Can You Get Disability Benefits If NY Workers’ Comp Is Denied?
Disability Benefits Can Keep Some Money Coming In While a Denied Claim Is Fought
A New York workers' compensation claim should replace part of your paycheck if you got hurt at work. Sometimes, though, the workers’ comp insurance company refuses to pay. It may argue your injury didn't happen at work or isn't as serious as your doctor says. When that happens, the bills don't stop coming, and injured workers need to act fast to get the compensation they deserve.
If a workers’ comp claim is denied, it’s often referred to as a controverted claim or disputed claim. No cash benefits are paid on a disputed claim until a Workers' Compensation Law Judge decides who is right, according to the New York State Workers' Compensation Board. Fortunately, there is an alternative. In certain cases, an injured worker may qualify for disability benefits.
Our New York workers' compensation lawyers at Pasternack Tilker Ziegler Walsh Stanton & Romano LLP understand how this complex system works. That’s because we have been helping injured workers for decades get the compensation they rightfully deserve. Disability benefits can help during a contested case. Knowing how they work can protect both your income and your claim.
Key Takeaways
|
What Happens When a New York Workers' Comp Claim Is Contested?
An insurance company that disputes a claim must file a notice of controversy with the Workers' Compensation Board. That starts a legal process with hearings, medical reports, and testimony. A judge will decide whether your injury is work-related and what benefits you should receive. Your controverted workers' comp claim can take months to resolve.
Weekly checks usually stop or never start during that time. The insurance company doesn't pay cash benefits while it contests the claim. Many workers are left without a paycheck at the moment they need one most. Rent, car payments, and grocery bills keep coming due.
A contested claim doesn't have to be the end of your case. A denied workers' compensation claim can still be approved after a hearing. The key is protecting your income while the case moves forward. That's where New York State disability benefits can make a real difference.
Can You Collect Disability Benefits While Your Comp Case Is Pending?
Yes, in most cases. New York disability benefits usually cover injuries and illnesses that happen off the job. There's an important exception. Under New York Workers' Compensation Law Section 206, a worker can collect disability benefits first if the comp claim is disputed as not work-related.
You apply by filing a Notice and Proof of Claim for Disability Benefits, known as Form DB-450. It goes to your employer or its disability insurance company. Your doctor must complete a section confirming that you can't work. You should file within 30 days after your disability begins.
Applying for disability benefits doesn't mean giving up your workers' comp claim. The two claims move forward side by side. Disability benefits help you get by until a judge decides. Be accurate on both forms. The insurance company may compare what you said in each one.
Who Qualifies for New York State Disability Benefits?
Most private-sector workers in New York are covered by the state's disability benefits law. New York is one of only a handful of states that require employers to carry this coverage for their workers. To qualify, you generally must meet these requirements.
- Four Weeks of Work – You generally qualify after working for a covered employer for four consecutive weeks, even if you recently changed jobs.
- Unable to Work – Your injury or illness must keep you from working. You also can't collect while earning wages from any job.
- Under a Provider's Care – You must be under the care of a licensed health care provider who confirms your disability, according to the Workers' Compensation Board.
- Seven-Day Waiting Period – Nothing is paid for the first seven days. Disability benefits start on the eighth day you're unable to work.
Some workers aren't covered. Government employees, for example, generally aren't covered unless their employer chose to provide it. Certain farm workers, railroad workers, and religious workers are also excluded. You also can't collect disability benefits and unemployment benefits for the same weeks. If you're not sure whether you're covered, your employer's human resources office should be able to tell you.
How Much Do Disability Benefits Pay, and for How Long?
Disability benefits equal half of your average weekly wage over your last eight weeks of work. The payment is capped at $170 a week under New York Workers' Compensation Law Section 204. That cap hasn't changed since 1989, according to a New York State Senate bill memo.
Disability benefits last up to 26 weeks within any 52-week period under New York Workers' Compensation Law Section 205. Disability benefits are cash only. They don't pay for medical treatment. That can leave injured workers wondering who pays the doctor bills during a disputed claim.
For most workers, $170 a week is far less than workers' comp would pay. Workers' comp generally pays two-thirds of your average weekly wage, up to a much higher state maximum. That's why winning the comp case still matters, even if disability benefits are paying for now.
| Question | Disability Benefits | Workers' Compensation |
|---|---|---|
| How much does it pay? | Half of your average weekly wage, up to $170 a week | Two-thirds of your average weekly wage, up to the state maximum |
| How long does it last? | Up to 26 weeks in a 52-week period | Depends on your injury and recovery |
| Does it cover medical care? | No | Yes, for a work-related injury |
What Happens to Disability Benefits If You Win Your Comp Case?
If a judge approves your workers' comp claim, the disability insurance company can ask to be paid back. Section 206 lets it file a claim for reimbursement with the Board before the comp award is made. That claim becomes a lien, which is a legal right to be repaid out of your workers' comp award. This means:
- No Double Payment – You don't get paid twice for the same weeks.
- Disability Payments Are Subtracted – Payments from the disability program are subtracted from your workers' comp award for the same period.
- You May Get the Difference – Since workers' comp usually pays more, you may still receive the difference for those weeks.
Getting that math right matters a great deal. Mistakes in the reimbursement can shrink the money you're owed for past weeks. A lawyer can check that the disability insurance company is repaid only for the weeks it actually covered. That protects every dollar of your award.
How Can a New York Workers' Compensation Lawyer Help?
A contested workers' comp claim in New York can leave you without a paycheck, without medical care, and without answers. You may be juggling disability forms, doctor's appointments, and hearing dates while you're hurt. One mistake on a form or a missed deadline can cost you money you need now.
Our New York workers' compensation attorneys at Pasternack Tilker Ziegler Walsh Stanton & Romano LLP know how contested claims work. We can help you apply for disability benefits while your workers’ comp case is pending. Then we can fight to prove your injury is work-related and to make sure any reimbursement is handled correctly.
You shouldn't have to choose between paying your bills and standing up for your rights. Contact us for a free consultation. We'll review your denied claim and explain your options. Then we'll help you keep money coming in while we fight for the workers' comp benefits you deserve.
"The workers comp process is a complicated one and to have knowledgeable compassionate people behind you makes the process easier. Do yourself a favor and hire this firm, you will not be disappointed." — Anaise F., ⭐⭐⭐⭐⭐