Meggesto, Crossett & Valerino, LLP

how does workers comp work by mcv law workers compensation attorneys near syracuse ny

Under the New York State Workers’ Compensation Law, there is a two-tier statute of limitations:

  • Pursuant to Section 18 of the Law, you have 30 days from the date of accident or knowing that you have a work-related sickness or illness to report it to your employer (this is called “notice”),
  • Pursuant to Sections 28 and 45, you have 2 years from the date of accident or knowing that you have a work-related sickness or illness to file a claim with the Workers’ Compensation Board.

How Does Workers’ Comp Work: Notifying Your Employer

An important part to understanding how Workers’ Compensation works is knowing deadlines for notifying your employer of your work related injury. The timing of when you notify your employer of your work related injury is very important, as it can affect the outcome of your case.

While you must give notice to your employer within 30 days of knowledge of the injury, some employers have a policy that requires almost immediate notice of an injury. The employer may attempt to use your failure to abide by this policy as a reason to deny workers’ compensation benefits. However, this is not controlling under the Workers’ Compensation Law.

How Does Workers’ Comp Work: Who Should You Tell About Your Injury?

Essential to answering the question “How does Workers’ Comp. work?” is knowing who at your workplace you need to tell about your injury. It is not enough to tell a co-worker that you’re injured. Rather, you need to give notice to:
• Someone with authority to take the injury report,
• Your supervisor, or
• Human Resources representative.

How Does Workers’ Comp Work In Terms of How I Should Tell My Employer?

Notice does not necessarily have to be in writing. It can be given orally, although it’s always best to document your injury. Keep in mind that in certain instances, such as being taken away by ambulance, it can be argued that there was an implied or actual notice of the injury.

On the other hand, sometimes people will have injuries or become sick at work and they won’t know exactly what made them sick until sometime later. This is particularly true with occupational disease claims. An example of this type of claim would be someone who becomes sick and has a problem breathing without recognizing that it is a work-related asthma condition until they’ve been evaluated by a variety of medical providers.

Once there is a diagnosis from a doctor that the problem was related to work, it is best to comply with Section 18 of the Workers’ Compensation Law by giving a written notice to your employer. There is no special form to give notice and then to file a claim.

How Does Workers’ Comp Work: How Long to File A Claim

How does Workers’ Comp work in relation to how long you can take to file a claim? You have two years to file a Workers’ Comp claim. This two year limit to file a claim applies to two years from the date of the accident or two years from knowing or should have known, in an occupational disease case.

How Does Workers’ Comp Work in Relation to Who Needs to File A Claim?

Injured workers should file a claim by completing a C-3 Employee Claim. The employer has a similar obligation to report injuries to the Workers’ Compensation Board.

How Does Workers’ Comp Work: Can An Employee File a Claim?

Many people are under the impression that only the employer can report an accident–this is not true. An injured worker or family member can commence a Workers’ Compensation claim on their own.
At MCV Law, it is out opinion that it is best practice to file a claim as soon as you have evidence that you have a work-related injury or illness.

How Does Workers’ Comp Work: Form C-3

Care must be taken when completing the paperwork; while not legally required almost all claims are started using the New York Workers’ Compensation Board forms. To file a claim an injured worker uses Form C-3, called “Employee Claim.”

The C-3 form contains questions about the injury or sickness, as well as biographical information about yourself and your employer. The form should be completed with care, especially the questions dealing with the details of the event or illness, as well as prior injuries or sicknesses.

What is my Employer Supposed To Do?

How does Workers’ Comp work on your employer’s end? The employer should make a report of an accident or sickness on form C-2 “Employers Report of Accident.” This can be done in writing, online, or by calling their insurance carrier. The employer must also complete other forms, which include Form C-240 showing the actual amount of money earned by the employee for the 52 weeks prior to the injury, Form C-11 reporting employee’s lost time from work, and to provide other information helpful to the Workers’ Compensation Board in administering the claim.

How Does Workers’ Comp Work With Help From A Workers’ Compensation Attorney?

This post is intended as an informative introduction for answering the question “How does Workers’ Comp work?” Workers’ Compensation law is complicated, and you risk receiving compensation that may be less than the maximum amount you may be entitled to when trying to navigate Workers’ Compensation without professional legal representation.

