When you’ve been injured at work, figuring out how you are going to support yourself in the short term can be a nightmare. While you will likely qualify for workers’ compensation benefits, your employer and their insurance company has the right to deny your claim for a number of reasons. Once you are approved for benefits, the coverage you receive includes medical care, cash payments and supplemental benefits such as social security disability. A schedule loss of use award is a cash payment that is in addition to any other benefits you receive from your injuries.
Determining Your Schedule Loss of Use Award
The schedule loss of use award is not an automatic payment. Once you have reached a medical end to your treatment, your provider must file a report with the workers’ compensation board. Your doctor will be asked to determine the percentage of your loss, whether it be 25% because you can’t quite use your hand in the same way, or 100% for a loss of a limb. Once your doctor has submitted the correct documentation, your award will be calculated.
How Your Schedule Loss of Use Award is Calculated
Your compensation is based on the percentage of your loss,the body part affected, and the amount you receive weekly from workers’ compensation. Workers in New York are currently entitled to 312 weeks of compensation for a permanent arm injury, down to 15 weeks of compensation for a fourth finger injury. For example, if you are receiving $500 a week in workers’ compensation benefits and you lost 100% use of your arm, you are entitled to $500 x 312 = $156,000.
When Your Treatment Provider and the Insurance Doctor Don’t Agree on Your Loss
Losses can be difficult to prove, and the amount of your award is based on a percentage of loss. It is beneficial to the insurance company when your loss is at a lower percentage. If your physician doesn’t agree with the assessment done by the insurance provider’s physician, you will have a hearing to determine the percentage of your loss. The workers’ compensation board will take a careful look of all of the information you provide and make a determination on your losses after a hearing.
Getting Paid When You Win a Schedule Loss of Use Award
Benefits are either paid out on a weekly basis, where you will receive your award amount after your workers’ compensation runs out and until the award is paid in full, or you can ask that you be paid in a lump sum. You will have to request a lump sum payment from the workers’ compensation board, who will then request a check on your behalf from the insurance company in full. While some claimants like a large payment in the beginning, others choose weekly payments so that they know what their income will be for a set number of weeks.
Increase In Prior Schedule Loss Of Use
In many instances, a claimant who has received a schedule loss of use award requires additional surgery or simply experiences a worsening of their condition.
If the subsequent worsening can be shown to have caused an increase in the level of permanency, it may be possible for an additional monetary award for loss of function to be made. This increased award must be requested within 18 years of the date of injury or 8 years from the last date compensation was paid pursuant to Section 123 of the New York State Workers’ Compensation Law.
A claim for an increase in schedule loss of use must be based on objective findings, not simply complaints of increased pain. The Workers’ Compensation Board’s Medical Guidelines document the criteria that physicians must use in rendering permanency opinions.
Why You Might Be Denied
If your treatment provider and the physician for the insurance company agree that you are not at a medical end to treatment, you may be denied a schedule loss of use award at this time. This payment is for permanent disabilities, and when you are still in treatment it will be impossible to determine the percentage of funds you should receive. If your paperwork is not complete, you may get a denial until you have submitted the correct paperwork. You may also be denied benefits if your treatment provider does not have a strong opinion that you are disabled, and the workers’ compensation board determines that there is no permanent disability.
The Limits to A Schedule Loss of Use Award and Workers’ Compensation
In 2016, the most you can receive in the state of New York from workers’ compensation insurance is $844.29 a week. This is a limit imposed by the state, and it doesn’t matter if your benefits would be much higher if calculated using your current salary. Workers’ compensation payments are your average weekly wage multiplied by 2/3. The schedule loss of use award is determined using your workers’ compensation payments, multiplying those payments by the number of weeks award and then multiplying that number by the percentage of your permanent loss.
Your schedule loss of use award does not take into consideration income that goes beyond $844.29 per week, which is why it is essential to determine the percentage of your loss correctly.
If you are injured and you are trying to deal with a workers’ compensation claim on your own, there is help available to you. When you’ve been denied workers’ compensation benefits and you need to file an appeal, it’s important to seek legal counsel. The longer you wait to file a strong appeal, the longer it will take for you to begin receiving financial compensation for your injuries. It’s hard enough when you get hurt at work, you shouldn’t have to worry about paying your bills at the same time. Contact us today.