Basic Facts and Practical Advice – Workers’ Comp
WHO IS ELIGIBLE TO RECEIVE WC BENEFITS?
An employee who is injured at work generally is eligible to receive WC benefits. WC benefits include medical and lost income benefits.
The employee pays for NONE of the medical treatment needed to treat the WC injury. If the employee is unable to work because of the WC injury, he or she may be entitled to a lost income benefit.
WHAT TYPES OF INJURIES ARE COVERED?
The two most common WC injuries are accidents and occupational diseases. You can also have a covered “consequential injury.”
An accident is a specific event when you get hurt. For example, if you trip and break your leg at work, you have suffered a WC accidental injury.
An occupational disease is an injury that is caused by the nature of your work and NOT by one specific event. For example, if you develop carpal tunnel syndrome because of years of working as a sheet metal fabricator, you have suffered a WC occupational disease.
A consequential injury arises from a WC accident or occupational disease. For example, if you break your right leg at work, you will put more weight on your left leg during your recovery. If you have problems with your left leg as a “consequence” of your right leg WC injury, you may have a consequential injury to your left leg.
HOW MUCH IS THE LOST INCOME WC BENEFIT?
You will be paid a weekly lost income benefit of up to two-thirds (66-2/3%) of your average weekly wage [“AWW”] but NOT more than a maximum amount set forth in the law.
If you were injured before July 1, 2007, the maximum lost income benefit is $400.00/week.
If you were injured after July 1, 2007, the maximum lost income benefit depends on when you were injured and on the average weekly wage of all New Yorkers in a given annual period.
For a complete list of all dates of injury and maximum lost income benefit amounts since July 1, 2007, visit: http://www.wcb.ny.gov/content/main/onthejob/wcBenefits.jsp
Here are the dates of injury and maximum benefit rates in recent years:
If you were injured between July 1, 2017 and June 30, 2018, the maximum lost income benefit is $870.61/week.
If you were injured between July 1, 2018 and June 30, 2019, the maximum lost income benefit is $904.74/week.
If you were injured between July 1, 2019 and June 30, 2020, the maximum lost income benefit is $934.11/week.
If you are injured between July 1, 2020 and June 30, 2021, the maximum lost income benefit is $966.78/week.
DOES THE AMOUNT OF THE AWW INCLUDE MY PENSION & OTHER BENEFITS?
NO. As a general rule, the AWW only includes your base earnings for the one year period before you were injured.
IF I AM UNABLE TO WORK, WHAT DETERMINES THE AMOUNT OF MY LOST INCOME BENEFIT?
If you are NOT working due to the WC injury, the exact amount of your lost income benefit will depend on your AWW and the degree or severity of your medical condition.
If you are TOTALLY disabled, your lost income benefit is two-thirds (66-2/3%) of your AWW but NOT more than the maximum lost income benefit. Unfortunately, a designation of total disability does NOT apply if you simply are unable to perform your usual job. To be totally disabled under the law, you have to be unable to do your job and just about every other job.
There are three common degrees of a partial disability. These include MARKED (75%), MODERATE (50%) and MILD (25%). This is best understood with an example.
Bill broke his arm at work. His AWW is $600.00.
On the day he had surgery to repair his arm, he was totally disabled. Thus, his lost income benefit was $400.00/week (66-2/3% of $600.00 is $400.00).
About four weeks after surgery, Bill still could NOT return to his job as a construction laborer. Because he still had significant physical restrictions (no lift more than 10 pounds), he had a marked partial disability. Thus, he collected a lost income benefit of $300.00/week (75% of $400.00 is $300.00).
About six weeks after surgery, Bill still could NOT return to his job as a construction laborer. Because he still had physical restrictions (no lift more than 20 pounds), he had a moderate partial disability. Thus, he collected a lost income benefit of $200.00/week (50% of $400.00 is $200.00).
About eight weeks after surgery, Bill still could NOT return to his job as a construction laborer. Because he still had physical restrictions (no lift more than 50 pounds), he had a mild partial disability. Thus, he collected a lost income benefit of $100.00/week (25% of $400.00 is $100.00).
IF I WORK & EARN LESS BECAUSE OF THE WC INJURY, CAN I GET A LOST INCOME BENEFIT?
If you are able to work, but earn LESS than your AWW because of the WC injury, you may be entitled to a REDUCED EARNINGS lost income benefit. The exact amount of your
reduced earnings lost income benefit will depend on your AWW and the amount of money that you are earning after the WC injury.
