Workers' Compensation

Main Contours of the WCL

1. No-Fault liability for injuries arising out of and in the course of employment

2. Exclusive Remedy for on-the-job injuries; no suits v. employer directly

3. Evolution from ‘hazardous employments’ to all employment

4. Coverage for all employers mandatory

5. Lost wages (and death benefits) tied to your average weekly wage and stat max

6. Permanency benefits for limb injuries, and soft tissue/psych

7. Medical benefits, via authorized providers

8. Accidents and Occupational Diseases

9. Notice and statute of limitations provisions

10. Bespoke provisions for taxis, ride share, farms, domestic employees, etc.

The players

• Parties: Employees, Employers

•  Insurance: Private Carriers, NY State Insurance Fund, Self-Insureds

•  Advocates: Claimant’s and Carrier/Employer’s Bar (Lawyers and LHRs)

•  Health Care: Physicians etc.

•  Adjudicator: NY Workers’ Compensation Board; App. Div Third Dept, Ct. of App.

•  Advocacy Groups: AFL, IWBA, NYS Bus. Cnsl.

•  Regulators:  NYWCB, NY Comp. Ins. Rating Board, Department of Financial Services 

•  Governance:  Legislature and Governor, via Workers’ Compensation Law

•  Applicable Law: WCL, 12 NYCRR 300 et seq., Insurance Law, Labor Law

No-fault Liability/ scope of employment

• Accident (or OD) arising out of and in the course of employment.

•  ‘Purely personal act’

•   Horseplay

•   Intoxication/ intent to harm self

•   Assault

•   Commuting

•   Lunchbreaks, Coffee breaks

 

Exclusive Remedy

• WCL §11

  • Can’t sue employer

  • Third-Party Actions

  • Contribution/Indemnification v employer: unique New York

  • Intentional Torts

  • Attica 1971 Prison Riot

Administrative law

• Workers’ Compensation Board

• Claimant’s bar

• Carriers/ self-insureds

• Workers’ Compensation law judges

• Administrative Appeal to Bd panels

• Full Board review

• Appellate Division, Third Department

• Court of Appeals

Laid off?

Unemployment Insurance (Labor Law

• Off-the-job temporary disability? 

NY Statutory disability benefits (WCL)

- Private disability policy

Car accident

• No-Fault (Insurance law Article 51)

Permanent disability

• Social Security Disability (US Code)

Unpaid, care for yourself or family member

FMLA

Paid, to care for family member, or bond with child

(NY PFL [WCL])

On-the-job disability (temporary, permanent

• NY WCL