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An injured worker files a claim with the New York State Workers’ Compensation Board (WCB or “the board”). The WCB has judges who sit and hear cases in various boroughs and counties throughout the state. In New York City, hearings are held in Brooklyn, Queens, Manhattan and Staten Island.

Compensation cases may be straightforward in the beginning but later become complicated. Your doctor may be requesting an MRI or surgery which the insurance company is hrefusing to authorize and pay for. Your cash benefits may be cut or stopped because the insurance doctor says you can work, even if your doctor says you are not yet able to return to work. To win your case and get paid, you need to do certain things right. Here are sixteen of them:

1. CALL AN AMBULANCE
If you are hurt on the job and you need an ambulance, call one. To establish your case, you have to show that you had an accident on the job (ACCIDENT), that you informed your employer (supervisor or boss) of the accident within 30 days (NOTICE), and that you suffered injuries as a result of the accident (CAUSAL RELATIONSHIP). ACCIDENT + NOTICE + CAUSAL RELATIONSHIP (ANCR) = COMPENSATION CASE. An accident is just that: an accident. You do not have to prove that anybody was at fault. Timely notice is required, so that your employer can also notify its insurance company in time for them to investigate. Here is how to establish ANCR.

Accident: An ambulance call report is one of the easiest ways to prove an accident on the job. The report will have such information as the place from which you were taken, the time, your injuries, and the hospital to which you were taken. If you are involved in a job related motor vehicle accident (MVA), a police accident report (MV-104) serves a similar purpose. Some workers hrefuse to call an ambulance and instead go to the hospital by themselves or in a friend’s car. This could make your case more difficult to prove. Your employer’s insurance company will pay the ambulance bill so do not hesitate to call one if you need it.

2. TELL YOUR SUPERVISOR OR BOSS
Notice: The law requires that you inform your employer (supervisor or boss) of the accident in writing within 30 days. The Judge will give you a break if you told your supervisor but did not put it in writing. Not telling your supervisor or boss may however, cast doubt on your claim. Because it is possible for you to be injured anywhere, including your home, the Judge may not believe that you were injured at work. So remember-when you are injured at work to tell a supervisor. Also write down and keep the names of witnesses to the accident. Give their names to your lawyer when you go to file your claim.

3. LIST ALL YOUR INJURIES
Causal Relationship: Causal relationship means that the injuries you are claiming compensation for were caused by the job accident. The insurance company will only pay compensation and medical bills for injuries caused by the work accident. You or your private health insurance is responsible for all your other health problems. As an example, let us say you slipped and fell at work and injured your knees. The insurance company will only pay for medical treatment to your knees. Unless you can show that you also injured your back in the fall, they will not pay for any treatment to your back. This means that you must make sure your medical reports list all the injuries you suffered in the accident.

4. SAY YOU WERE INJURED AT WORK
Judges and insurance companies review medical reports to see if they say that you were injured at work. If you are taken to a hospital and you are conscious, tell the staff that you were injured on the job and describe the accident so that they can put these in their report. It is important for your medical reports to state that you were injured at work. Mention all your injuries to the doctors and emergency room (ER) staff, although in most cases, if your visit is to the ER, they will only diagnose and treat your most serious injuries. For that reason, it is very important that you see a compensation doctor as soon as you leave the hospital.

(To be continued)

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