Understand the Claims Process in Workers’ Compensation Cases

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Robert Golan

To ensure that claims are obtained in Queens Workers’ Compensation, after receiving medical treatment, it is an imperative to speak with a manager or administrator to discuss the incident and how the injury happened.

You have to act promptly. An employer should receive the documented information within one month of the incident for which a claim is being filed. Submitting in writing is the best way to handle this.

Once all the forms are complete in the workplace, it is time to file with the Board on Form Employee Claim (C-3). Send all appropriate forms and documents to the Board District Office that will handle the current claim. After two years, you will not receive Queens work injury compensation if the claimant (employee) has been aware the injury is related to work. Review the claims process below, according to the New York State Workers’ Compensation Board.

Within 48 Hours

A healthcare professional should be visited to complete an Initial Report (C-4). The doctor should then mail it to the corresponding district office. The employee filing the claim should also ensure that a copy has been sent to their employer, their insurance company, whomever handles their legal proceedings, and a copy for their own records.

Within 10 Days

By this time, the employer of the claimant should have had time to report on the accident to both company administrators and insurance carriers. This should take no longer than 14 days after submitting the Form Employer’s Report of Work-Related Injury/Illness.

Once the insurance provider has received the Employer’s Report of Work-Related Injury/Illness the claimant should receive a written statement of rights from the insurer by the time their first check is received or two weeks has passed. Any other requirements for coverage should also be received at this time.

Within 18 Days

Claimant should be starting to receive money and benefits for time lost if it has accrued to seven days. Disputed claims must be reported by the time to either the Queens Workers’ Compensation Board as well as the claimant and their legal advisor. Refusal of payment and benefits must be stated on any notices received or all parties must be notified.

The Workers’ Compensation Board handling the claim will receive information in writing about the beginning of compensation or the denial of it. If the employee does not file their claim promptly, this information may be stored promptly.

Every 2 weeks

Benefits will be receive by the injured claimant. Any modifications or stopping of benefits and payment must be reported to the board.

Every 45 days

Injuries that quality for compensation this long will require a healthcare professional to report the claimants progress on Form Doctor’s Progress Report (C-4.2) to the Board.

After 12 weeks

The insurance provider involved with handling the claim will re-evaluate the claimants need for medical treatment and payment or benefits.

Claims not filed within this time period may be subject to loss of rights or compensation for any Queens work injury compensation.

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