The workers’ comp process in New York. What happens, and when.

A New York WC case has six stages. Here is what each one means.

Stage one is filing. The carrier has 18 days after receiving the first medical report (C-4) to accept or deny your claim under § 25. If they accept, benefits begin and medical bills are paid. If they deny, the case goes to a hearing before a Workers’ Compensation Law Judge (WCLJ). Most cases are first scheduled for hearing within 60 to 90 days of the C-3 filing date.

Stages two and three are the hearing phase and independent medical exams (IMEs). The carrier can send you to their own doctor — called an IME — at any point. The IME doctor’s opinion often differs sharply from your treating doctor’s opinion. The WCLJ weighs both sides, along with your wage records, to set your weekly benefit rate under § 15. Hearings are held at regional Workers’ Compensation Board offices across New York and typically last 30 to 60 minutes each.

Stage four is maximum medical improvement (MMI). When your doctor says you have recovered as much as you will, the case moves to permanency. Your treating doctor files a Form C-4.3 rating the loss of function in the injured body part as a percentage. The carrier’s IME doctor files their own rating. The WCLJ issues a schedule loss of use (SLU) award using statutory week values under § 15(3), or the parties negotiate a lump-sum Section 32 settlement under § 32.