New York requires all businesses to have workers comp for employees, with only a few exceptions.
Workers compensation insurance generally pays some lost income and the medical bills for a worker who's hurt while doing a job-related task. The types of work injuries that can be covered by workers comp might include breathing problems, carpal tunnel and muscle injuries.
New York workers compensation law defines many details on the limits of workers comp payments, as well as who must be covered and who can be exempt from coverage. Below are many of the specifics contained in the workers comp law in New York. The New York Workers' Compensation Board also has a page with helpful information for employers.
Who must be covered by New York workers comp insurance
Can any employees opt out of New York workers compensation with a waiver?
Yes - corporate officers who hold all offices and owns all stock can elect to be excluded from coverage. A sole proprietor can elect whether or not to be covered by the policy for all employees.
Is self-insurance for workers comp allowed in New York?
Yes, for individual employers and groups of employers.
Political subdivisions that were in existence prior to March 31, 2011 and meet certain criteria can self-insure. Political subdivisions in New York are typically the state or a city, county, special district, school district or public agency.
By self-insuring, a business assumes responsibility for paying their own workers comp claims. A self-insured company typically hires a claims service company to handle claims administration and other services.
Are there exclusions for:
Small employers? No.
Agricultural employers? Yes, if an employer pays less than $1,200 in wages.
Domestic employers? Yes, if an employee works less than a certain amount of time.
Independent contractors? Yes.
Casual employees? Yes.
Volunteers? Yes, volunteers for non-profit organizations who receive no compensation are excluded from coverage. Compensation includes stipends, rooms, board and other perks that have monetary value.
Professional athletes? No.
New York workers comp medical benefits
Is there a New York workers comp fee schedule?
Yes.
Fee schedules define payments for surgery, radiology, hospital services, chiropractic care, ambulance service, prescription drugs and other medical services for an injured worker.
Are there limits on medical treatment?
Yes.
Prior-authorization must be requested for surgery, physical and occupational therapy, and certain tests that cost more than $1,000, unless pre-authorized as part of the medical treatment guidelines for the mid and low back, neck, shoulder, knee, carpal tunnel or non-acute pain.
Who makes the initial choice of treating physician?
The employee, from a list of providers authorized by the workers compensation board. However, if the employee is part of a PPO plan at work, the employee must choose physicians from within the PPO.
Disability payments for workers in New York
Workers comp usually pays a portion of lost income for an employee who can't work because of a job-related injury. Based upon both permanent and temporary disability, state law specifies the amount and length of disability payments.
How are temporary total disability (TTD) payments calculated?
66 2/3% of the employee's pre-injury wage, subject to a minimum and maximum.
Weekly minimum: $150, unless employee's wages are less than $150, then the employee will receive full wages.
Weekly maximum: $844.29
Maximum length of TDD benefits: For the duration of total temporary disability.
How are permanent total disability (PTD) payments calculated?
66 ⅔% of the employee's pre-injury wage, subject to a minimum and maximum.
Weekly minimum: $150, unless employee's wages are less than $150, then the employee will receive full wages.
Weekly maximum: $844.29
Are there cost of living increases for PTD payments? No.
Maximum length of PTD benefits: Benefits are payable for the length of disability and may be paid for life.
How are permanent partial disability (PPD) payments calculated?
For scheduled PPD benefits, 66 ⅔% of the worker's pre-injury average weekly wage multiplied by the appropriate number of weeks based on the percentage loss of use for the particular body part.
For non-scheduled PPD benefits when the employee is not working, the basis is 66 ⅔% of the difference between the pre-injury average weekly wage and the employee's wage-earning capacity as agreed to by the parties or determined by the workers' compensation board. However, if the employee is working, the employee will receive PPD benefits equal to ⅔ of the difference between the pre-injury average weekly wage and the post-injury wages. Unless the worker earns less than $150, then employee receives full wages.
Weekly minimum: $150, unless employee's wages are less than $150, then the employee will receive full wages. However, if the employee who earns less than $150 is working, the employee will receive the difference between the pre-injury average weekly wage and the post-injury wages.
Weekly maximum: $844.29
Fatality benefits under New York workers compensation law
Maximum burial benefit: $5,000 to $6,000, depending on the county.
Dependency benefits, weekly minimum / maximum: $30/$844.29
When do children's dependency benefits end? At age 18; age 23 if the child is a student; benefits can continue if child when the physical disability ends.
Other injuries covered by New York workers compensation
Mental stress with no physical injury? Yes.
Cumulative trauma (such as injuries caused by repeated exposure or repetitive motion)? Yes.
Occupational hearing loss? Yes.
Disfigurement? Yes.
Source: Workers Compensation Research Institute, May 2016 report