New York Workers' Compensation Limits: What You Need to Know

What New York Workers' Compensation Covers

New York's workers' compensation system protects employees who are injured on the job. It covers medical treatment, temporary and permanent disability benefits, and a portion of lost wages. The state sets strict caps on each benefit type, and the amounts are adjusted annually for inflation.

Medical Benefit Limits

Medical expenses are covered up to the statutory maximum of $15,000 per injury, excluding out‑of‑state care and certain dental procedures. After the cap, the employee must pay the balance out of pocket. The law also limits the cost of durable medical equipment and prescription drugs to the same threshold.

Temporary Disability (TD) Payouts

Temporary disability benefits are paid at 2/3 of the employee's average weekly wage (AWG), but the maximum weekly amount is $1,650. The benefit period can last up to 52 weeks, depending on the injury's severity and the employee's recovery timeline. If the injury is deemed permanent, the TD cap does not apply, but the benefit is converted to permanent disability benefits.

Permanent Disability (PD) Compensation

Permanent disability benefits are calculated as a percentage of the employee's AWG, based on the degree of loss. The maximum PD payout is $30,000 for total permanent disability. For partial permanent disability, the benefit is capped at a percentage of the AWG multiplied by the injury's severity rating, with an overall cap of $30,000 per injury.

Lost Wages and Replacement Limits

Lost wages are reimbursed at 2/3 of the AWG, capped at $1,650 per week. The benefit period is limited to 52 weeks for most injuries. For occupational illnesses, the period can extend to 78 weeks. Employers can request wage replacement claims only if the employee is unable to perform their job duties.

Claim Process and Time Constraints

Employees must file a claim within 30 days of the injury. If the claim is filed late, the employer may be liable for additional penalties. Once filed, the employer's insurer typically reviews the claim within 20 days and issues a decision. Workers who disagree can appeal to the Workers' Compensation Board within 30 days of the decision.

Key Takeaways for Employers and Employees

• Medical coverage is capped at $15,000 per injury.
• Temporary disability benefits max out at $1,650 per week.
• Permanent disability benefits cannot exceed $30,000.
• Lost wages are limited to 52 weeks, with a higher cap for occupational illnesses.
• Claims must be filed within 30 days to avoid penalties.