Workers Compensation in New York: How to File a Claim

Federal law does not establish a mandatory workers' compensation system; instead, the Occupational Safety and Health Act (OSHA), 29 U.S.C. § 651 et seq., requires employers to maintain safe workplaces and prohibits retaliation against workers who report unsafe conditions. The Federal Employees' Compensation Act (FECA), 5 U.S.C. § 8101 et seq., provides workers' compensation coverage only for federal employees. For private-sector employees, workers' compensation is governed entirely by state law. The federal government does not mandate workers' compensation insurance or set benefit levels; each state designs its own program, employer coverage thresholds, and benefit structures.

Under federal law, injured workers cannot generally sue their employer for negligence (a principle derived from the common-law trade-off embedded in state workers' comp systems), but they retain the right to sue third parties whose negligence contributed to the injury. OSHA also enforces workplace safety standards and investigates fatalities and serious injuries, though this is separate from workers' compensation benefits. There is no federal cap on benefits or federal mandate for rehabilitation services; these are determined by state programs.

New York Workers' Compensation Law Article 1, Section 1 requires nearly all private employers with one or more employees to carry workers' compensation insurance or self-insure. Public employers (state, county, and municipal) are also covered under Article 4. The law is significantly more protective than the federal baseline because it provides automatic, no-fault coverage for work-related injuries and occupational diseases, requiring no proof of employer negligence.

Covered employers include private businesses, public employers, farms, and non-profits. Excluded from mandatory coverage are certain categories: sole proprietors and partners not electing coverage, certain family members in family businesses, and volunteer firefighters and ambulance drivers (though these groups may elect coverage). Independent contractors are generally not covered unless the hiring entity treats them as employees and pays into the system.

New York's benefits are among the most generous in the nation. Injured workers receive: (1) full medical benefits with no caps for work-related treatment; (2) temporary disability benefits equal to two-thirds of average weekly wage (AWW), capped at the statewide average weekly wage (currently $1,333.33); (3) permanent partial disability awards based on body part and degree of disability (New York uses a schedule); (4) permanent total disability benefits continuing until age 65 or death; (5) vocational rehabilitation and retraining services; and (6) death benefits to dependents equal to two-thirds of the worker's AWW.

New York also permits what is called a "third-party claim." If a third party (not your employer or co-workers) caused your injury, you may sue that party while simultaneously receiving workers' compensation benefits. If you recover from the third party, the workers' compensation insurer has a lien against the recovery to recoup benefits paid. This is a unique feature that gives New York workers greater recovery potential than in many states.

The state law is administered by the Workers' Compensation Board, which processes claims, resolves disputes, and enforces compliance. Employers must report claims to their insurer; insurers must issue decisions on claims within a statutory timeframe. If a claim is denied, the worker can file a protest and request a hearing before the Board.

New York law excludes certain categories from mandatory coverage, creating important exceptions. Independent contractors are not covered unless the hiring entity treats them as employees and remits payroll taxes. Sole proprietors and partners can opt out of coverage for themselves. Family members working in a family business may be excluded if not on payroll. Volunteers serving as firefighters or ambulance drivers are excluded from mandatory coverage, though they may elect it.

Employers may raise the "employee vs. independent contractor" defense if they successfully argue that the injured person was not an employee. The test focuses on: (1) control over the work, (2) provision of tools and materials, (3) right to hire and fire, and (4) method of payment. New York courts strictly interpret this test in favor of coverage, making the independent contractor defense difficult to sustain.

A major exception exists for injuries caused by the employee's sole negligence or intentional misconduct. However, New York interprets this narrowly; ordinary negligence by the worker does not bar recovery. The exception applies only when the injury is caused solely by the worker's gross negligence or deliberate act unrelated to the job.

Another limitation: benefits do not cover injuries arising solely from the worker's intoxication or drug use, though intoxication alone does not bar recovery if it did not solely cause the injury. If the injury results from the worker's violation of a safety rule or instruction, recovery is not barred if the violation itself was not the sole cause.

Employers cannot avoid coverage by claiming an injury is not work-related if it occurred during working hours and at the workplace, unless the worker was on a personal frolic. Occupational diseases (asbestosis, silicosis, repetitive strain injuries) are covered, though the worker must prove the disease arose out of and in the course of employment in that industry.

Also notable: workers' compensation benefits are the exclusive remedy against the employer; an injured worker generally cannot sue their employer for negligence. This is the trade-off inherent in the no-fault system. However, workers retain the right to sue third parties and collect both workers' comp and third-party damages.

Step 1 — Document the injury immediately. Report the injury to your supervisor or manager on the day it occurs, or as soon as practicable. Keep written records of when and how the injury happened, names of witnesses, and the body part(s) injured. Photograph visible injuries, preserve medical records from any emergency room or doctor visits, and keep receipts for out-of-pocket medical expenses. Document all communication with your employer about the injury.

Step 2 — File an internal claim with your employer. Obtain Form C-3 (Employee Claim for Workers' Compensation Benefits) from your employer or the New York Workers' Compensation Board website. Complete the form with your name, injury date, description of injury, and the names of any treating physicians. Submit the form to your employer or their insurance carrier. Your employer is required to provide the form; if they refuse, request it in writing. Keep a copy for your records. Note that you must report the injury to your employer within 30 days for your claim to be timely; failing to do so may bar recovery, though exceptions exist for latent occupational diseases.

Step 3 — File with the insurance carrier if the employer fails to report the claim. If your employer does not submit the claim to their insurer within 10 days, you may file directly with the carrier using Form C-3. You can obtain the insurer's name from your employer's safety officer or payroll department. File the claim at: New York Workers' Compensation Board, 20 Park Place, New York, NY 10007, or online at wcb.ny.gov. Include the claim form, medical documentation, and a written statement describing the injury and how it occurred. The insurance carrier must acknowledge receipt within 25 days and issue a decision (approve, deny, or request more information) within 25 days of receiving a complete claim package.

Step 4 — Understand the investigation and decision process. Once filed, the insurance carrier will investigate the claim. The insurer may contact your treating physician for medical records and may conduct an independent medical examination. You have the right to be present and represented during the examination. The insurer will review whether the injury is work-related and whether you were an employee at the time. If the insurer denies the claim, they must send you a written denial letter explaining the reason. Approval decisions lead to benefit payments within two weeks of the approval decision.

Step 5 — Appeal a denial or file a dispute if the insurer delays payment. If your claim is denied, you have the right to file a "Protest" with the New York Workers' Compensation Board within 30 days of the denial. The Board will schedule a hearing before an administrative law judge (ALJ). File the protest at wcb.ny.gov or mail it to the Board at the address above. At the hearing, present evidence (medical records, witness testimony, photographs) that the injury occurred and is work-related. The ALJ will issue a decision; either party can appeal to the Board's Appellate Division.

Step 6 — Consult an attorney if the claim is complex or denied. You should consult a workers' compensation attorney if: (1) your claim is denied and you need representation at a Board hearing, (2) the injury resulted in permanent disability and you need help calculating appropriate benefits, (3) you are offered a settlement and need advice on whether it is fair, or (4) the insurer is delaying payment or disputing your medical treatment. New York allows workers' compensation attorneys and workers are not required to pay upfront; attorneys work on contingency, receiving a percentage of the award if you win. Contact the New York Workers' Compensation Board's office or visit wcb.ny.gov for an attorney referral.