There’s a lot more that goes in to fully answering the question “How does Workers’ Comp work?” As your case moves forward, questions will arise in relation to the specifics of your case. Because of this, fully understanding the intricacies of the Workers’ Compensation claim process to benefit injured workers requires extensive experience. For over 30 years, MCV Law’s Workers’ Compensation attorneys have protected the rights of injured workers.

For a free initial consultation, contact us.

William W. Crossett, IV
Partner

Email: crossett@mcvlaw.com

Phone: 315-471-1664

Mr. Crossett concentrates his practice in the representation of Injured Workers. Since 1982, he has regularly appeared before the Workers’ Compensation Board and the Courts of New York. As an advocate for the Injured Worker, he has testified before the New York State Senate and has presented many Continuing Legal Education programs. Presently, Mr. Crossett serves as President of the Injured Workers Bar Association of New York and is an active member of Workers Compensation Law Division of the New York State Bar Association. In 2012, he was inducted as a fellow in the College of Workers Compensation Lawyers. Mr. Crossett practices throughout Central New York with an office in Syracuse.


The law providers for Workers’ Compensation benefits for all injuries or illness that arise from or occur during the course of employment. This does not mean that the accident or illness has to occur at any particular place. Many people don’t work in a factory or an office every day. Some work from their vehicles or at different sites each day, such as a home health aide, a construction worker, or a salesperson.

Portal to Portal
Certain employees are entitled to “Portal to Portal Coverage,” which is essentially door-to-door coverage. An example of this might be an exterminator who uses a company vehicle to pick up supplies once per week and then travels to customers from home during the remainder of the week. Under Portal to Portal Coverage, he would be entitled to Workers’ Compensation benefits if he was involved in an automobile accident on the way to a job.

Another example is a home health aide who travels from patient to patient and falls and breaks a hand in between visits on a snowy day. This person may be entitled to Workers’ Compensation benefits, as an argument can be made that the injury arose out of or in the course of employment.

Your employer or Insurance Company, however, is likely to argue that Portal to Portal Coverage does not apply. The Carrier may argue that there was a deviation for a personal reason that was outside the duties of the job. For example, if the home health aide on that same snowy day decided to check on a child and slips and falls on the sidewalk going into the school, the Carrier could argue that the injury did not arise out of or occur in the course of employment. Rather, the Carrier will argue the injury was the result of a personal act. Even for people who work in an office or factory, Workers’ Compensation benefits may extend to injuries that occur outside of the physical office. Often, this occurs in the context of parking. If your employer provides parking, and you are injured while you’re in the parking lot, this is generally covered under the Workers’ Compensation law. A similar situation arises if you work in a high-rise building and are injured in the lobby or elevator.

Cases of this type are very fact dependent. When considering to bring a Workers’ Compensation case arising out of an accident that occurs away from the workplace, it is best to seek immediate legal help. There may be other legal remedies, such as New York State No-Fault Benefits or a civil action against the owner or operator of the property where the injury occurred that must also be considered. See the Chapter on Third Party Actions.

William W. Crossett, IV
Partner

Email: crossett@mcvlaw.com

Phone: 315-471-1664

Mr. Crossett concentrates his practice in the representation of Injured Workers. Since 1982, he has regularly appeared before the Workers’ Compensation Board and the Courts of New York. As an advocate for the Injured Worker, he has testified before the New York State Senate and has presented many Continuing Legal Education programs. Presently, Mr. Crossett serves as President of the Injured Workers Bar Association of New York and is an active member of Workers Compensation Law Division of the New York State Bar Association. In 2012, he was inducted as a fellow in the College of Workers Compensation Lawyers. Mr. Crossett practices throughout Central New York with an office in Syracuse.


The New York State Workers’ Compensation Law is the exclusive remedy of an employee who is injured or made sick while at work in New York State.
“Exclusive remedy” means that, by law, you cannot sue your employer for an injury or illness that arises from your work. There are some very limited exceptions to this rule, such as where your employer has no Workers’ Compensation insurance. However, you can sue a third party whose negligence caused your injury.
Under New York State Workers’ Compensation Law, you are entitled to:
• Lost wage benefits, and
• Medical care.

