15.2 New York Benefits, Waiting Period, Notice and Filing Deadlines & Board Claims Reporting
Key Takeaways
- New York cash benefits equal two-thirds of the average weekly wage multiplied by the percentage of disability, subject to a maximum of two-thirds of the NYSAWW and a minimum of one-fifth of the NYSAWW.
- For accidents from July 1, 2026 through June 30, 2027 the maximum weekly benefit is $1,281.50 and the minimum is $384.45; the rate is fixed by the date of injury.
- No cash benefits accrue for the first seven calendar days of disability unless the disability extends beyond 14 days, in which case payment is retroactive to day one; medical benefits have no waiting period and no deductible.
- The employee must give the employer notice within 30 days under WCL § 18 and file the claim within two years under WCL § 28; the employer files the C-2F first report within 10 days.
- Funeral or burial allowance is up to $12,500 in the New York City metropolitan counties and up to $10,500 elsewhere in the state.
New York Benefits, Waiting Period, Notice and Filing Deadlines & Board Claims Reporting
Exam Focus: This is the numbers section. Know the two-thirds formula, the 7-day waiting period and the 14-day retroactive rule, the 30-day notice / 2-year filing pair, the employer's 10-day first report, and the current maximum and minimum weekly rates. Rates change every July 1, so memorise the formula as well as the figure.
The Benefit Formula (WCL §§ 2, 15)
New York weekly cash benefits are calculated as:
- The average weekly wage (AWW) is derived from the claimant's earnings in the year before the accident.
- The maximum weekly benefit is two-thirds of the New York State Average Weekly Wage (NYSAWW) for the previous calendar year, as determined by the Department of Labor on March 31 and applied from July 1.
- The minimum weekly benefit is one-fifth of the NYSAWW, or the employee's actual wages, whichever is less.
- The rate is fixed by the date of injury and does not increase when new maximums are later adopted.
| Date of accident | Weekly maximum | Weekly minimum |
|---|---|---|
| July 1, 2026 – June 30, 2027 | $1,281.50 | $384.45 |
| July 1, 2025 – June 30, 2026 | $1,222.42 | $325.00 |
| July 1, 2024 – June 30, 2025 | $1,171.46 | $275.00 |
Worked example. A Buffalo warehouse worker injured on August 1, 2026 has an AWW of $1,200 and is found temporarily totally disabled. Two-thirds of $1,200 is $800.00, which is below the $1,281.50 maximum and above the $384.45 minimum, so the weekly rate is $800.00. If the same worker were later classified at 50% temporary partial disability, the rate would be $800.00 × 50% = $400.00.
The Waiting Period
Cash benefits are not payable for the first seven calendar days of disability, unless the disability extends beyond 14 days — in which case compensation is paid retroactively from the first day out of work. Medical benefits, by contrast, are payable from the outset with no deductible and no waiting period, and the claimant pays nothing toward authorised treatment.
Classifications of Disability
| Classification | Meaning | Benefit |
|---|---|---|
| Temporary total (TTD) | Cannot work at all, expected to recover | 2/3 of AWW, subject to max/min |
| Temporary partial (TPD) | Can work with restrictions, reduced earnings | 2/3 of the wage loss |
| Permanent partial — schedule loss of use (SLU) | Permanent loss of use of an enumerated member (arm, hand, leg, foot, eye, ear, finger, toe) | A fixed number of weeks from the statutory schedule × the weekly rate |
| Permanent partial — non-schedule | Permanent impairment of the spine, lungs, heart or a systemic condition | Capped weeks based on loss of wage-earning capacity |
| Permanent total (PTD) | Never able to work again | 2/3 of AWW for life |
Death benefits are payable to a surviving spouse and dependent children at two-thirds of the AWW subject to the maximum, plus a funeral or burial allowance of up to $12,500 in the New York City metropolitan counties and up to $10,500 in the remainder of the state.
The Special Disability Fund (WCL § 15(8)) historically reimbursed carriers for the disproportionate cost of a subsequent injury to a worker with a pre-existing permanent impairment. New claims for § 15(8)(d) and § 15(8)(h) reimbursement were closed by the 2007 reform legislation, so the Fund is now a legacy exposure rather than a live planning tool — a point worth knowing because older study material still presents it as current.
Notice and Filing Deadlines
| Duty | Deadline | Authority |
|---|---|---|
| Employee gives notice to the employer | 30 days from the accident (written preferred) | WCL § 18 |
| Employee files the claim (Form C-3) with the Board | 2 years from the accident | WCL § 28 |
| Occupational disease notice and filing | 2 years from disablement, or from when the claimant knew or should have known the condition was work related | WCL §§ 28, 45 |
| Employer files the first report of injury (Form C-2F) | Within 10 days of the accident or of learning of it | WCL § 110 |
| Carrier files the first report of injury (Form C-669/FROI) | Within 14 days of notice | Board regulation |
Late notice under § 18 may be excused where notice could not reasonably have been given, where the employer had actual knowledge of the accident, or where the employer's case was not prejudiced. Both the § 18 notice defence and the § 28 statute of limitations defence must be raised by the employer or carrier at the first hearing or they are waived — a procedural trap that catches carriers who appear unprepared.
Claims Reporting to the Board
New York runs an electronic claims reporting regime. The Board publishes an Event Table identifying every claim event that must be reported and the timeframe and maintenance type code for each. Practical points an adjuster must know:
- Form C-2F — Employer's First Report of Work-Related Injury/Illness.
- Form C-3 — Employee Claim.
- Form C-4 series — Doctor's Initial Report, Progress Report and Permanent Impairment report.
- Form C-8/8.6 — Notice that payment has been stopped or modified, which must state the reason.
- Form C-7 — Notice that the right to compensation is controverted.
- CMS-1500 — the medical billing form; electronic submission is mandatory.
- Medical Treatment Guidelines — the Board's guidelines govern authorised care for the back, neck, shoulder, knee, carpal tunnel, non-acute pain and other body parts; treatment consistent with the guidelines is pre-authorised, and treatment outside them generally requires a variance request.
Compliance Cue: a carrier that stops or reduces payments without filing the required notice, or that fails to controvert timely, exposes itself to penalties under WCL § 25 — an independent adjuster handling New York compensation files must calendar Board deadlines as rigorously as Regulation 64 deadlines.
A New York worker is injured on August 1 and is out of work for 11 calendar days. How is the waiting period applied?
A claimant with an average weekly wage of $1,500 is injured on September 1, 2026 and is found temporarily totally disabled. What is the weekly cash benefit?