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Workers Compensation Issues & Eligibility Hurdles in New York

workers compensation issues

Are You Dealing With a Complicated Workers Comp Claim? Discover the Most Common Reasons Why NY Workers’ Compensation System is So Complex.

Here’s the thing about workers’ compensation in New York – it’s as complicated as it gets. Just look at the medical treatment guidelines. For EACH body part, the rulebook hits a whopping 100 pages. Doctors have to follow all these confusing rules on what they can and can’t do for injuries without getting extra approval first.

New York’s extensive workers’ compensation regulations create complex barriers for injured personnel attempting to navigate the system and receive entitled benefits. For instance, despite evident work-related injuries, insurance carriers habitually deny claims—even plausible ones warranting due compensation.

That said — if you are not well-versed in the medical care and treatment guidelines, if you’re not an attorney who is dealing with such compensation claims day in and day out, and if you don’t know the tactics of the insurance companies, you do not know what claims are compensable.

Red Tape Deters Doctors from Providing Care

In order for a treatment that requires permission, the doctors filling out the complex forms must word them correctly to get permission for a treatment that is not explicitly stated in the guidelines.

If the insurance company denies it, the doctor must seek three levels of review justifying the need for the treatment. The doctors are not paid anything additional for the extra paperwork (a.k.a RED TAPE).

Not even the judges on the workers’ compensation board making these treatment decisions are well-versed in the guidelines. Say you injured your knee, and a certain injection is allowable per the guidelines. Some of the judges ruling on your claim are unaware of the types of allowable injections. But treatment is only one part of workers’ compensation claims.

Income Replacement is Limited

While many people think you are paid your full salary while at home healing, in New York State, you are only entitled to two-thirds of your income, not to exceed the state maximum.

For example, your average weekly wage is $900 per week. If you are totally disabled and out of work, you’d be entitled to $600 a week.

However, if you’re found to have a 50% disability, you only get $300 per week. And if you don’t have a total disability, you also have to look for work in the way that they want you to look for it.

Ten Percent of Workers’ Compensation Claims Are Fraudulent

You might think that workers’ compensation has to be complex and difficult to reduce fraud. This is a misconception.

New York State, depending on the year, files somewhere between 200,000 and 300,000 workers’ compensation cases. Only 1-2 percent of Workers’ Compensation cases are fraudulent.

The reality is that insurance companies are good at controlling the narrative. In 2018, they profited over one billion dollars in New York State just on workers’ compensation coverage alone. So, insurance companies have a vested interest in denying workers’ claims and making workers feel embarrassed to submit a claim, that the injury was their fault, or even that the company will do the right thing based on a good working relationship.

Even if you think, “My employer would never do that to me,” because you have an excellent working relationship with your employer, you DO NOT have one with their insurance company. Your employer pays the insurance company the premiums. If the insurance company can pay out less, they make more in profits.

You also might think that workers’ compensation is extremely expensive and thus contributes to the failure of small businesses. But 75% of businesses in New York State pay less than $5,000 a year for workers’ compensation benefits.

Job Loss Loophole in At-Will Employment States

Under Section 120 of the Workers’ Compensation Law, an employee cannot be fired for filing a workers’ compensation case. However, because New York State is an employment-at-will state, employers have no obligation to hold your position open.

It’s difficult to win a case unless you have a smoking gun, such as an email that says something like, “I can’t believe you filed for workers’ compensation. You’re fired!”

Don’t Go Up Against The NY Workers Compensation System Alone

If you or a loved one suffered a workplace injury, you’re likely facing plenty of confusion navigating New York’s complicated workers’ compensation system. Denied claims, delays, reduced wages – we’ve seen it all. But with an experienced attorney, many pitfalls can be mitigated or reversed.

Don’t let workers’ comp issues stand in the way of the care and compensation you deserve. Our legal team knows this complex web of laws inside out. We prepare airtight cases, appeal wrongful denials, and battle for fair settlements. Don’t wade through bureaucracy alone – contact our offices today for a consultation. Justice awaits.

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