New York’s workers’ compensation system has gone through real changes over 2025 and into 2026 — not the vague “coverage expansion” talk that circulated ahead of 2025, but specific rate updates and claims-processing rules with actual effective dates. Here’s what changed, what’s still coming, and what it means for practices handling workers’ comp cases.
2026–2027 Weekly Benefit Rates
New York’s maximum weekly workers’ compensation benefit rate is $1,281.50, effective for claims with a date of injury between July 1, 2026 and June 30, 2027. The minimum weekly rate for the same period is $384.45. Both figures are set annually by the Workers’ Compensation Board, calculated as two-thirds of the New York State Average Weekly Wage (NYSAWW) reported by the Department of Labor for the prior calendar year — $1,922.25 for 2025. Workers injured before July 1, 2026 continue to be paid under the rate in effect on their own date of injury; the new maximum and minimum only apply to new claims filed within the current period.
Medical-Only Claims Can Now Be Paid Without Accepting Liability
Under a Section 21-a amendment signed by Governor Hochul in May 2025 and taking effect January 1, 2027, insurers can pay for medical treatment on a claim — without formally accepting liability — for up to one year. This provision previously applied only to claims involving lost work time; it now extends to medical-only claims, which make up more than 60% of all workers’ comp claims in New York. Unless the claim is controverted, liability is automatically accepted at the one-year mark. The stated goal is fewer denials and less litigation over claims where treatment is already underway.
More Providers Can Treat Injured Workers
The same May 2025 legislation lets resident and fellow physicians in ACGME-accredited training programs treat injured workers under faculty supervision, the same way they already treat patients under regular health insurance. The Workers’ Compensation Board estimates this adds roughly 20,000 providers across nearly 70 teaching hospitals statewide to the pool authorized to treat workers’ comp patients.
What This Means for Practices Handling Workers’ Comp Cases
- Rate changes are automatic, not something to code around. Claims should reflect the maximum/minimum in effect on the date of injury, not the date of filing — documentation and billing workflows built for New York workers’ comp need to track dates of injury against the correct rate period.
- Medical-only claims may move faster. With the Section 21-a change, practices billing medical-only workers’ comp claims should expect treatment to be payable sooner, without waiting on a formal liability decision, once the January 2027 effective date arrives.
- The Board continues pushing administrative simplification. Universal billing forms and online prior authorization are part of the Board’s ongoing effort to reduce paperwork burden — relevant for any practice still handling New York workers’ comp documentation manually.
Medi-EHR’s Workers Comp/No-Fault module keeps documentation, coding, and claim submission aligned to New York’s current workers’ comp requirements, so rate and rule changes like these don’t have to be tracked by hand.
Frequently Asked Questions
For claims with a date of injury between July 1, 2026 and June 30, 2027, the maximum is $1,281.50 per week and the minimum is $384.45 per week. These figures are recalculated annually based on the state average weekly wage.
No. Workers injured before July 1, 2026 continue to be paid under the maximum and minimum rates in effect on their own date of injury, not the current period’s rate.
Starting January 1, 2027, insurers can pay for medical treatment on a medical-only claim for up to a year without formally accepting liability, with liability automatically accepted at the one-year mark unless the claim is controverted. This extends a provision previously limited to lost-time claims.
Yes, as of May 2025, resident and fellow physicians in ACGME-accredited programs can treat injured workers under faculty supervision, the same way they treat regular health insurance patients.