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Home » Workers' Compensation » Workers Compensation Claim Process

Workers Compensation Claim Process

Home » Workers' Compensation » Workers Compensation Claim Process
Workers compensation claim process

There are many important aspects to the New York workers’ compensation claim process.  In order to maximize compensation and medical care, there are four key things the injured worker must understand. An experienced workers’ compensation attorney can assist in each of these areas.

In the Workers’ Compensation Claim Process, the Insurance Carrier Will not Act in the Worker’s Best Interest

The Insurance carrier’s only goal in handling a workers compensation claim is to minimize cost.  In all cases, the carrier looks to keep the cost of weekly payments and medical care as low as possible. Many claimants mistakenly trust the insurance carrier’s medical consultants and claims adjusters when making important decisions.  But, in reality, the insurance carrier is only looking to cheaply dispose of the injured worker’s claim.  An injured worker should always defer to a workers’ compensation attorney when making decisions in their case. This is especially important when considering a settlement offer or treatment option, such as surgery. The insurance carrier will hire a lawyer to represent it at hearings and other proceedings before the Board. The injured worker is at disadvantage if they do not consult with an attorney of their own.

Every Workers’ Compensation Claimant Has a Right to a Hearing

The injured worker may request a hearing before the Board. This is a due process right. The worker should request a hearing if the insurance carrier denies treatment or lowers weekly payments. These requests are filed directly with the Workers’ Compensation Board.  In addition, the Board may ask the parties to take further steps. Depending on the issue, the parties may question doctors under oath. Or, the judge may ask a witness to testify. From there, the judge will review all of the evidence and make a decision. A skilled lawyer who is familiar with the law, the Medical Treatment Guidelines (MTG’s) for workers’ compensation claims, and procedure before the Workers’ Compensation Board, is invaluable. An experienced attorney puts the worker in the best position to win.

There are Different Ways to Settle a Workers’ Compensation Claim


When it comes to settlement, the injured worker has many options.  Claims may be settled in total, or in part. If an injured worker thinks he or she may need costly medical care in the future, that should be factored into settlement. For example, the worker can settle the lost wages part of their claim while leaving medical treatment open. Or, the parties could agree to close all aspects of the claim with a settlement agreement.

The parties can also settle on specific issues in a case, such as Schedule Loss of Use or Loss of Wage Earning Capacity. Both Schedule Loss of Use and Loss of Wage Earning Capacity refer to the permanent disability resulting from the accident. Before making a final decision as to any type of settlement, the injured worker should consult with an attorney. The attorney should be familiar with all forms of settlement to determine what structure is best for the worker and their family.

Someone Other Than the Injured Worker’s Employer May Need to Be Sued

Generally, an injured worker may not sue their employer for an accident on the job.  As a substitute for a lawsuit against the employer, the worker must instead file a workers’ compensation claim.  However, if a third party, such as a building owner or general contractor is responsible for the accident, a lawsuit may be possible. Importantly, a worker may have both a workers’ compensation claim and a lawsuit from the same accident. This is often the case in construction accidents. In many cases, a lawsuit against a negligent third party will result in compensation greater than the value of a workers’ compensation claim. When seeking guidance on the workers’ compensation claim process, the injured worker can always rely on the attorneys from The Platta Law Firm to answer any questions and to fight for their rights. Contact us for any help.