The New York State Workers’ Compensation Law requires there be a direct connection or nexus between employment and injury or illness.
The law provides for two types of claims:
• Accidents and
• Occupational Diseases.

Accident
Accident claims generally arise from a sudden, unexpected event. Examples include a slip and fall, auto accident, or a fall from a ladder or other heights. Accidents also include injuries that arise from lifting, pushing, or pulling. Sometimes nurses and other health care professionals are injured while helping those they are caring for.

Occupational Disease
Occupational disease cases traditionally refer to injuries or illnesses that result over time. For example, occupational disease cases can include a secretary or clerk who develops carpal tunnel syndrome from typing or a baker who develops asthma from exposure to flour. Exposure to asbestos or other harmful substances and chemicals are included in this type of case.
Often, there is a thin line between what the law designates as an accident and an occupational disease. There are, however, some important differences regarding statute of limitations, burden of proof, and permanency that must be carefully considered.

William W. Crossett, IV
Partner

Email: crossett@mcvlaw.com

Phone: 315-471-1664

Mr. Crossett concentrates his practice in the representation of Injured Workers. Since 1982, he has regularly appeared before the Workers’ Compensation Board and the Courts of New York. As an advocate for the Injured Worker, he has testified before the New York State Senate and has presented many Continuing Legal Education programs. Presently, Mr. Crossett serves as President of the Injured Workers Bar Association of New York and is an active member of Workers Compensation Law Division of the New York State Bar Association. In 2012, he was inducted as a fellow in the College of Workers Compensation Lawyers. Mr. Crossett practices throughout Central New York with an office in Syracuse.


In short, yes. In New York State, anyone with an employee is required to carry Workers’ Compensation insurance. If you are a sole owner or stockholder of a company, you do not need insurance for yourself, although it is required for your employees. Additionally, the owners or stockholders are entitled to opt in or out of coverage.

Independent Contractor
Sometimes, people who do not want to be considered an employer try to create an “independent contractor relationship” with the people performing services for them. An independent contractor, if working by themselves, is not required to carry Workers’ Compensation insurance. Meaning that if you are injured while working as an independent contractor you are not entitled to medical and lost wage Workers’ Compensation benefits.

What defines an independent Contractor?
Simply because you are called an independent contractor does not mean that the court will accept this arrangement. This can be true even where there is a written contract calling you an independent contractor. Rather, the court looks at the level of control and other important factors to determine whether you are a true independent contractor. If, after considering all the factors, the Court finds that the relationship fails to meet the criteria of a true independent contractor, then the Court will deem an employee-employer relationship exists. Such a decision means that you are entitled to both medical and wage benefits under the Workers’ Compensation Law.

This typically occurs where the injured party is required to sign a contract stating that they are an independent contractor. The law looks at the bargaining power, the actual control over the worker, and other relevant factors in making their determination. This most commonly arises with drivers, delivery workers, hairdressers, care givers, and other personal service providers. Given the nature of some kinds of work, certain groups will try to avoid the Workers’ Compensation Law.

Uninsured Employers Fund
Under New York State Workers’ Compensation Law, if your employer does not have Workers’ Compensation insurance, a unique type of Workers’ Compensation case is commenced. The New York Law established the Uninsured Employers’ Fund to administer and pay both medical and lost wage benefits for these kinds of cases.

William W. Crossett, IV
Partner

Email: crossett@mcvlaw.com

Phone: 315-471-1664

Mr. Crossett concentrates his practice in the representation of Injured Workers. Since 1982, he has regularly appeared before the Workers’ Compensation Board and the Courts of New York. As an advocate for the Injured Worker, he has testified before the New York State Senate and has presented many Continuing Legal Education programs. Presently, Mr. Crossett serves as President of the Injured Workers Bar Association of New York and is an active member of Workers Compensation Law Division of the New York State Bar Association. In 2012, he was inducted as a fellow in the College of Workers Compensation Lawyers. Mr. Crossett practices throughout Central New York with an office in Syracuse.


If you are involved in a motor vehicle accident in the course of your employment, New York State provides No-Fault Benefits in addition to Workers’ Compensation Benefits. No-Fault Benefits are provided by the insurance company for the vehicle you are riding in. There are exceptions to this rule and other coverages may also apply depending on your particular circumstances.

