Often, injured workers face delays in the processing of their claims. Such workers can be out of work due to an on-the-job injury and not see a check from the insurance company for weeks, or even months. This can cause untold hardships for the worker. How is the comp system supposed to work? And what actually happens?
When an employee in New York is injured at work, that employee has 30 days under state law to timely report the incident to the employer. The longer he/she waits, though, the more time it will take to receive needed medical care and comp checks. So it’s always best to report a workplace incident as soon as it happens.
But how much time does the employer have, by law, to turn around and forward this incident report from the employee to the employer’s insurance company (called the “workers’ compensation carrier”?) and to New York State? The answer: 10 days. (Do they sometimes wait longer? Yes, all the time.)
So now, it’s possible at least 10 days have gone by. Our poor injured worker has now waited 10 days for permission to see a Workers’ Comp (WC) doctor, because most such doctors won’t see a WC patient without a “carrier case number.” Do these cases get set up by the carriers in a mere 10 days?
Not from my experience. Usually, it takes longer. My past experience shows it takes at least 2-3 weeks at minimum for a Workers’ Comp carrier to set up a file. Even then, in the early stages of a WC case, there is really nothing forcing insurance companies to make fast payments to injured workers. Often, they will wait it out a while until they finally decide to start paying.
The most important thing to know is this: WC Insurance companies are under no obligation to pay injured workers AT ALL until the Workers’ Comp Board orders them to. And the Board usually takes months—-yes, months—-to hold a hearing or make a decision in any case. So if you are the insurance company, do you rush to make payments to the injured worker? Often, the answer is no.
If the employer contests the case, the injured worker must wait for a hearing at the Workers’ Comp Board (WCB.) Under the WCB’s “Rocket Docket” ( a supposedly streamlined hearing process,) the Board says the following:
The Rocket Docket sets a goal of having a pre-hearing conference within 30 days…………on average it took 75 days to address the issues in the controverted claims. Nearly 60% of controverted claims met the goal of being resolved within 90 days, while another 21%were resolved in 91-180 days.”
(WCB 2011 Annual report)
So if the employer simply says to the insurance carrier “I don’t believe the employee was injured, so contest their case”, the injured worker has to wait at least 3 months for a decision.
My experience: 3 months is the minimum; often it takes a lot longer.
So, if your question is, is Workers’ Comp going to pay me right away for my work-related injury? The answer is: Probably not.
Hiring a lawyer who can navigate through the system and help speed things along is always a good idea, though.
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