The New York workers’ compensation system is designed to provide benefits for people who were injured at work, so that they can pay for medical expenses and cope with lost income while they are recovering. When all goes smoothly, an injured worker reports the injury to the employer, files a claim for workers’ compensation, and the employer’s insurance company begins paying the worker benefits in a timely fashion.
Unfortunately, the process often does not go smoothly, and the worker is left without the benefits, with benefits that are insufficient, or with late payment. When this happens, injured workers must fight for the benefits they deserve in hearings and appeals through the state Workers’ Compensation Board.
When an insurer fails to honor a claim, or some other dispute arises over benefits, claims examiners from the Workers’ Compensation Board office first try to resolve the issue informally. If that fails, they hold hearings in front of a judge. These hearings are less formal than civil or criminal trials in many ways — the Workers’ Compensation Board even has a “virtual hearings” program under which participants attend hearings online — but they do involve evidence and testimony from witnesses.
The judge in these hearings issues a decision. Either side may then appeal that decision. Appeals are heard by three members of the board. Once the three-member panel issues a decision, both sides get a chance to appeal again. If the board agrees to hear this appeal, the full board reviews the case and issues decision agreeing with, changing or overturning the earlier decision.
A workers’ compensation attorney can help workers at many stages in the process of applying for benefits, including the initial filing of claims, but it is crucial that workers have legal help when they get to the hearings and appeals process. A lawyer can gather evidence and witnesses, argue on a worker’s behalf, give sound advice and negotiate with the other side.
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