Workers’ Compensation Is Primary
Workers’ Compensation benefits are primary. This means that the Workers’ Compensation carrier pays medical and lost wage benefits first. No-Fault Benefits are secondary. Typically, there is a little bit of additional money from the No-Fault carrier, because Workers’ Compensation pays 2/3 of your average weekly wage and No-Fault pays 80%. Typically, No-Fault policies have limits, which are exhausted before the Workers’ Compensation benefits.
Because an auto accident is often the result of the negligence of a “third-party” (not your employer or co-worker), the law allows you to bring a separate civil lawsuit against the negligence party. This is referred to as a “third-party action.”

Many third-party cases happen in automobile accidents. However, third-party cases may also arise from negligence of a third-party in the workplace or on sites that you may be working. New York State’s Labor Law provides for some very important protections for construction workers and those working from elevated heights. Again, this type of case is very fact-driven and may have additional, short statutes of limitations. Therefore, if you think your injury may fall into one of these categories, you should immediately seek legal assistance.

The law does not allow a double recovery, therefore, the Workers’ Compensation Carrier has a lien under Section 29 of the Workers’ Compensation Law against the monies paid in a third-party action. What this means is that the injured worker will have to pay from the proceeds of the law suit, the Workers’ Compensation Carrier for both the medical and lost wage benefits paid. There is a credit for the cost of the recovery. It is very important that the Workers’ Compensation Carrier consent to a settlement in a third-party action.

Why Do I Have To Obtain Workers’ Compensation’s Consent?
Because If you do not obtain consent and/or satisfy the lien, it is likely that you will have forfeited your rights to future benefits under the Workers’ Compensation Law. Meaning that you may no longer have medical care or be entitled to lost wage payments. This is especially true in cases involving Motor Vehicles as often the policy limits are much less than what is paid in a Workers’ Compensation Case.

It’s very important that you understand the rights and obligations when you have more than one action arising from the same injury. At MCV Law, we make a real effort to take a holistic approach to third party cases that arise from a work-related event to ensure that the claimant is getting the greatest benefit they can. This maximum benefit approach does not always involve bringing a third party suit, because of the lien provisions and the fees associated with third party actions.

William W. Crossett, IV
Partner

Email: crossett@mcvlaw.com

Phone: 315-471-1664

Mr. Crossett concentrates his practice in the representation of Injured Workers. Since 1982, he has regularly appeared before the Workers’ Compensation Board and the Courts of New York. As an advocate for the Injured Worker, he has testified before the New York State Senate and has presented many Continuing Legal Education programs. Presently, Mr. Crossett serves as President of the Injured Workers Bar Association of New York and is an active member of Workers Compensation Law Division of the New York State Bar Association. In 2012, he was inducted as a fellow in the College of Workers Compensation Lawyers. Mr. Crossett practices throughout Central New York with an office in Syracuse.


Many injuries cause workers to not only lose time from one job, but may also cause them to lose time from a second job. Under the law, the lost time from the second job is also compensable. This is known as “Concurrent Employment.” The place of employment where you were working when you actually got injured is referred to as the “Primary Employment.”

The first step is to amend your Average Weekly Wage (“AWW”) to include wages earned from your Concurrent Employment. This is calculated the same was as your Average Weekly Wage; by taking your gross earnings for one year prior to your injury and dividing them by the number of weeks or days worked in that year. For an in-depth explanation on calculating the Average Weekly Wage, see “Quick Answers by MCV Law: Just What is the Average Weekly Wage”.

If you are out of work from both jobs, the inclusion of your Concurrent Employment wages into your Average Weekly Wage will increase your weekly benefits, because your rate is based on your Average Weekly Wage.
Often times, injured workers are able to return to one employment and not the other. This generally occurs if your doctor has limited your hours or provided you with restrictions that one employer can accommodate but not the other. In that case, Reduced Earnings would apply. For help calculating your Reduced Earnings, please use our “Workers’ Compensation Reduced Earnings Calculator”.

