If you are injured while on the job, the following steps should be taken immediately in order to qualify for workers’ compensation benefits:
- Inform your supervisor of your injury and the way in which it occurred.
- Seek medical attention as soon as possible. Unless the injury requires a trip to the emergency room, the treating physician must be authorized by the Workers’ Compensation Board (i.e., do not seek treatment from your primary care physician unless your physician also happens to be a board-certified workers’ compensation physician). To find a participating workers’ compensation physician, please call the New York State Workers’ Compensation Board – (800) 781-2362 – or view their website.
- Obtain from your payroll secretary/timekeeper the following forms:
- Claimant Information Packet (includes Employee Claim (C-3 form)) mployee’s Notice of Injury (WCD 23 form)
- Comprehensive Injury Report (administrative employees only) Election of Rate of Charge Against Annual and/or Sick Leave Balances for Absence Due to Injury Sustained in the Performance of Official Duties (DP 2002 form) (only if you are absent six or more days following the accident)
- Complete all forms found in the Claimant Information Packet and mail them to the New York State Workers’ Compensation Board district office as soon as possible but no later than two years from the date of the accident. The mailing address is:
New York State Workers’ Compensation Board
Centralized Mailing Address
PO Box 5205
Binghamton, NY 13902-5205
- Complete and return the other forms and submit them to your payroll secretary/timekeeper.
Injured employees who fail to inform their employer in writing (i.e., by submitting the documentation listed above) may lose their right to workers’ compensation benefits.
Absences Relating to Workers’ Compensation Injuries
The date of the accident: This is a regular paid day regardless of what time your injury occurred.
Five consecutive days following the date of the accident: Following the date of the accident, you may apply to receive up to five consecutive working days off; you will be paid for these days and the absences will not affect your accrued annual leave or paid sick leave balances. In order to be eligible, obtain a doctor’s note, recommending that you do not return to work, and complete one of the two following forms, as appropriate:
Once completed, have it signed by your principal/supervisor and then submit it, along with the doctor’s note, to the appropriate person or office:
- School-based Employees: Submit the OP 198 form and doctor’s note to your payroll secretary
- Administrative Employees: Submit the PD 19 form and doctor’s note to your timekeeper.
By signing the form, your principal/supervisor is excusing your absence(s) and your accrued annual leave or paid sick leave balances will not be reduced.
Six or more absences following the date of the accident: If you are absent six or more days following the work-related injury, you have two options:
- Option 1: Provided you have enough vacation or sick time accrued, you may elect to use these balances to cover the absences. To do this, inform your payroll secretary/timekeeper of this decision and provide a doctor’s note, indicating that the time off is related to the work injury.
You may be eligible to have your used vacation or sick time restored. Keep track of these days and once all accrued time has been used (or you have fully returned to work), contact your benefits examiner to report the use of your paid vacation or sick time. You may be asked to attend a hearing to determine this matter. Restoration is based on the degree of your disability and your rate of pay. If restored, you will likely receive only a portion of your used vacation or sick time; full restoration of vacation or sick time is determined on a case-by-case basis.
- Option 2: If you choose not to use your accrued time off (or if you do not have accrued time to use), you will not receive pay for days not worked. Consequently, if you participate in direct deposit, this benefit will be cancelled. By selecting this option, you must formally apply for a leave of absence without pay . The maximum time allowed for leave associated with a workers’ compensation case is one year. During this period of unemployment, you will receive reimbursement of wages from the New York City Law Department. The weekly rate is determined by the New York City Workers’ Compensation Board.
Applying for a Leave of Absence Without Pay for Workers’ Compensation
If you are considering applying for a leave of absence without pay, you should be aware of the following:
- Once you begin your approved leave, you will no longer receive a pay check from the DOE. Pay from the DOE will not resume until you return to work.
- If you are currently enrolled in direct deposit, it will automatically be cancelled.
- The maximum time allowed for a workers’ compensation-related leave of absence is one year.
- You will be reimbursed for the days you are absent without pay. This pay, the amount of which is determined by the New York State Workers’ Compensation Board, will be issued by the New York City Law Department’s Workers’ Compensation Division.
In order to ensure you receive wage reimbursement benefits from the New York City Law Department, you must do the following:
- Once your leave of absence is approved, contact the DOE’s Workers’ Compensation Unit – (718) 935-2213 – to make it aware of your effective leave date.
- Forward a copy of your doctor’s note to your examiner at the New York City Law Department. This note must state the effective date that you are unable to work and that your inability to work is related to your workers’ compensation claim.
To request a leave of absence without pay, complete one of the following forms, as applicable:
Depending upon your personal circumstances, your payroll secretary/timekeeper may recommend completing one or more of the following forms as well:
Once all documentation is collected, your payroll secretary/timekeeper will submit it to HR Connect for processing. A determination letter will be mailed to you once your leave application has been processed.
‡ The EB 1054 form is used by paraprofessional to apply for Special Leave of Absence Coverage (SLOAC). If you are an administrative employee, the HR Connect Leaves Unit will check your eligibility for SLOAC automatically; there is no need for these titles to apply. SLOAC entitles eligible employees up to a maximum of 18 weeks or 4 months (depending on pay cycle) of health benefits coverage in a 12-month period during unpaid leave resulting from a work-related injury. Without the submission of the EB 1054 form, a paraprofessional’s health benefits will terminate once the employee is removed from payroll and placed on unpaid leave. Once SLOAC benefits expire, all employees, regardless of title, may apply for COBRA to extend their health benefits coverage.
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