A Step-By-Step Breakdown Of The Workers’ Compensation Process

When you have, or suspect you have, a work-related injury, the first thing you should do is give notice to your Employer. This can be done either orally or in writing to a supervisor or someone else in management. MCV Law recommends giving notice in writing and keeping a dated copy that you can submit into evidence.

Second, Seek Immediate Medical Treatment

You should immediately seek medical care. Often you do not know you have a claim until learning from a doctor that your condition is related to your employment. When this happens, give notice to your employer after you have seen a doctor. An example is where you have hand pain that wakes you at night. After talking to your doctor you learn that you have Carpal Tunnel Syndrome and your doctor thinks it is related to your job as a secretary.

When talking to medical professionals it is important to give a concise but comprehensive history of how the accident or illness occurred. If you think your condition is related to work, it is important to discuss this with your doctor so as to obtain his or her opinion on causal relationship.

In an occupational disease or illness case, it is important for the medical professional to understand the exact nature of your job and the nature of your exposure. It is always helpful if you can identify the substances, chemicals, or other items that you work with. Sometimes you can obtain the Material Safety Data Sheet (MSDS) of the substances you work with.

Third, Obtain Your Medical Reports

It is best practice to obtain copies of your medical reports. It is very important to know what the doctor has said as you prepare to file your claim. While it is possible, and sometimes necessary to file your claim before you see a doctor, it is usually best to wait until you have the medical evidence that supports your case.

Fourth, File a C-3

A case is formally commenced by the filing of a C-3, “Employee Claim.”

Many times a case is informally started by someone other than the injured worker, such as when an Employer or Carrier reports the injury or a medical provider files a report with the Board. However, simply because the filing process has started does not obligate the Carrier to pay.

What the Board Does

The Workers’ Compensation Board has a two-step process for commencing cases:

• Assembling – A Notice of Assembly is simply an acknowledgement that some information has been received indicating a work-place injury or illness. The importance of the assembly is that a Workers’ Compensation case number is assigned (WCB case number).
• Indexing – A Notice of Indexing is the legal commencement of the claim, which starts the clock for the Carrier to make a decision to accept or deny the claim.

Sometimes, the Board will jump over Assembly and go directly to Indexing. At other times, the Carrier may voluntarily accept the case before the Board issues a Notice of Indexing.

Electronic Case Folder

The New York Workers’ Compensation Board uses an ever-evolving electronic filing system. This system is referred to as the “ECF” or “Electronic Case Folder.” It is from the ECF that all parties, including the judges, make decisions. The Board is working towards an entirely electronic filing system. Until such time, however, it is important that claimants understand that some documents are submitted electronically and others on papers.

A Prepared Claimant Keeps

• A record of doctors’ visits,
• Copies of decisions from the Workers’ Compensation Board,
• A record of payments received, and
• Correspondence from the Carrier.

Depending on whether the case has been commenced by the filing of the C-3 or by some other document or process, the first thing to determine is whether the case has been indexed. Once the case has been indexed, the legal process has commenced. If the case has not been indexed, an investigation must be undertaken to find out why.

Accept or Deny

Assuming the case has been Indexed, the insurance company or Employer must either legally accept or deny the case. Denying is often referred to as controverting the case.

If the Carrier accepts the case, payments may commence if you are out of work for more than 7 days. However, if you are out more than 14 days, benefits are payable from the first day of lost time.

Simply because the Carrier accepts your case does not mean that all issues are resolved. Sometimes, a hearing is necessary to resolve issues, including:

• Injury Sites,
• Lost Time,
• Degree of Disability or Impairment,
• Average Weekly Wage,
• Employer Reimbursement,
• Denied Medical Requests,

Hearings are scheduled by the New York State Workers’ Compensation Board when they deem a legal controversy to exist. Often the Board attempts to resolve cases by Administrative Decisions or Proposed Decisions, which allow for a period to object. An objection may result in a hearing.

If you are considering representation, it is best to obtain an attorney before the Board commences the adjudication process. This will allow your attorney an opportunity to analyze the facts, file the correct documents, and explain the legal strategy to you.