The law says that if you are return to work but earn less because of your injury, you can collect 2/3 of the difference between your Average Weekly Wage and your current earnings. Entitlement to Reduced Earnings requires you to demonstrate two things: restrictions or a limitation on your work abilities from your medical providers and a loss in pay, which is generally shown through your payroll. Also, the Concurrent Employment must be “covered employment” under the statute.

To demonstrate how Concurrent Employment affects your Reduced Earnings benefits, consider this example. If your Primary AWW is $400.00 and your Concurrent AWW is $100.00, this results in a total AWW for your case of $500.00. If you are only able to return to work for your Concurrent Employer, you are losing $400.00 a week in wages. Thus, you could collect $266.40 in Reduced Earnings Benefits. The idea is that your injury is preventing you from your earning what you were earning when you got hurt, regardless of the employer.

Written By:
Bethany Nicoletti

Email: barliss@mcvlaw.com

Phone: 315-471-1664

Bethany Nicoletti is a graduate of Ithaca College where she earned her B.A. in Communication Studies. She graduated cum laude from University at Buffalo Law School in 2013 and was admitted to the New York State Bar in the Fourth Judicial Department in 2014.

Can I Receive Workers’ Compensation?

The New York State Workers’ Compensation Law provides for two types of hearing loss:
Traumatic Hearing Loss, which is the result of a sudden, unexpected event, like an explosion
Occupational Hearing Loss, which is the result of exposure to loud noise over a period of time

What is Covered?

• Your medical treatment, including hearing aids
• A schedule loss of use award, depending on the percentage of hearing loss

The Statute of Limitations

• For Traumatic Hearing Loss, the statute of limitations is 2 years from the date of the event.
• For Occupational Hearing Loss, the statute of limitations is 2 years and 90 days after the knowledge that the loss of hearing is or was due to the nature of employment.

The Process of a Hearing Loss Claim
  1. By law, you have to be out of the harmful exposure for 90 days before your hearing loss can be measured. We recommend that you make arrangements to see an otolaryngologist (ear, nose, and throat doctor) after this 90 day period.
  2. See an approved otolaryngologist. The Workers’ Compensation Board has a search tool that can be used to find a nearby otolaryngologist.
  3. Be sure to give the otolaryngologist a history and description of employment, as well as the type of noise you were exposed to. Also note any noise exposure that you had prior to this job, or currently have in addition to this job.
  4. The otolaryngologist will determine whether or not you have experienced hearing loss an complete a form regarding this. They will also file a C-4NARR or C-4 form.
  5. Once you have medical evidence, it is important to file a claim using a C-3 form within 2 years of the injury. The Board will then assemble/index a claim. The C-3 form can be tricky and confusing to fill out
  6. The insurance company representing your employer will then either accept or controvert the claim. If they controvert the claim, a hearing will occur to determine which issues need to be adjudicated.
  7. If your claim is successful, you are entitled to medical equipment related to your hearing loss. You may also be entitled to a schedule loss of use award.
  8. At MCV Law, we have developed a process which ensures claims the best chance of success. Don’t hesitate to schedule an appointment to review your claim.

William Crossett IV
Partner

Email: crossett@mcvlaw.com

Phone: 315-471-1664

William Crossett concentrates his practice in the representation of Injured Workers. Since 1982, he has appeared before the Workers’ Compensation Board and the Courts of New York. As an advocate for the Injured Worker, he has testified before the New York State Senate and has presents Continuing Legal Education programs.


Parents are responsible for the negligent acts of their children. While this statement may seem logical, it is untrue. Parents are not responsible for the consequences of their children’s negligent conduct. If, however, the parents own conduct is negligent, then the parent can be held responsible for their own actions.

As an example, the child finds a firearm in the woods and negligently discharges it, causing property damage or personal injury. A parent would not be responsible for those acts. However, if the same child found a loaded hand gun in their home that the parent negligently failed to secure and the child discharges that firearm, causing property damage or personal injury, the parent could be held responsible for their own actions in negligently failing to secure the firearm.

The same is true for automobile accidents. A parent is not responsible for the negligent conduct of their child if they cause personal injury or property damage in an automobile accident. However, if the parent owns the motor vehicle being operated by their child and it is being operated with the permission and consent of the parent, then the vehicle and traffic law in the State of New York imposes responsibility upon the owner of such vehicle. Therefore, responsibility would be imposed, not because of the parent/child relationship, but rather the ownership of the motor vehicle.

