Workers’ Compensation in New York

A Legal Overview for Injured Workers

New York’s Workers’ Compensation Law provides statutory benefits to employees who suffer injuries or illnesses in the course of their employment. These benefits include wage replacement, medical treatment, and, in some cases, vocational rehabilitation or ongoing disability compensation. While the system is intended to operate without regard to fault, it remains procedurally complex and highly regulated.

The information below offers a legal overview of the claims process. It is not a substitute for legal advice. Injured workers should consult an attorney early in the process to protect their rights and ensure the claim is managed properly from the outset.

1-The first step in any workers’ compensation claim is providing timely notice to the employer.

Under WCL § 18, an injured employee must notify their employer of a work-related accident or injury within 30  days. Although oral notice is legally sufficient, written documentation is strongly advised to create a clear and verifiable record.

Following the injury:

-The employee must seek treatment from a healthcare provider authorized by the New York State Workers’ Compensation Board.  A list of authorized providers is available on the Board’s website.

-The injured worker must inform the provider that the injury is work-related so that proper documentation and reporting procedures are followed under the Workers’ Compensation system.

Medical providers are currently encouraged to submit the CMS-1500 form, accompanied by a narrative report outlining the mechanism of injury, clinical findings, diagnosis, proposed treatment, and opinion on causal relationship and disability status. Use of CMS-1500 forms will become mandatory in August 2025.

Legal Note: Failure to notify the employer within 30 days or to file a formal claim within the statutory time limit under WCL § 28  may result in a denial of benefits, regardless of the severity or legitimacy of the injury.

2. Filing a Formal Claim

Initiating a formal workers’ compensation claim requires:

-Filing Form C-3 (Employee Claim Form) with the Workers’ Compensation Board as soon as possible, but no later than two years from the date of injury or from the date the worker knew or should have known that the condition was work-related.

-The employer is obligated to submit Form C-2F (Employer’s Report of Work-Related Injury/Illness).

-The treating provider must submit narrative reports (and CMS-1500 billing if applicable) to the insurance carrier and the Board.

Insurance carriers and self-insured employers are required to file electronically through the Board’s eClaims system,  using FROI (First Report of Injury) and SROI  (Subsequent Report of Injury) forms. If the carrier denies the claim, it must file a SROI-04 (Denial) indicating the specific grounds for dispute.

If the claim is controverted, the matter will proceed to a pre-hearing conference, and if unresolved, to a formal hearing before a Workers’ Compensation Law Judge (WCLJ).

3. Medical Treatment and the Medical Treatment Guidelines (MTGs)

Medical care provided through the workers’ compensation system must comply with the New York State Medical Treatment Guidelines (MTGs), which are mandatory for commonly treated injuries such as those affecting the back, neck, shoulder, knee, and wrist, as well as conditions like carpal tunnel syndrome.

There are three categories of treatment requests:

-MTG-compliant care: These services do not require pre-authorization and are presumed appropriate.

-Variance requests: If a provider wishes to depart from the MTGs (for frequency, duration, or type of service), they must file Form MG-2 along with a medical rationale.

-Special services: For more extensive procedures—such as surgeries, spinal injections, or advanced diagnostics—Form MG-2 is also required, even if the treatment falls within the MTGs.

If the carrier denies a request for treatment, the denial proceeds through:

1-Level 1: Administrative or procedural grounds.

2-Level 2: Peer review conducted by the carrier’s retained physician.

3-Level 3: Final review by the Medical Director’s Office (MDO)  of the Board.

Only after a Level 3 denial can the issue be brought before a WCLJ for adjudication. The Board will not entertain hearings on treatment issues that have not been through the MDO review process.

4. Indemnity Benefits and Disability Classifications

Workers who lose time from employment due to a compensable injury may be eligible for weekly cash benefits, known as indemnity payments. Entitlement is based on two key factors:

-Average Weekly Wage (AWW): Typically calculated using the injured worker’s earnings from the 52 weeks preceding the date of injury. Wages from concurrent employment may be included under WCL § 14(6).

-Degree of Disability: Determined by the treating physician and subject to rebuttal via Independent Medical Examination (IME) by  the carrier.

Disability classifications include:

-Temporary Total Disability (TTD)  – unable to work at all for a limited period.

-Temporary Partial Disability (TPD) – partially disabled but capable of limited work.

-Permanent Partial Disability (PPD) – permanently impaired but able to perform some type of work.

-Permanent Total Disability (PTD)  – permanently unable to engage in any form of employment.

Benefit amounts are computed as two-thirds of the AWW multiplied by the degree of disability, subject to statutory caps and minimums set annually by the Board.

5. Labor Market Attachment Requirements

In cases involving partial disability, an injured worker must demonstrate that they remain attached to the labor market  in order to continue receiving weekly indemnity benefits.

Demonstrating attachment requires:

-Conducting a persistent, good-faith job search consistent with the medical limitations.

-Logging all efforts using Form C-258.1, which should include dates, employers contacted, and the outcome of each application.

-Submitting this documentation every 60 to 90 days  or as directed by the WCLJ.

-Enrolling in and cooperating with vocational rehabilitation or job placement programs, if applicable.

Failure to demonstrate labor market attachment can result in a suspension of benefits. Reattaching requires significant documentation and may involve further hearings and updated medical reports.

6. Hearings and Dispute Resolution

When disputes arise—whether over medical treatment, causation, wage calculation, or degree of disability—the matter is referred to a Workers’ Compensation Law Judge (WCLJ) for adjudication.

Common hearing issues include:

-Conflicting medical opinions between treating physicians and IMEs.

-Disputes regarding the necessity or appropriateness of treatment.

-Challenges to the causal relationship between the claimed injury and employment.

-Average weekly wage disputes, especially in cases involving seasonal or part-time work.

-Disagreements over classification versus scheduled loss awards.

-Allegations of non-compliance with labor market attachment requirements.

Judges issue binding decisions that may be appealed to a Board Panel. Further review may be sought before the Appellate Division, Third Department, in accordance with WCL § 23.

7. Additional Legal Considerations

-Taxation: Workers’ compensation indemnity payments are not taxable under federal or New York State income tax laws.

-Choice of Medical Provider: Injured workers may select their own provider, so long as the provider is authorized by the Workers’ Compensation Board. Employers may not direct medical care.

-Reimbursement and Amended W-2s: If an employer advances wages and is subsequently reimbursed by the carrier, those funds may be converted from taxable wages to non-taxable compensation. This may require issuance of an amended W-2 by the employer for tax purposes.

Conclusion: Why Legal Representation Matters

The Workers’ Compensation system in New York is highly technical, medically nuanced, and procedurally unforgiving. Insurance carriers are represented by experienced counsel, medical vendors, and claims examiners who understand the intricacies of the law and the tactics available to limit exposure.

Unrepresented claimants risk procedural defaults, underpayment, treatment denials, or premature case closure. Engaging legal counsel early in the process significantly increases the likelihood of securing full and fair compensation and preserving long-term medical and financial protections.

If you have sustained a work-related injury, consult a qualified workers’ compensation attorney to ensure your claim is handled correctly from the outset.