Under New York state law, businesses are legally mandated to carry workers’ compensation insurance and can buy it through private providers, the state insurance fund or self-insuring.
Small business owners can save money by accurately classifying their employees. Misclassification may lead to costly workers’ comp premiums; New York employers can quickly verify coverage using our free search tool online search.
Policy Exclusions
New York state laws mandate workers’ compensation (WC) coverage for most businesses employing employees. The Workers’ Comp Board oversees this policy, providing details regarding eligibility for coverage and premium rates as well as purchase options such as private insurance carriers or the New York State Insurance Fund (NYSIF) – or approved businesses may self-insure if approved.
Employers that offer workers’ comp insurance generally do so because they understand its importance for employees injured on the job or who become sick as a result of work-related incidents and illnesses. Not only can workers’ comp help cover medical bills but it may also provide income benefits that help replace lost wages.
Workers’ comp policies cover various injuries and illnesses, such as eye injuries, musculoskeletal conditions and mental health problems. Workers’ comp does not exclude coverage for harm caused by drug or alcohol consumption. Sometimes employees must submit to an independent medical examination (IME), with a physician chosen by either their employer or insurer.
When an employee experiences work-related injury or illness, it’s essential that they immediately report it to their supervisor in order to file all necessary paperwork and have their injury assessed appropriately. Furthermore, it’s essential that they visit their medical provider promptly so they can document its severity.
Employers that fail to comply with workers’ compensation insurance requirements in their state could be subject to fines, penalties and lawsuits from injured employees. To reduce this risk, many states require employers to display notices informing employees about available WC coverage options for them. If you want to know whether your employer meets this standard, New York offers an online tool which will verify coverage easily: Simply input your business name, FEIN/SSN and state.
Coverage Limits
If an employee is injured on the job, workers’ compensation insurance companies provide medical care and part of their lost wages as benefits. Benefit amounts vary by state; some have per-occurrence or per employee limits while others set specific weekly maximums for temporary disability benefits. A workers’ comp policy typically covers costs such as hospitalization, surgery and physical therapy as well as some rehabilitative treatments to aid a return to work such as job coaching or assistive devices.
Workers’ compensation policies do more than cover injured workers; they also help employers protect against costly litigation. Employers in many states are required to carry a workers’ comp policy for all employees; it can often bankrupt smaller companies, so having coverage provides businesses with an effective risk mitigation solution at an affordable premium rate. It’s crucial for business owners to understand how costs are calculated and their potential impact on a business’s bottom line.
Workers’ comp insurance policies fall under property and casualty insurance and should be treated as separate expenses from payroll costs, making tax return deductions possible. Policy costs depend on several factors including estimated payroll wages, class codes and states covered. It can be complicated to determine the optimal options for your business – to help make your selection process smoother we recommend partnering with an experienced insurance specialist to find what’s right for your organization.
New York provides small business with access to its State Insurance Fund or Assigned Risk Pool as an alternative source for coverage if they do not have access to private policies, as well as the option to become self-insured through direct payment of claims directly. We can assist your organization in meeting state mandates while avoiding penalties due to noncompliance.
New York state provides a free online tool that allows anyone to search by business name or FEIN to check whether a valid workers’ compensation insurance policy exists for that company. The tool displays details on all verified coverage within New York including business name, insurer and policy number for any coverage found.
Payment Options
Since 1914, most New York employers are required to carry workers’ compensation insurance. This coverage reimburses lost wages when an employee is injured on the job as well as medical treatment related to that injury and can even provide death benefits if their loved one dies on the job. To qualify for these benefits, employees must report injuries within ten days and file claims with authorized providers within fourteen days; once claims have been filed and treatment sought.
Employers must provide workers’ comp coverage to all full-time, part-time and temporary employees working for them, including contractors, volunteers and family members. Only certain groups are exempt from workers’ comp, such as uniformed police and fire department personnel, teachers, seamen longshoremen and federal government employees – sole proprietors who don’t employ anyone can opt out under certain conditions.
Some businesses opt to become approved self-insured rather than pay premiums to a third-party insurer for workers’ compensation benefits, taking on financial risk themselves rather than paying premiums monthly. Once approved as self-insured employers must post a security deposit (bond, credit or cash) with the state in order to cover potential claims against them; cities, counties, school districts and some local governments fall within this “local government self-insurance fund.”
If an employer cannot obtain or afford workers’ compensation insurance, applying for a NYSIF policy might be their only solution. While the application process can be dauntingly complex, applicants are evaluated on several criteria such as class codes assigned to their business, estimated payroll, covered states and past workers’ comp claims. Our team can help guide this complex process so your business remains adequately covered.
No matter your coverage: private insurer, NYSIF, or self-insured; both workers’ comp carriers and employers have financial incentives to deny or limit claims since this reduces costs and helps boost profits. If you suspect your employer of cutting corners by withholding payments to valid claims, our attorneys can review evidence on your behalf and file an appeal on your behalf.
Balance Billing
Insurers enter contracts with healthcare providers to negotiate rates and only cover specific services that fall under their coverage. Providers in-network are required to accept this payment as full (minus any applicable copays, deductibles or coinsurance payments) without further charging the consumer; however out-of-network providers can still bill consumers for services not covered – known as surprise balance billing.
Certain states have laws against balance billing; however, balance billing in most instances is legal unless an in-network provider charges more than their contracted rate and refuses to negotiate it with you. Furthermore, balance billing may also be legal if you have Medicare or Medicaid and visit an out-of-network provider who accepts assignment from either of these insurance plans but then charges you more than allowed under their contract with these providers.
Patients can take steps to lower their exposure to balance bills. First, contact the provider and notify them that you intend on disputing it – this helps ensure your bill won’t go to collections while under dispute. Furthermore, asking for a payment plan or writing off part of it could help. Many providers are willing to work with patients who are having trouble paying their bills.
When an unexpected balance bill appears, it is wise to file a claim with your workers’ compensation insurer immediately. Your insurer can then communicate with the provider to negotiate and potentially reduce or waive it altogether – saving both of you money in the process.
The Congressional Budget Office estimates that cutting balance billing by one percent could save patients up to $2 billion in reduced out-of-pocket costs, providing an affordable path towards universal health coverage. Yet more needs to be done.
