insurance provider does not dispute the claim for damages, benefits should be paid every two weeks. At the same time, every 45 days, the attending physician must fill out a form called "Report on the progress of the doctor (C-4,2)", which allows them to provide updated information on the progress of the patient, and sends it to the Council.

After the injured Brooklyn New York workers were reached in the 12th week mark of their recovery or treatment process, the insurance company dealing with their claims may consider the possibility and / or need for rehabilitation. In most cases, rehabilitation programs are voluntary, although there are circumstances in which they may be required to compensate for the benefits of continued payments.