NYS Workers Compensation insurance provides benefits due to a work-related injury or illness.
NYS Workers Compensation insurance is a form of insurance that is funded by your employer. It offers financial assistance and medical treatment in the event that you are unable to work due to an injury or illness that is directly related to your job. The Workers’ Compensation Law applies to all employees of the state, ensuring that they are protected. In the unfortunate event of a work-related injury or illness leading to death, benefits are provided to the surviving spouse and/or dependents.
What Are Your Responsibilities?
Prompt: Rewrite the text provided.
1. To receive wage replacement benefits from workers’ compensation insurance carrier, it is crucial to promptly seek first aid or any necessary medical treatment. Make sure to inform your healthcare provider that your injury or illness is work-related so that the medical information can be sent to NYS workers’ compensation insurance carrier. Please note that your treating healthcare provider must be authorized by the Workers’ Compensation Board (WCB), unless it is an emergency situation. To find an authorized provider, you can visit the WCB website or call 1-877-632-4996. Remember, all medical expenses related to your work-related injury or illness will be covered by your NYS workers’ compensation insurance, not your health insurance.
2. In order to report a work-related injury or illness, please contact the Accident Reporting System (ARS) at 1-888-800-0029. Make sure to keep a record of your ARS incident number. The ARS Call Center operates from 8:00 a.m. to 5:00 p.m. EST, Monday through Friday, and is closed on state holidays. However, you can leave a message after hours, on weekends, and holidays. If you leave a message, a Call Center representative will return your call on the next business day to assist you in reporting your injury or illness. Once your incident is reported to the ARS, you will receive an acknowledgement letter. However, please note that contacting the ARS does not automatically initiate a workers’ compensation report to the WCB and NYS workers’ compensation insurance carrier. Your personnel office will only submit a report of your injury if certain criteria are met, including:
a. You require or required medical treatment beyond first aid; and/or
b. You lost or lose one work shift (one full lost work day); and/or
c. You require or required more than two first-aid treatments.
3. It is essential to inform your supervisor about your injury or illness and how it occurred as soon as possible, following your employer’s accident reporting procedures. Failure to inform your employer in writing about your injury or illness may impact your ability to receive wage replacement benefits from NYS workers’ compensation insurance carrier.
4. Please review the workers’ compensation article in your contract. The benefits provided by the Workers’ Compensation Law for New York State employees are enhanced in the collective bargaining agreements and vary depending on the bargaining unit and the date of the injury or condition. Please refer to the following articles: Article 11 of the CSEA Agreements, Article 13 of the PEF and Rent Regulations Services Unit Agreements, Article 14.9 of the SSU and SSPU Agreements, and the workers’ compensation section of the Handbook for Management/Confidential Employees.
Afterwards, please
- Follow the instructions given by your healthcare provider to ensure a speedy recovery.
- It is important to stay in contact with your employer and
- Inform them of the name and address of your healthcare provider.
- Additionally, provide your employer with any necessary medical documentation.
- Remind your doctor to send all medical information related to the accident or illness to NYS workers’ compensation insurance carrier. and WCB.
- When contacting NYS workers’ compensation insurance carrier., please refer to your carrier case number.
- Attend any scheduled independent medical examinations (IME) as directed by NYS workers’ compensation insurance carrier
- If you receive a notification to appear, make sure to attend any WCB hearings related to your case.
- Before returning to work, contact your employer and follow their return-to-work procedures.
- It is important to return to work as soon as you are able. In certain contracts, management is obligated to provide an alternative duty position if your disability is 50 percent or less and you are expected to return to full duty within 60 days, as determined by your treating healthcare provider. If you choose not to return to work, there may be serious consequences. Additionally, if you fail to return to work after being deemed fit for duty, the WCB may deny all wage benefits.
If you have any questions regarding your leave status, leave credits, eligibility for a supplement, return-to-work procedures, or the Mandatory Alternate Duty Program or Light Duty Assignment, please contact your employer or the Business Services Center.
What Are Your Employer’s Responsibilities?
1. ASSIST you in acquiring immediate medical treatment or initial aid.
2. SUPPLY you with a Claimant Information Packet that contains an Employee Claim form (C-3), HIPAA release form (C-3.3), details on obtaining legal representation, and information regarding the utilization of the pharmacy network.
