Rosenbaum & Rosenbaum, P.C. | September 28, 2023 | Workers' Compensation
Workers’ compensation is a workplace insurance program that you can use to compensate you for the economic consequences of most workplace accidents—medical expenses and lost earnings. It offers on-demand, weekly, and even lump sum benefits, depending on the circumstances.
The great advantage of workers’ compensation benefits is that you do not have to prove that your employer was at fault in order to win your claim. In fact, in most cases, you can win even if you are the one at fault.
Standard Workers’ Compensation Benefits
Standard workers’ compensation benefits include medical expenses and wage replacement.
100% of Your ‘Reasonable and Necessary’ Medical Expenses
Just about any medical expense you incur is covered under workers’ compensation. That includes ambulance rides, emergency room treatment, hospital stays, surgery expenses, diagnostic tests, doctor’s appointments, and just about anything else. The only types of medical expenses that workers’ compensation might balk at paying are:
- Medical expenses that bear a questionable relationship to the accident that generated your claim;
- Experimental or fringe medical treatments such as homeopathy, acupuncture, and even chiropractic services; and
- Unreasonable expenses that arise from the need to seek out-of-town medical care (a suite at the Hilton instead of a roadside motel, for example.)
You might have to negotiate to get all of your medical expenses covered.
Two-Thirds of Your Lost Earnings (Wage Replacement Benefits)
You are entitled to two-thirds of your previous wage, up to the statutory maximum weekly wage. Due to this statutory maximum weekly wage replacement, wage replacement benefits don’t necessarily work all that well for employees with high incomes.
In New York, the statutory maximum weekly workers’ comp replacement wage is $1,145.43 until June 30, 2024. After this date, the maximum will be adjusted upward to reflect any increase in the cost of living.
None of Your Non-Economic Damages
The major disadvantage of workers’ compensation is that it entitles you to far fewer benefits than you might qualify for if you win a personal injury lawsuit in a court of law. Under workers’ compensation, you cannot receive any form of non-economic damages such as:
- Pain and suffering;
- Emotional distress;
- Bodily disfigurement;
- Loss of consortium; or
- Loss of enjoyment of life.
In personal injury cases, non-economic damages frequently add up to far more than the total of economic damages, such as medical expenses and lost earnings. If you seek non-economic damages, you need to file a third-party lawsuit (see below) and prepare to prove that the accident was the defendant’s fault.
Lump Sum Settlements
Workers’ comp divides your eligibility for benefits into four categories based on the severity and duration of your injury-related impairment:
- Temporary partial disability: Weekly wage replacement payments for partial disability, plus medical expenses.
- Temporary total disability: Weekly wage replacement for total disability, plus medical expenses. These payments might add up to more than partial disability benefits, but they are more likely to be limited by the statutory maximum.
- Permanent partial disability: You receive permanent partial disability benefits when you can eventually return to work, but never again at your previous position. You might have to work part-time, for example, or you might need to switch to a less demanding job. You can also receive compensation for medical expenses. You might be eligible for a one-time lump sum payment.
- Permanent total disability: You receive permanent total disability when your injuries are so severe that you have to retire immediately because of them. You can receive weekly payments plus (potentially) a one-time lump sum payment. You are also eligible for medical expenses. To qualify for permanent total disability under the legal definition, you must be unable to engage in even sedentary employment within a 50-mile radius of your residence.
Workers’ comp can settle with you for a lump sum if you suffer permanent disability, but they are under no obligation to do so.
Maximum Medical Improvement (MMI)
MMI is a point you reach in your recovery where your doctor does not expect further improvement in your medical condition. If you are lucky, this means you have made a full recovery.
If you’re not so lucky, you might have been left with a permanent disability. You must reach MMI before you can receive a lump sum settlement (because only after you reach MMI will workers’ comp know how much money to settle for).
Third-Party or Employer Lawsuits
Generally speaking, you cannot file a lawsuit against your employer if it carries workers’ comp insurance. However, there are exceptions in New York for construction workers in some cases.
In a third-party lawsuit, you file an ordinary personal injury lawsuit against a third party. This is not considered a workers’ compensation action. If the situation is appropriate, however, you can be involved in a workers’ compensation claim and a third-party lawsuit at the same time.
The advantage of a third-party lawsuit is that you can seek non-economic damages such as pain and suffering. The disadvantage is that you will have to prove that the third party was at fault to win your claim.
Finding a Third Party for a Personal Injury Lawsuit
To find a third party to sue, enlist the help of your lawyer. You may or may not be able to find one. What you are looking for in a “third” party is someone other than you (the first party) or your employer (the second party).
For example, if you were involved in a serious car accident during the course of your work, you may be able to pursue a lawsuit against the at-fault driver in addition to your workers’ comp claim.
Contact a New York Workers’ Compensation Attorney for a Free Initial Consultation
A New York workers’ compensation attorney cannot offer a guarantee that you will win your claim or that you will win every dime you are entitled to. Hiring a workers’ compensation attorney, however, will greatly increase your odds of success.
Most workers’ compensation lawyers offer free initial consultations so that they can screen potential new clients. Take advantage of this fact to discuss your case with an experienced professional.