What Does the New York Workers’ Compensation Board Do?
An experienced work injury attorney can deal with the Board on your behalf
If you’ve been hurt on the job in New York, you are now dealing with a system that you were likely aware of but not particularly familiar with. The workers’ compensation system is complex, with strict deadlines and exacting administrative requirements. At the top of that system is the New York State Workers’ Compensation Board, a 15-member body appointed by the Governor and confirmed by the State Senate.
Dealing with the Board at various stages in the workers’ compensation process can be a challenge. Fortunately, you don’t have to do it alone. Our experienced New York workers’ compensation attorneys work with the Board every day, and we have the experience and resources you need to move your workers’ compensation claim forward.
If you have been hurt at work in New York, here’s what you need to know about what the Board does:
The Board administers the workers’ compensation system
The Board is charged by New York law with administration of the New York State Workers’ Compensation Law. The Board has several broad responsibilities when it comes to the system as a whole, such as making sure employers provide the legally required coverage for their employees. In addition, the Board plays a vital role in individual claims, including:
- Processing the initial claim. A workers’ compensation claim starts when an Employee Claim (Form C-3) is filed with the Board. Legally, this can be done any time within two years after the injury, but it’s best to file as soon as possible.
- Overseeing treatment progress. While you undergo treatment for a work injury, your doctor is required to submit a Doctor’s Progress Report (Form C-4.2) to the Board every 45 days.
- Helping workers return to work. The Board employs vocational rehabilitation counselors and social workers who can assist injured workers with their transitions back to the workplace.
- Approving workers’ compensation settlements. There are two ways to settle a workers’ compensation claim in New York: a stipulation agreement, or a Section 32 settlement. Either type of settlement must be presented to the Board:
- Stipulation agreements can be submitted in writing using Form C-300.5 or by testifying to the terms before a workers’ compensation judge.
- Section 32 settlements must be filed in writing using Form C-32. The Board will briefly review the form and, if it seems acceptable, schedule a settlement hearing with a workers’ compensation judge.
- Handling workers’ compensation disputes and appeals. If your claim is disputed or denied, the Board administers the hearing process to resolve those disputes. If you are unhappy with the outcome of the hearing, the Board also handles the first level of appeals. More on that in a moment.
In short, the Board is involved at some level in every stage of your workers’ compensation claim. Even if the insurance company is cooperative, you still need to satisfy the Board’s administrative requirements in order to get the treatment and benefits you deserve. And of course, if the insurance company tries to dispute your treatment or deny your claim, the role of the Board is even more critical as you move through the hearing and appeal process.
The Board authorizes doctors and “independent” medical examiners
While some states allow employers to choose which doctor injured workers see, in New York, the injured worker has control over that choice. When you’ve been hurt on the job, you can choose any doctor authorized by the Board to treat work injuries.
The Board authorizes health care providers, including doctors, nurse practitioners, and other medical professionals, to diagnose and treat injured workers. You can find an authorized provider on the Board website. Note that just because a doctor is authorized by the Board does not mean they are endorsed or recommended by the Board, so you still need to do your own research to find the right health care provider.
The Board also authorizes independent medical examiners (IME), who are doctors hired by the insurance companies to examine injured workers as part of the claims process. By law, IME doctors are not allowed to treat injured workers, only to give opinions on the extent of the injury or disability and whether medical treatment is appropriate. Note that because the IME doctors work for the insurance companies, the word “independent” is a misnomer; they bring a certain amount of bias to those examinations.
The Board handles disputed (controverted) claims
If the insurance company disputes or denies your claim, then they must notify the Workers’ Compensation Board of the disputed claim by filing a Notice of Controversy. If you disagree with the insurance company’s decision, then the Board oversees the process of resolving the dispute.
The Board employs claims examiners and conciliators who work to resolve disputes informally. If the dispute cannot be resolved, then the Board will hold a hearing before an administrative law judge (ALJ). The ALJ is a judge employed by the Board to interpret and apply the Workers’ Compensation Law and the Board’s policies and procedures to resolve disputed claims.
The hearing process has first steps. First, the ALJ will hold a pre-hearing conference, which is a preliminary hearing to resolve matters that affect the formal hearing. For instance, the ALJ can decide which issues will be reviewed at the formal hearing or whether you need an IME.
Second, there will be a formal hearing during which both sides are allowed to present their case. Always in attendance at the hearing are the injured worker (and their lawyer if they have one), the insurance company’s lawyer, and the ALJ. The employer may send a representative as well. After the hearing, the ALJ will issue a decision regarding the amount of benefits, impairment rating, average weekly wage, or other issues that were in dispute.
The Board also handles appeals of disputed decisions
If either the injured worker or the insurance company disagrees with the ALJ’s decision, they can appeal that decision to the Board itself by submitting an Application for Board Review (Form RB-89).
The initial review of the ALJ’s decision is completed by a panel of three Board members. The three-member panel may affirm, modify, or reverse the decision. They may also send it back to the ALJ for more hearings.
If the three-member panel is not unanimous, then the full Board must review the decision if asked to do so by either party. If the three-member panel is unanimous, then the full Board can still review the decision at their discretion. Either way, the Board’s decision can be appealed to the New York Supreme Court, Appellate Division, Third Department, and from there to the New York Court of Appeals.
An experienced workers’ compensation lawyer can deal with the Board on your behalf
Dealing with the Workers’ Compensation Board is challenging. There are strict deadlines that must be met, and all forms and paperwork must be completed to the Board’s satisfaction in order to keep your claim moving forward. Of course, the workers’ comp insurance companies deal with the Board every day, so they start out with the advantage. You need your own advocate to level the playing field.
The workers’ compensation attorneys at Pasternack Tilker Ziegler Walsh Stanton & Romano LLP have been representing injured New York workers for decades. We know how the Board operates and how to navigate the process as we pursue meaningful results for our clients. If you’ve been hurt on the job in New York, don’t deal with the complex claim process on your own. Contact us today for a free consultation with an experienced New York workers’ compensation lawyer.
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