The workers' compensation and employers liability policy and the general principles of no-fault benefits and exclusive remedy are covered in the national Workers' Compensation guide. New York's rules are in the Workers' Compensation Law (WCL), not the Insurance Law. This guide covers who must insure and how, the grave injury exception, benefits and deadlines, and penalties. New York's statutory disability benefits and Paid Family Leave, which are part of the same law, are in the New York Disability Income Insurance guide.

Who must insure, and how

• Nearly all employers must secure workers' compensation for their employees (WCL 10). Sole proprietors and partners with no employees may be exempt (WCL 2, 3).
• Household workers: domestic workers employed by the same employer at least 40 hours a week must be covered (WCL 3, Group 12). The homeowners endorsement HO 24 93 (Workers Compensation, Certain Residence Employees, New York) adds this coverage to a homeowners policy.
• An employer secures coverage in one of three ways (WCL 50):
  • a private insurer,
  • the New York State Insurance Fund (NYSIF), or
  • approved self-insurance.
• NYSIF is a state-run insurer that competes with private carriers and also covers employers who can't get coverage elsewhere (WCL 76). It writes statutory disability benefits coverage too. New York is not a monopolistic state.
• Premiums are based on payroll by job classification, adjusted by the employer's experience modification.

Exclusive remedy and the grave injury exception

• Workers' compensation is the employee's exclusive remedy against the employer (WCL 11).
• A third party sued by the injured worker can't bring the employer into the case unless the worker suffered a grave injury. The list is specific. It includes death, permanent and total loss of use or amputation of an arm, leg, hand or foot, loss of multiple fingers or multiple toes, loss of an index finger, paraplegia or quadriplegia, and total and permanent blindness or deafness. Losing a single toe isn't a grave injury (WCL 11).
• Uninsured employer: the injured employee may choose a compensation claim or a lawsuit in which the employer loses its common-law defenses (WCL 11).

Benefits

• Waiting period: no compensation for the first 7 days, except medical care. If disability lasts more than 14 days, compensation is paid from the first day (WCL 12).
• Temporary total disability: 66 2/3% of the average weekly wage, up to the weekly maximum (WCL 15(2)).
• Benefits are classified as temporary or permanent, total or partial (WCL 15). Workers' compensation doesn't pay pain and suffering.
• Death benefits include a share of wages and funeral expenses for surviving dependents (WCL 16).

Deadlines and records

• Employee notice to the employer within 30 days. Late notice may be excused if the employer knew or wasn't harmed by the delay (WCL 18).
• Claim within two years of the accident, or for an occupational disease, two years from knowing it was work-related (WCL 28).
• Employer report within 10 days after the accident. Not reporting is a misdemeanor (WCL 110(2)). The injury record is kept at least 18 years (WCL 110(1)).
• Injuries not required to be reported don't affect the experience modification when the employer pays the treatment cost itself (WCL 110(3)).

Penalties for not insuring (WCL 52)

• Failing to cover five or fewer employees is a misdemeanor. Failing to cover more than five is a class E felony. Fines escalate.
• A corporation's president, secretary and treasurer are personally liable, unless they show they took reasonable steps.
• Intentionally understating payroll or misrepresenting employees' duties counts as failing to secure compensation.
• The Board can also issue stop-work orders (WCL 141-a).

Off-the-job injuries

Injuries and illnesses that aren't work-related are covered by New York's Disability Benefits Law (WCL Article 9), not by workers' compensation. See the New York Disability Income Insurance guide.

Common exam traps

• Three ways to insure: private carrier, NYSIF or self-insurance. NYSIF competes; New York isn't monopolistic.
• Grave injury is the only way a third party can bring the employer into a lawsuit.
• 7-day waiting period, paid back if disability lasts more than 14 days.
• 30 days for employee notice, 2 years to file a claim, 10 days for the employer's report.
• More than five uncovered employees is a felony.
• Domestic workers on 40 or more hours a week must be covered.