Workers’ Compensation Process
The New York State Workers’ Compensation Board is the state agency that decides workers’ compensation cases. If you are injured on the job, you must do three things to make a claim:
- Notify your employer,
- File a C-3 form with the Workers’ Compensation Board, and
- See a doctor who accepts workers’ compensation cases and the doctor must file a C-4.0 form with the Workers’ Compensation Board.
Unless you do all three things, your claim will not be properly filed.
Once your claim has been properly filed, the Workers’ Compensation Board will send you a Notice of Case Assembly. This document will include your WCB Case Number, which is the number assigned to your case by the Workers’ Compensation Board. A WCB Case Number usually begins with the letter “G.”
The insurance company will also send you papers about your case, although they may not do so until the Board has issued the Notice of Case Assembly. The insurance company’s papers will include the “carrier case number,” which is the number assigned to your case by the insurance company. It is important that you give your doctor’s office both the WCB Case Number and the carrier case number, because the doctor is required to file reports with both the Workers’ Compensation Board and the insurance company.
The insurance company will respond to your claim one of two ways: it will either accept the case, or it will contest the case. If the insurance company accepts the case, then it will pay you and your doctor for your injuries and the level of disability it has accepted. You may disagree with the insurance company’s position about the extent of your injuries or level of disability. If you disagree, you can ask the Workers’ Compensation Board to schedule a hearing for your case.
If the insurance company accepts your case, and you do not ask for a hearing, then the Workers’ Compensation Board may send you either an Administrative Decision or a Proposed Decision. The decision will make findings about your injuries, wages, and compensation benefits, and may close your case without a hearing. If you get an Administrative or Proposed Decision, you may want to consult with a lawyer to make sure it is correct and that you have been awarded all of the benefits you are due.
If the insurance company contests your case, it will not pay any benefits to you or pay for any medical treatment. If the Workers’ Compensation Board has a medical report from your doctor, it will schedule a hearing for your case. Most contested cases require a trial, where you and your employer may have to testify. If your case is contested, you may want to consider consulting a lawyer.
Legal Editor: Robert Grey, March 2016
Changes may occur in this area of law. The information provided is brought to you as a public service with the help and assistance of volunteer legal editors, and is intended to help you better understand the law in general. It is not intended to be legal advice regarding your particular problem or to substitute for the advice of a lawyer.