Q. What is workers' compensation?
A. Workers' compensation is insurance that provides cash benefits and/or medical care for workers who are injured or become ill as a direct result of their job.
Employers pay for this insurance, and may not require the employee to contribute to the cost of compensation. Weekly cash benefits and medical care are paid by the employer's insurance carrier, as directed by the Workers' Compensation Board. The Workers' Compensation Board is a state agency that processes the claims and determines, through a judicial proceeding, whether a worker will receive benefits and/or medical care, and how much he/she will receive.
In a workers' compensation case, no one party is determined to be at fault. The amount that a claimant receives is not decreased by his/her carelessness, nor increased by an employer's fault. However, a worker loses his/her right to workers' compensation if the injury results solely from his/her intoxication from drugs or alcohol, or from the intent to injure him/herself or someone else.
A claim is paid if the employer or insurance carrier agrees that the injury or illness is work-related. If the employer or insurance carrier disputes the claim, no cash benefits are paid until the Workers' Compensation Law Judge decides who is right. If a worker is not receiving benefits because the employer or insurance carrier is arguing that the injury is not job-related, he/she may be eligible for Disability Benefits in the meantime. Any payments made under the Disability Program, however, will be subtracted from future workers' compensation awards.
Q. Can I receive a monetary award even if I did not lose time from work?
A. ABSOLUTELY. In fact, in many cases the injured worker will receive a greater cash award if he/she loses minimal or even no time from work. There are certain injured parts of the body, such as arms, legs, hands and feet, as well as hearing & vision loss, that allow for impairment awards.
Q. Should I file a claim only if I suffer a serious injury?
A. ALWAYS file a claim, notifying your job and seeing a doctor immediately, because you never know what medical problems can develop as a result of an apparently minor injury. You need to protect your future rights to monetary benefits and medical treatment. You may be due an award for even a minor injury!
Q. Do I need a lawyer for a workers' compensation case?
A. NEVER try to represent yourself in any legal action. Attorneys are trained in their stated fields and nothing could be more important than to have an experienced legal team to assist and guide the injured worker. The insurance companies are NOT in business to pay an injured worker his/her full benefits and will never act in the best interests of the injured worker.
Q. If I am disabled for my job and I am not collecting any workers' compensation payments, can I collect unemployment or other disability benefits?
A. SOMETIMES under certain circumstances, an injured worker can apply for unemployment or state disability benefits. Each case must be viewed individually. However, when a worker is deemed partially disabled and unable to do his particular job, yet able to perform light duty work which is not available, he/she may apply for unemployment benefits. The injured worker may also collect a partial payment from workers' compensation. Also, an injured worker should file a New York State disability benefits claim when the workers' compensation insurance company denies the claim as being work-related, pending a final determination by the Workers' Compensation Board.
Q. What if the worker fails to file a claim for workers' compensation?
A. The worker may lose his/her right to benefits and medical care.
Q. Is medical care provided in the case of an accidental injury even when no claim is made for weekly cash benefits?
A. Yes. If medical care is necessary, it will be provided even though there has been no lost time from work and no cash benefits paid.
Q. Can I collect Social Security Disability Benefits while I am collecting workers' compensation?
A. DEFINITELY. If the injured worker remains disabled or is expected to remain disabled for at least 12 months, then a claim for SSDB should be filed. If approved, the monthly SSDB payment will supplement the weekly workers' compensation payments. The Social Security Administration may adjust the monthly benefit depending upon the weekly compensation amount.
Q. How do I know which doctors to get treatment from and how often?
A. ALL physicians and chiropractors who accept workers' compensation can treat an injured worker. Initially, any hospital will accept the patient on an emergency basis but follow-up care should be with the WC Board approved doctor. The injured worker should see his/her doctor at least once per month for any period of time he/she claims to be disabled and unable to work in order to prove the disability status to the WC Board and be paid for the lost of wages.
Q. Can I file a claim for workers' compensation benefits if I believe my work caused an injury or illness even if I did not have an accident?
A. YES. In fact, many claims for benefits arise from injury or illness caused or aggravated by the nature of the occupation. The more obvious cases include a computer keyboard operator who develops carpal tunnel syndrome in the hands, an asbestos handler who suffers from a respiratory disease, or a machine operator who suffers hearing loss. However, a home care attendant, a delivery person or construction worker can develop a low back disorder from repetitive heavy lifting and carrying while working over a period of time. Another example is a carpet installer who injures his/her knees due to the nature of the occupation. These are all valid claims as long as there is supporting medical proof that they were caused, aggravated or developed while working.
Q. Do I have any out-of-pocket expenses, costs or fees for filing a claim?
A. NO. There are essentially no costs to the injured worker. All necessary medical treatment is paid by the workers' compensation insurance company. No co-payments should be paid by the injured worker. Any test or procedure costing more than $1000 needs pre-approval and, of course, ordinary treatment or therapy privileges should not be abused. The worker is entitled to reimbursement for his/her "reasonable" expenses for medications and travel for treatment visits. Additionally, an injured worker is not permitted to pay a lawyer directly for legal services. Instead, any attorney's fee must be approved by a WC Law Judge first and deducted from an award to the injured worker only if an award is obtained. Otherwise, no fees are payable.