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New York Workers’ Compensation Law Reference Chart for Adjusters, Produced by AI

17 Aug, 2025 Frank Ferreri

new york 31503 640
                               

Adjuster Essentials

  • Jurisdiction: Governed by the New York Workers' Compensation Law (WCL).
  • Oversight Agency: New York State Workers' Compensation Board (WCB).
  • Claim Forms: C-3 (Employee’s claim form), C-2F (Employer’s report of injury).
  • Reporting Deadlines: Injury must be reported to employer within 30 days; formal claim must be filed within 2 years.

Core Benefits Overview

Benefit TypeDetails
Medical CareCovers all necessary treatment from authorized providers. No out-of-pocket costs.
Temporary Disability (TD)Up to 2/3 of average weekly wage, subject to state max (e.g., $1,145.43 in 2023).
Permanent Disability (PD)Includes partial and total disability. Based on medical evaluation and Loss of Wage Earning Capacity (LWEC).
Death BenefitsFuneral expenses plus wage replacement to dependents.
Occupational DiseaseCovered if linked to workplace exposure. Must file within 2 years of awareness.

Claims Handling Procedures

  • Initial Steps: Employee reports injury → Employer files C-2F → Employee files C-3.
  • Medical Provider Selection: Must be authorized by WCB. Searchable via WCB Provider Database.
  • IME (Independent Medical Exam): May be requested by insurer. Attendance is mandatory.
ProcessDetails
HearingsConducted by WCB Law Judges.
AppealsTo WCB Panel, then NY Supreme Court Appellate Division.
SettlementsSection 32 Waivers allow lump-sum settlements.
DisputesCommon issues include employment status, causation, and coverage.

Compliance & Penalties

  • Employer Coverage: Mandatory for most employers. Failure to insure can result in $2,000 fines per 10-day period.
  • Regulations: Governed by Title 12 of NYCRR. Includes fee schedules, pharmacy networks, and treatment guidelines.

Resources for Adjusters

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About The Author

  • Frank Ferreri

    Frank Ferreri, M.A., J.D. covers workers' compensation legal issues. He has published books, articles, and other material on multiple areas of employment, insurance, and disability law. Frank received his master's degree from the University of South Florida and juris doctor from the University of Florida Levin College of Law. Frank encourages everyone to consider helping out the Kind Souls Foundation and Kids' Chance of America.

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