The reduced earnings lost income is two-thirds (66-2/3%) of the amount of income that you are losing each week due to the WC injury. You subtract your current weekly earnings from the AWW in your WC case and multiply by two-thirds (66-2/3%). This is best understood with an example.
Bill broke his arm at work. His AWW is $600.00.
He was NOT able to return to his job as a construction laborer, however, he got a job at a convenient store that does not require him to lift heavy objects. His weekly wage at the convenient store is $300.00.
Bill is entitled to a reduced earnings WC lost income benefit of $200.00/week. His wage loss is $300.00/week ($600.00/week AWW minus $300.00 earnings in new job). The reduced earnings WC lost income benefit is two-thirds (66-2/3%) of the weekly wage loss due to the WC injury. Two-thirds of $300.00/week is $200.00/week.
Of course, Bill gets the $200/week WC lost income benefit AND gets to keep what he earns by working.
IF I HAVE TO TRAVEL TO GET MEDICAL TREATMENT, WILL SOME OF MY EXPENSE BE REIMBURSED?
YES. If you using a personal automobile to travel to get medical treatment, you can receive mileage reimbursement and, if you have to pay for parking, reimbursement for that expense.
DO I HAVE TO LOOK FOR WORK WHILE I AM COLLECTING WC LOST INCOME BENEFITS?
YES. If you are NOT considered to be totally disabled, you have an obligation to look for work. For more details about this important issue, check out the article on our
site about this important issue.
If you are eligible, you can collect unemployment insurance [“UI”] benefits at the same time that you are collecting WC lost income benefits as long as you are NOT totally disabled.
HOW OFTEN DO I HAVE TO GO TO THE DOCTOR TO REMAIN ELIGIBLE FOR WC LOST INCOME BENEFITS?
Unless a Judge has already ruled that you have a permanent disability, you generally must get some form of medical treatment at least once every 90 days to keep your eligibility for WC lost income benefits. Your treating medical provider must submit the appropriate report to the WC Board and the WC insurance carrier. For more details about this important issue, check out the article on our site about this important issue.
WILL I HAVE TO SEE A WC DOCTOR?
As a general rule, you may be examined one or more times by a doctor who is paid by the WC insurance carrier. This doctor can comment on just about any issue in your case, including the severity of your disability due to the WC injury. For more details about how to prepare for such an examination, check out the article on our site about this important issue.
DO I GET SOMETHING MORE IF MY WC INJURY IS PERMANENT?
Once your condition is stable (known as maximum medical improvement), an effort will be made to determine whether you have permanent injury. Generally, this will happen
as early as six months, or as late as two years, AFTER your injury or last surgery.
If there is NO permanent injury, no additional WC lost income benefits will be paid.
If there is a permanent injury, however, you may be entitled to additional WC lost income benefits. The issue of permanency is usually resolved in one of two ways. You may be classified as having a permanent partial disability. This usually applies to back and neck injuries. Alternatively, you may have a schedule loss of use award. This usually applies to extremity injuries such as carpal tunnel syndrome. For more details about this important issue, check out the article on our site about this important issue.
DO I HAVE TO PAY INCOME TAX ON THE WC LOST INCOME BENEFIT? IS TAX WITHHELD FROM IT?
NO and NO. WC lost income benefits are TAX FREE to you.
WHAT CAN I DO TO HELP MY CASE?
There are MANY things that an injured worker can do to help with their case. For how you can help us help you, check out https://modicalawfirm.com/helping-us-help-you/
WHY SHOULD I HIRE AN EXPERIENCED LAW FIRM TO HELP ME?
An experienced law firm will help you understand your rights and obligations as an injured worker. To illustrate, an experienced law firm will: (1) secure medical, wage
and employment records; (2) develop all relevant legal issues; (3) prepare you thoroughly for each hearing–particularly when you testify; and (4) advise you about your
entitlement to other benefits (e.g., unemployment insurance, Social Security Disability and New York State Retirement System benefits).
WC law is very complex. Proper interpretation requires knowledge in several areas other than the law. To illustrate, one must be familiar with medicine, medical terminology and the description and physical demands of various jobs.
WHAT DO LAW FIRMS CHARGE FOR THEIR SERVICES?
A law firm who represents an injured worker can NEVER receive payment for legal services from you directly. As a general rule, the law firm can only receive a fee for
providing legal services IF money is paid to you AND any fee requested is approved by a Judge of the WC Board.
We hope this information is helpful to you and your family. We wish you safe work days and nights.