Liability or responsibility for negligent acts can most often be insured against and most homeowner’s policies include children of the named insured, provided that they are residents of the household. Automobile insurance policies have their own unique coverages, and parents should from time to time review their insurance coverages for their homeowner’s coverage and automobile coverage regarding the protection not only for themselves but for their children.
James Meggesto
Partner

Email: jmeggesto@mcvlaw.com

Phone: 315-471-1664

James A. Meggesto has been practicing as a trial lawyer for over 40 years. He is a graduate of Niagara University who served in the United States Navy during the Vietnam War prior to attending and graduating from Syracuse University College of Law.

An example state insurance fund notice
STATE INSURANCE FUND CLAIMANTS – PLEASE IGNORE THIS LETTER

As of September 30th, 2015, a letter has been going out from the New York State Insurance Fund to its Workers’ Compensation Claimants. This unfortunately worded letter has caused a bit of a panic with claimants who are insured through the State Insurance Fund.

It is clear from the very first reading that this letter will cause compensation claimants to believe they need to schedule diagnostic tests such as MRI’s or CT Scans immediately, and schedule them at some out-of-state facility.

This is not the case at all.

This letter is nothing more than a list of the home offices of the carrier’s in-network diagnostic preferred providers. These are the main contact numbers for groups like One-Call Diagnostic, and Med-Focus, which many claimants will be familiar with from scheduling tests. These providers administrate the scheduling for diagnostic testing at local offices where your treating physician will send you for testing. These are preferred providers only and there is no requirement to use them in any capacity.

No insurance carrier can order a claimant to get diagnostic testing. As with any other medical testing, diagnostic tests are requested by your treating physician with your full knowledge and consent.

John M. Bellinger
Paralegal

Email: jbellinger@mcvlaw.com

This entry was written by John Bellinger, who is part of the Worker’s Compensation team at MCV Law.

8 Prescription Tips For The Compensation Claimant

  1. Know your medications (i)
    Always keep a list of your current medications, and know which ones you are trying to fill. Be sure you know which medications you take are related to your compensation claim, and which are not.
  2. Know your medications (ii)
    Do not be afraid to ask your doctor what your medications are and what they are being prescribed for. Look them up on the internet. Be aware that doctors will prescribe medications for uses which are not considered as primary. For example, a doctor may prescribe a medication for nerve pain that is normally prescribed for seizure behavior. Medications not prescribed for their primary use can raise a red flag with the insurance carrier.
  3. Know the prescribing doctor
    Most often, when you have a medical appointment, you will see a nurse practitioner or physician’s assistant. If you do, try to be sure you know the name of the supervising physician who is signing off on your medical reports.
  4. Fill prescription as early as possible
    The more time you give the process, the better off you are.
  5. Fill in the morning on a weekday, if possible, and avoid Friday, or days prior to a holiday
    Once again, the more time the better – insurance adjusters often have heavy case loads, start their day early, and they are usually unresponsive after 4 PM. Most calls left with the insurance carrier come with an expected response delay of at least 24 hours. It is best to assume a 48 hour turnaround to resolve any prescription that is not being authorized. Avoiding Friday means lowering the chances of going through a weekend without medication.
  6. Use the phone
    Whenever possible, attempt to fill prescriptions by phone. There is no mileage reimbursement for trips to the pharmacy. If you are stuck waiting, it is better to wait at home.
  7. Contact your attorney
    If you are represented by an attorney, contact the legal staff with any issues filling medications. Adjusters will not speak with represented claimants. Your attorney and their staff are experienced at handling medication issues, and are the quickest road to resolution of any prescription-related problems.
  8. Have your information handy
    When you contact your attorney’s office for help with the prescription you should have the following information:
    a. Date of injury
    b. Body part for which medication is prescribed
    c. Name of medication
    d. New medication or refill?
    e. Prescribing physician/office name and location
    f. Name of the filling pharmacy
    g. Phone number of filling pharmacy

John M. Bellinger
Paralegal

Email: jbellinger@mcvlaw.com

This entry was written by John Bellinger, who is part of the Worker’s Compensation team at MCV Law.