Insurers will often accept a claim and promptly begin paying benefits. However, an insurer can dispute a claim for various reasons. It may not agree that you were injured, it may not believe the injury occurred while it provided insurance, or any number of other situations. Board claims examiners and conciliators first attempt to resolve issues. If they can't, the Board will hold hearings in front of a workers' compensation law judge. The judge takes testimony and reviews your medical records and wages. The judge then decides the issue, and sets the amount of any award.
Either side may appeal the judge's decision. This must be done in writing within 30 days of the decision. Three Board members review appealed cases. They may agree, change part of a decision or reject it. They may also return the case for more hearings. Insurers don't have to pay lost wage benefits while the case is being reviewed by the three Board members. An insurer can accept part of a case and appeal another. In that instance, it must pay the accepted part of the award while the case is reviewed. The insurer must pay your wages and medical bills if your award is upheld by those Board members, even if it appeals the case further.
Either side may appeal that decision to the full Board of workers' compensation members. If the full Board takes the case, it will either agree, change or overturn the decision.
Appeals from Board decisions may be taken within 30 days to the Appellate Division, Third Department, Supreme Court of the State of New York.
You always have the right to an attorney or licensed representative, who may not ask for or accept a fee. The legal fee is determined by the Board and deducted from a compensation award.
A Section 32 Waiver Agreement is
Learn more about Section 32 Waiver Agreements.
When there is a request for administrative review and the claimant is represented, parties may wish to explore participation in the Voluntary Binding Review program.