3. NOTIFY NYS workers’ compensation insurance carrier promptly, adhering to the reporting requirements of the Workers’ Compensation Law, by submitting the First Report of Injury (FROI) to both NYS workers’ compensation insurance carrier and the WCB within 10 calendar days following the accident.
Note: As per the Workers’ Compensation Law, your organization is obligated to file a report for any accident resulting in personal injury that leads to a loss of time from regular duties beyond the working day or shift on which the accident occurred, or that necessitates medical treatment beyond initial aid or more than two treatments by a doctor or individuals providing initial aid. Your organization should also report any occupational disease through the submission of the FROI.
4. COMPLY with all requests for information from the WCB and NYS workers’ compensation insurance carrier, such as statements of your earnings before and after the accident (C-240), reports of your return-to-work date (C-11 & C-256.2), or any other reports that may be necessary to determine your work status following the injury.
5. SUBMIT the required transactions promptly and in accordance with the procedures of the Office of the State Comptroller (OSC) (Payroll Bulletin 1366) to initiate, modify, or cease workers’ compensation leave or supplemental wage payments.
6. INFORM you about your rights and responsibilities concerning accident reporting, submission of medical documentation to your organization, leave status, due process, and return-to-work procedures.
7. CREATE an alternative duty assignment if you become eligible to participate in the Mandatory Alternate Duty Program or Light Duty Assignment, where applicable.
What Are NYS Workers’ Compensation Insurance Carrier’s Responsibilities?
1. VERIFY the facts. NYSIF confirms the work-related accident claims, receiving assistance and cooperation from all parties involved.
2. SUBMIT a First Report of Injury (FROI) notice on behalf of the employer, with the WCB.
3. ISSUE payment in undisputed cases where lost time exceeds seven calendar days and you are not being paid by your employer. NYSIF initiates compensation within 18 calendar days after your disability begins or within 10 calendar days after your employer’s knowledge of your injury, whichever is greater.
4. COVER payment in undisputed cases for causally related medical bills and medication or medical supplies prescribed by WCB authorized medical providers according to the NYS Medical Fee Schedule.
5. PROVIDE you with a written statement of your rights under the Workers’ Compensation Law within 14 calendar days or along with the initial check, whichever is earlier.
6. SUBMIT a notice to the WCB by filing a Subsequent Report of Injury (SROI), indicating either the commencement of compensation payments or the reasons for non-payment. This notice must be filed within 18 calendar days after disability begins or within 10 calendar days after your employer becomes aware of your injury or illness, whichever period is longer. A copy of the notice must be mailed to you and your representative, if applicable.
7. CONTINUE making bi-weekly benefit payments to you for your workers’ compensation-related time off work, corresponding with the extent of your disability.
8. NOTIFY the WCB with a new SROI when compensation is terminated or modified. If NYSIF has been instructed by the WCB to continue payments, inform the WCB (Form RFA-2) of the intention to stop or modify compensation. These notices should be sent promptly and must be accompanied by, or refer to, the medical information or other evidence on which the action is based. A copy of the notice must be mailed to you and your representative, if any.
9. EVALUATE the need for scheduling independent medical examinations on your behalf to verify ongoing disability.
10. Ensure your presence at hearings regarding your case whenever they are scheduled by the WCB, and adhere to the instructions provided by the WCB and its Law Judges.
11. Settle any awards issued by Law Judges or the WCB within a maximum of 10 calendar days, unless you have applied for a review.
12. Promptly reply to the treatment/testing prior authorization requests from your treating doctor within the designated timeframe. For specific time frames, please refer to the page containing the information on each Prior Authorization Request
Compare New York Workers’ compensation Insurance Costs & Quotes
Seriously, understanding workers’ compensation is an essential part of being a small business owner. Put simply, if you have employees, you should have workers’ comp insurance. Even if you think you would never need to file a claim, not having it opens you up to state penalties, including fines. Having workers’ compensation insurance gives you and your employees peace of mind. You’ll know any on-the-job injury-related claims will be handled!
Ready to compare the cost of Workers’ Compensation Insurance policies for your business? Fill out our brief online application, and one of our agents will send Workers’ Compensation Insurance quotes to your email inbox. In most cases, you can expect to receive business insurance quotes within a matter of minutes.
