The document provides an overview of New York workers' compensation law, outlining who is covered, the claims investigation process, benefits provided, and reasons for denial of claims. Key aspects of the claims process are explained, including initial reporting of accidents, medical treatment and forms, employer responsibilities, and ongoing payments. Potential issues like consequential injuries and the appeals process are also briefly discussed.

1. NYS Workers Compensation - 101
William S Jones- Jones Jones LLC

2. New York Workers’ Compensation Law
In New York, certain injuries and illnesses that occur while an employee is
on the job qualify for workers’ compensation benefits.
-“Injury” and “personal illness” mean only accidental injuries arising out of and in the
court of employment
- While the injury may be physical, or at least in some circumstance mental, there must
be some direct relationship between the injury or disease and the employment
- Liability for workers’ compensation benefits are imposed on the employer without
regard to the existence of fault, however, the employer’s liability to the injured
employee generally extends no further.

3. So, Who’s Covered?
Today, virtually all employees, other than casual
laborers, babysitters, real-estate brokers, and certain
other sales associates, are covered under the New
York Workers’ Compensation Law.
*Additionally, independent contractors are not
entitled to workers’ compensation benefits unless
covered by their own policies of insurance

4. The Initial Investigation
ANCR – The foundation for each and
every claim! But what does this mean??
1- A = Accident
2- N = Notice
3- CR = Causal Relationship

5. Things to look for when investigating a claim
• Was the accident witnessed?
• Was the accident reported immediately?
• Who was first notice given to?
• On what day did the accident occur and how long was the claimant employed?
• Did all the facts and events make sense?
• Was the claimant known to be disgruntled?
• Was the claimant treated for this accident and/or a similar injury or illness in the past?
What if something doesn’t add up… What then??

6. Denial Of a Claim
• Coverage
• Arising In and Out of Course of employment
• Employer-Employee Relationship
• Notice & Timely Claim Filing
• Lack of Prima Facie Medical Evidence

7. The Life of a Claim
The worker obtains the
necessary medical treatment and
notifies his/her supervisor;
Notifies the employer, in
writing, within 30 days; The
employee files a claim with the
Board on Form Employee Claim
(C-3)
The doctor completes a
preliminary medical report on
Form Doctor's Initial Report (C-4)
The employer reports the injury
to the Board and the insurance
company on Form Employer's
Report of Work-Related
Injury/Illness (C-2)
The insurer provides the injured
worker with a written statement
of his/her rights under the law.

8. If the claim is accepted (C-669) the
insurer begins payment of benefits if lost
time exceeds seven days. If the claim is
being disputed (C-7 and PH-16.2) , the
insurer must inform the Workers'
Compensation Board and
claimant/representative.
The insurer continues to make payments
of benefits to the injured employee (if the
case is not being disputed). The board
must be notified of any changes in
payment (C-8.6).
The doctor submits progress
reports on Form Doctor's Progress
Report (C-4.2) to the Board.

9. Finally! Our world is safe and our claims are under
control… Right?

10. Consequential Injuries: Wait a minute… What?
What are Consequential Injuries?
- A consequential injury is an injury that occurs as a
consequence of the original work related injury.
- Consequential injuries come in many varieties from the obvious to subtle. *There is even case
law that says that if a claimant goes to a doctor or therapist for an appointment to treat a
Workers’ Comp injury and is injured, on the way to or from the appointment, the injuries thus
sustained are considered “consequential” to the original injury and are added to the original
Workers’ Compensation injuries.*
- The claimant needs to produce prima facie medical evidence of the consequential injury.

11. A Solid Foundation for your defense
Anything that is reasonable and in Matters that Matter
good faith
Matter of Jaquin v. Community Covenant Church , 2010 NY Slip
Lack of casual relationship Op 33, Jan 7, 2010 and Matter of Kot v. Beth Ameth Home
Attendant, 2010 NY Slip Op 773 Feb 4, 2010
Not Arising Out of and in the Matter of Zahm v. National Fuel, 2010 NY Slip Op 3018 April
15, 2010 and Matter of Bigelow v. Wpac Prods., Inc. 2010 NY Slip
Course of Employment Op. 8665 Nov 24, 2011
Matter of Yarleque v. Sally Lou, Inc. 2010 NY Slip Op 4072, May
Time Bars 13, 2010 and Matter of Lavigne v. Peru Central School
District, 2011 NY Slip Op 2089; March 24, 2011

12. For additional Workers Compensation
Information, please visit our new Webpage
@ WWW.JONESJONESLLC.COM