A guide to filing workers' compensation claims for on-the-job accidents

Nearly 16 years ago, Greg Cody, an eighth grade social sciences teacher, injured his right shoulder while breaking up a fight between students at school.

The Massapequa Park resident said he needed multiple surgeries over the years.

He applied for workers' compensation through his employer's insurance provider, which paid for his initial treatments and surgeries.

But Cody, 54, said he sought approval for another medical procedure in March related to a workplace knee injury, which was denied by the insurer, according to his attorney.

The process is "extremely, extremely frustrating," Cody said.

Legal experts say navigating the workers’ compensation system is sometimes challenging given the complexity of laws and statutes. 

"There’s a lot of rules, there are statutes involved and it may not be the most friendly to an injured worker," said Justin B. Lieberman, an attorney specializing in workers’ compensation cases at Terry Katz & Associates in Uniondale. 

Here are seven things to know about what is covered under workers' compensation and how to apply for benefits.

What is workers' compensation insurance?

Workers’ compensation insurance provides cash benefits and medical care for workers who are injured or become ill as a direct result of their job, according to the New York State Workers’ Compensation Board, which oversees the program. Cash benefits and medical care costs are covered by the employers' workers' comp insurance carrier, not public funds.

"When someone is injured or becomes ill on the job, they should never hesitate to file a claim with us here at the Workers' Compensation Board," board chair Freida D. Foster said in a statement. "Our mission is to ensure the proper delivery of medical treatment and lost wage benefits for those who qualify." 

As of last year, the state board received and processed 165,320 claims, down slightly from the 169,961 new claims processed in 2023, according to annual reports from the board.

What should I do first if I’m injured on the job?

Employees should immediately notify their employer of any injuries and promptly fill out an accident report, said Jonathan Klee, a workers' compensation attorney and managing partner at Klee Woolf Goldman & Filpi, LLP in Mineola, who represented Cody in his claims.

"Preferably, the notice should be in writing in order to be able to prove that proper notice was given," Klee said.

Klee cautioned that misrepresenting injuries, such as saying the injury occurred off the clock or vice versa, could result in denial of benefits. 

Injured workers should file a C-3 form, which can be obtained from the Workers' Compensation Board website. They must submit their employer's name and address, their pretax wage amount per pay period and the name and address of the doctor or hospital that provided initial treatment following the injury or illness.

What's the timeline on filing a report?

Workers have two years to file a claim from the day of the accident, Lieberman said. "But you also have to give notice to your employer, and that’s within 30 days." 

For conditions or illnesses that develop over time as a result of the job, Lieberman said, the timing requirements can vary since it could take years before illness.  

Who qualifies for workers’ compensation?

All employers, part time or full time, are required to have coverage for their employees, according to the state.

And all injuries, as long as they occur on the job and the worker is eligible, are covered under workers' comp, Klee said. 

An employee, according to the Workers' Compensation Board, is someone who performs "under the supervision, direction, and control of an employer either on or off their premises." 

Independent contractors and sole proprietors typically are not eligible for benefits and are responsible for their own insurance coverage, unless they were under the supervision of another contractor, according to the board. 

How much does workers’ compensation cover?

The total cash benefits depends on both a recipient's average weekly wage before the accident and the severity of the injury or illness, according to the board website.

Workers who receive cash payments can get up to two-thirds of their average weekly wages up to a maximum cap set by the state every July 1. As of 2025, the cap is $1,222.42, according to the board.

Claimants can receive benefits for up to 525 weeks for "loss of wage earning capacity of greater than 95%," according to the board. More severe permanent injuries can result in lifetime payments.

What kind of workplace injuries are covered by worker’s comp?

Injuries fall into two basic categories, according to the state.

One covers injuries that spring from a one-time incident, such as an employee lifting a heavy box and throwing out their back or a worker getting a hand caught in a piece of machinery, Klee said.

The second covers occupational disease, which refers to "any illness or condition associated with a particular occupation or industry," according to the board. For example, long-term exposure to asbestos or the development of carpal tunnel syndrome due to years of typing would fall under occupational diseases.

Under workers' comp law, "no one party is determined to be at fault" for a workplace accident, and the amount of money a claimant might receive is not impacted by carelessness on their part, according to the state board. 

However, workers who were injured because they were intoxicated from drugs or alcohol or because they intended to hurt themselves lose their right to claim benefits, according to the board.

How can employees navigate challenges?

Challenging denials of treatment or appealing denials of workers' comp benefits can be a lengthy process, experts said.

If an employer contests a claim, that can extend the approval process.

"It could be months or over a year depending on how complicated the situation is," Lieberman said.

If a claim is denied, injured workers can use their own health insurance to cover medical expenses, though the process may require documentation of the denial, according to the state. 

Cody said he is still waiting for insurance to approve treatment for an MRI of his knee and only recently successfully appealed a denial of coverage for a shoulder procedure, his attorney said.

"I began this process in March, and it's almost seven months later and I’m still at step one," he said.

"It’s a very convoluted system to take on yourself," Lieberman said.