Claimant FAQs

When do workers' compensation benefits apply?

When an employee is injured in the course of his/her employment and requires medical treatment, and/or loses wages as a result of the work-related injury, workers' compensation benefits are paid by NYSIF on behalf of the injured worker's employer.

What workers’ compensation benefits am I entitled to for an injury I sustained in the course of employment?

You are entitled to medical benefits and compensation benefits. Medical benefits may include hospitalization, doctor services, dentist services, physical therapy, chiropractic treatment, x-rays, laboratory tests, nursing service, durable medical goods and prescribed drugs. Compensation benefits are two-thirds of the average weekly wage in New York State, subject to statutory maximums. An injured worker may collect compensation benefits to replace lost wages due to job related disablement. Compensation benefits are not paid for the first seven calendar days of the work related disability, unless the disability extends beyond 14 calendar days.

If an injured worker dies from a job-related injury, the surviving spouse and/or minor children or, lacking such, other dependents as defined by law, are entitled to death and survivor benefits. Funeral expenses are payable up to statutory maximums.

How do I file a report of injury or illness?

If you are injured on the job, you should immediately tell your supervisor and your employer when, where and how you were injured. Your employer a Report of Work-Related Accident/Occupational Disease with the Workers' Compensation Board (WCB) and the workers' compensation insurance carrier.

You will file Form C-3, “Employee’s Claim for Compensation,” with the WCB. Providing a copy of your C-3 to your employer's workers' compensation insurance carrier is helpful because it describes what happened in your own words and identifies the treating medical providers you have chosen. New York State law requires Form C-3 to be filed with the WCB within two years from the date of accident, or from the date the medical condition is known, or should have been known, to be caused by an occupational disease.


What is the Workers’ Compensation Board (WCB) case number?

The WCB manages records and hearings for claims made by claimants by using a unique WCB number for each individual case. The WCB case number is different from the carrier case number. A carrier case number (CC#) is a unique identifier created by insurance carriers to identify, process and pay your claim. NYSIF’s carrier case number is also referred to as NYSIF’s case number, your claim number, or your loss ID.

NYSIF’s case number typically has eight digits and a hyphen (-) followed by three digits. The last three digits typically represent the claim unit assigned to handle your claim. Example: NYSIF case number is: 12345678 – 249. The claim unit assigned to handle your claim is unit 249. Claimants should always use their NYSIF case number when contacting NYSIF.

Use the NYSIF claim number when communicating with NYSIF and the WCB case number when communicating with WCB.

How do I submit requests for reimbursement from NYSIF for prescriptions, durable medical equipment, and mileage and transportation (M&T)?

When claimants submit reimbursement requests to NYSIF for prescription and durable medical equipment, they must include a copy of the prescription from the prescribing doctor and the purchase receipt. For transportation and mileage, they must include the dates of medical appointments, medical providers' names and addresses where treatments were rendered, receipts for tolls and public transportation, and total amount of miles traveled.

Always include your name, the NYSIF case number and the date of correspondence in all communication with NYSIF. Retain copies of all correspondence and receipts sent to NYSIF. You are not entitled to mileage and transportation expenses for attending a Workers' Compensation Board (WCB) hearing.

When is my next compensation benefit check due?

If you receive continuing compensation benefits as awarded by the WCB at a hearing, expect us to issue the next payment no later than two weeks after the last “paid to date.”
 
If you are receiving voluntary payments from NYSIF (before or after a hearing takes place that doesn't mandate continuing benefits) those payments are based on NYSIF receiving continuing medical evidence of disability, so they may not be issued in precisely two-week intervals and/or on the same day within the two-week period.

How do I get my compensation checks directly deposited into my bank account using Electronic Funds Transfer (EFT)?

Contact your case manager to find out if you qualify for EFT.

When does medical care require advance authorization?

Under NYS Workers' Compensation Law, advance authorization must be obtained from NYSIF when medical services, such as specialist consultations, surgical operations, physiotherapeutic or occupational therapy procedures, and any diagnostic tests exceed $1,000.

Your doctor or treating medical provider must submit a medical report to NYSIF that includes date of report, diagnosis, comments regarding causal relationship, what is being requested, and the doctor's signature. If the request is based on the result of a diagnostic test, NYSIF must be provided with a copy of the test results.

Must an injured worker agree to a medical examination when requested by the employer or insurance carrier?

Yes, refusal to submit to an exam may affect the injured worker's claim.

What happens when a claim is contested by the insurance carrier?

An insurance carrier contesting a claim must file Form C-7, “Notice That Right to Compensation is Controverted,” with the WCB within 18 days after the disability begins, or within 10 days of learning of the accident, whichever is greater. The carrier must state the reasons why the claim is not being paid. The issue is resolved by a WC Law judge at a pre-hearing conference or a hearing.

If an injured worker's claim is controverted, the injured worker has the right to make a claim for disability benefits. If a controverted claim is determined to be compensable, the amounts paid to the injured worker by the disability benefits carrier will be awarded to the disability benefits carrier as reimbursement.

May an insurance carrier suspend or modify compensation benefits?

In a case where the carrier has made payments without waiting for a judge's decision, it may suspend or modify the payment based on payroll or medical evidence submitted to the WCB.

What is the penalty for making a false claim?

A person who willfully misrepresents the circumstances of a claim in order to obtain benefits is guilty of a felony.

Is a work-related motor vehicle accident resulting in a compensable employee injury covered by workers' compensation or by automobile insurance?

Workers' compensation coverage is primary to NYS no-fault automobile insurance benefits. A worker injured in the course of employment while operating a motor vehicle, or as a passenger or a pedestrian, typically will be covered by the employer’s workers' compensation insurance for medical and compensation benefits.