Since July of 1914, New York has required nearly all employers to carry workers compensation insurance. How they go about insuring their employees, according to the New York State Insurance Fund (NYSIF) may vary since there are three approved methods including insuring through NYSIF, using a private insurance carrier or self-insuring. Regardless of the method, however, there are certain benefits you are entitled to collect if you have suffered an on-the-job injury.
Compensation for Lost Wages
Workers’ compensation will not cover your entire paycheck in most cases. New York uses a formula based on what is called “average weekly wage” to determine the amount of compensation you may be entitled to receive. The maximum amount of weekly benefits is capped at $400 per week; anyone who is out of work for more than 14 days will also be entitled to receive benefits for the first week they missed work.
Compensation for Medical Costs
Anyone who is injured on the job has the right to have their medical payments reimbursed through their workers compensation insurance. Unless a medical visit will cost more than $1,000 there is no need for preapproval. Some of the costs that may be eligible for reimbursement include:
- X-Rays – any necessary x-rays performed in the diagnosis or during treatment of an injury may be reimbursed as an approved medical expense.
- CT/MRI – MRI and CT scans may also be covered if the accident victim’s doctor orders the testing. Keep in mind, should these tests be expected to cost in excess of $1,000 the claimant must obtain prior approval.
- Standard and follow-up visits – all doctors’ visits that are necessary for your care and treatment are covered under your workers compensation benefits. Even if you have other health insurance, your bills should be submitted through your workers compensation insurer.
- Medical equipment – should your injury require any type of medical equipment such as crutches, canes, wheelchairs or other device, you would have to submit the bill as well as the prescription from your physician to be reimbursed through workers compensation.
- Prescription drugs – all medication required to treat the illness or injury that is work-related are typically reimbursed. In a manner similar to medical equipment, the prescription and bill must be submitted as well. Those who use CVS (Caremark) may not have to pay out of pocket for their prescription meds.
- Rehabilitation costs – in nearly all cases, if you require rehabilitation therapy to enable you to return to your current job or be retrained for a more suitable position due to your injury these costs would be covered as well.
- Mileage/fuel allowance – mileage and transportation allowances must be claimed by providing the name, address and date of appointment with a provider. Should you be using public transportation or pay tolls, these receipts must be submitted. No reimbursement is offered for traveling to/from workers compensation hearings.
Keep in mind, if a worker is disabled or loses their life on the job, there are other benefits that will apply in those cases. For disabled workers the benefits may include:
- Ongoing wage payment – Depending on whether your disability is permanent or temporary, you will be entitled to a certain amount of wages which will be ongoing. Even if you are able to return to work on a part-time basis, you may be entitled to continue to collect wages. The formula that is used to calculate your ongoing wage payments is typically calculated based on the pay you were receiving before the accident and your current pay. Up to two-thirds of the difference may be paid. If you are unable to return to work, there will be a permanent disability payment made to you based on the appropriate formulas. These payments would be stopped should the employee qualify for social security disability.
- Ongoing medical – When you have to continue to seek medical care, even if you have returned to work those expenses will still be paid by workers compensation.
- Death benefits – When an employee loses their life on the job, workers compensation benefits will be paid to their spouse or dependent children. The same formula used to determine your weekly benefits will apply and an additional payment for funeral expenses will be paid to the family.
Work Related Extremity Reimbursement
One part of the workers compensation insurance that is often overlooked is injuries that occur that do not result in any time lost from work. Some employees may be entitled to a flat reimbursement in the event they have suffered any injury involving:
- Limbs – Fingers, toes, hands, arms, feet and legs
- Scarring – Facial scarring may qualify for reimbursement
- Sight/hearing – Anyone who has suffered sight or hearing loss
Generally, you will be offered a “one-time” award. Should the injury result in lost time from work, however, the final award may be reduced by the amount of cash compensation you receive while out of work.
Workers compensation benefits may be claimed only after filing the appropriate documents with an employer proving an on the job injury or illness. Workers have up to two years to file such a claim and failure to do so will result in forfeiture of benefits. Keep in mind, the insurance company has the right to deny the claim and that is why it is important to speak with a New York worker’s compensation attorney if your claim has been denied. Remember, insurance companies often deny legitimate claims and you need someone to protect your rights.