Workers’ Compensation Benefits
All causally related medical expenses are payable from the date of your workplace injury, even if there is no lost time from work. These expenses include tests, treatments, hospitals, medicines, physical therapy, surgery, medical equipment, and transportation to and from the doctor or hospital.
The injured or ill worker who is eligible for New York workers’ compensation will receive necessary medical care directly related to the original injury or illness and the recovery from his/her disability. Medical expenses related to the work-related injury/illness are paid by the employer or the employer’s insurance carrier. These usually include:
- A health provider of your choice* who is authorized by the Workers’ Compensation Board.
- Prescriptions, x-rays, tests and eye glasses
- Hospital and nursing care
- Dentistry and false teeth
- Artificial limbs and other prosthetic devices
- Rehabilitation and therapy
- Travel expenses to and from medical care
If the workplace accident/injury requires immediate medical care, go to the nearest hospital or clinic. But for follow-up care, choose your own physician. Most workers in New York State have the right to choose their own physician for a Workers’ Compensation injury/illness. However, if you have been told you must see an employer-designated doctor or go to a particular clinic, and you have legal representation, notify your FOA workers’ compensation attorney immediately.
At your first visit, ask if the doctor is registered with the New York State Workers’ Compensation Board and will file a C-4 for you. No workers’ compensation claim can be established without the proper medical documentation. Use of a C-4 form is highly preferred.
No provider of medical care for a workers’ comp case (physician, nurse, dentist, hospital) is permitted to ask you to pay the bill. Their bills must be submitted directly to your employer’s workers’ comp insurance carrier.
Keep all receipts for out-of-pocket expenses you may have, such as payments for medication, etc. You will be reimbursed for these expenses if you can show documentation of the expense.
When appropriate, workers’ compensation claimants will be awarded reimbursement for automobile mileage to and from a health care provider’s office and any facility for testing or physical therapy The per-mile reimbursement rate is set by the Workers’ Compensation Board.
Cash Payments for Loss of Earnings
You are entitled to cash payments to compensate for loss of earnings if your job injury or illness keeps you out of work for more than one week (seven days). You will receive no cash payments if you are out of work for one week or less. If you are out of work for more than two weeks, you will receive cash payments beginning with the first day of your workplace injury.
If you are totally or partially disabled, and unable to work for more than seven days, you will receive cash benefits to be paid as long as you are disabled from work.
The maximum weekly benefit is set by the NYS Legislature. As of July 1, 2010, the maximum weekly benefit is calculated based on the average New York State weekly wage.
The exact amount of the workers’ compensation cash benefit is based on your average weekly wage for the year preceding your date of accident, as well as your degree of disability. Your maximum weekly rate will remain the same throughout the life of your Workers’ Compensation case; your weekly rate will NOT change yearly.
If you are able to return to work but unable to earn your previous wage because of your work-related disability, your cash payment will equal 2/3 of the difference between your average weekly wage before the job injury/illness and your wage afterwards—up to the current maximum rate.
If your Workers’ Compensation claim is not contested, the employer’s workers’ compensation insurance carrier must begin sending you checks within 18 days following the start of your disability or within 10 days following notice of the workplace accident/injury to the employer, whichever is later.
If you are not receiving payments in a timely fashion, notify your FOA workers’ comp attorney immediately. Failure by your treating physician to timely file C-4 forms may result in delayed payments to you even if the claim is not contested.
Awards for Permanent Injuries
The New York State Workers’ Compensation Law provides for cash benefits to injured workers for permanent damage to a limb (fingers, toes, hands, feet, legs and arms), total or partial loss of hearing or vision, or disfigurement to your face resulting from an on-the-job injury.
You do not have to lose time from work in order to qualify for this type of cash benefit. The amount of compensation awarded depends on the part of the body involved and the degree of permanent loss of use.
Section 32 Agreements
Section 32 of the Workers’ Compensation Law permits a claimant to enter into a written agreement with the employer or its insurance carrier to resolve open issues and bring an end to a claim, almost always in return for the claimant receiving a specified sum of money.
Since these agreements are generally intended to end the claimant’s right to future benefits, they should not be entered into without careful consideration on the part of the claimant.
Though Section 32 agreements are subject to approval by the Workers’ Compensation Board, the Board does not review these agreements from the point of view of their appropriateness for the claimant. A claimant should always consult an experienced workplace injury lawyer before signing a Section 32 agreement.
If a worker dies from a compensable injury, the surviving spouse and/or minor children are entitled to weekly cash benefits. The amount is equal to 2/3 of the deceased worker’s average weekly wage for the year ending on the date of the accident. These payments continue until the spouse remarries. If there are children, the payments continue until the youngest child turns 18 (or 23 if the child is a full-time student). Anyone who pays for funeral expenses will be reimbursed up to an amount set by the Board.