Rosenbaum & Rosenbaum, P.C. | August 19, 2020 | Workers' Compensation
New York Workers’ Compensation Insurance covers most employees in the state. State workers’ comp laws require that employers purchase and maintain workers’ compensation coverage for their employees. There are only a few limited exceptions to the law.
What is Covered By Workers’ Compensation Insurance?
If your employer has workers’ compensation insurance, workers’ comp covers most work-related injuries, accidents, and illnesses. However, workers’ compensation does not cover all work accidents or injuries.
For an accident, illness, or injury to be covered by workers’ compensation insurance:
- The employee is covered under the law
- The illness, disability, or injury must be directly related to the employee’s job duties
- The accident or incident took place while the employee was performing duties within the scope of employment
- The employee notified the employer in writing of the event that caused the illness or injury no later than 30 days after it occurred
- The treating physician’s report states that a job-related accident or incident caused the illness or injury
If a workers’ compensation claim is approved, the worker may be entitled to one or more benefits provided by workers’ compensation insurance.
Workers’ Compensation Benefits in New York
Cash benefits under the workers’ compensation system supplement an employee’s income when the employee is unable to work because of a work-related illness or injury. The amount of cash benefits depends on the employee’s earnings before the accident.
An injured employee can receive a weekly cash benefit equal to two-thirds of the worker’s average weekly wage. The weekly cash benefit cannot exceed the maximum benefit allowed by law. The maximum cash benefits are adjusted each year on July 1.
You can receive up to the maximum allowed cash benefit if you cannot return to work because of your injury. If you can work, you may receive partial cash benefits that increase what you earn up to the two-thirds amount for total disability.
Injured workers are entitled to receive reasonable and necessary medical care for work-related illnesses or injuries covered by workers’ comp. The physician or health care provider performing the treatment must be approved by the Workers’ Compensation Board, except when the worker requires emergency medical care.
There is no charge for treatment for the employee if the workers’ compensation carrier or employer approves the claim. The employee may also receive reimbursement for mileage to and from doctor’s appointments.
Other Workers’ Compensation Benefits
There are other types of workers’ compensation benefits that might be available in some instances.
If a worker dies from a work-related illness or injury, the surviving spouse, minor children, and other dependents defined by law may be entitled to death benefits. The dependents may be entitled to weekly compensation, in addition to reimbursement for funeral expenses.
If there are no surviving heirs entitled to compensation, the worker’s estate might be entitled to a lump-sum payment of $50,000. The estate distributes the funds to the legal heirs.
Workers who sustain disabilities because of a job-related accident can also receive assistance through or more rehabilitation programs. The programs help workers return to work, when possible, or cope with the restrictions on their daily life caused by the work-related disability.
Rehabilitation services include:
- Vocational rehabilitation
- Selective placement
- Medical rehabilitation
- Social Services
Participation in rehabilitation programs does not cut off your cash benefits. If you are unable to work, you continue to receive cash benefits based on your disability. In most situations, participation in rehabilitation programs is voluntary.
Permanent Disability Benefits
If a worker is permanently disabled because of a work-related injury or illness, the worker may receive disability benefits. There is no limit on the number of weeks a worker can receive total disability benefits.
Workers who experience a partial disability receive cash benefits based on the severity of the disability and the type of disability. The severity of the disability is measured when the patient reaches Maximum Medical Improvement (MMI), which is assumed to occur no more than two years after the date of the injury.
Filing for Workers’ Compensation Benefits
The workers’ compensation system should be straightforward. An employee injured at work files a claim and receives benefits. However, workers’ comp cases are not always that straightforward.
Employers and insurance companies deny many workers’ comp claims. They also attempt to undervalue disability claims, restrict medical treatment, or reduce cash benefits.
Employees have the right to hire a workers’ compensation lawyer for help with a claim or to pursue a third-party negligence claim, if applicable. If your employer or its insurance provider is denying your workers’ compensation benefits, it can be beneficial to talk with a workers’ comp lawyer as soon as possible.