Yes. The Workers’ Compensation law provides that notice of an injury be given within 30 days of the occurrence (in the case of an accident), or 30 days when you knew or should have known that a condition is work related (in the case of an occupational disease). Injuries that don’t appear serious at the outset can worsen over time requiring expensive medical treatment and lost earnings. It is important that you notify your employer of each and every injury when it happens and to advise of all body parts involved. Failure to give timely notice can disqualify you from benefits.
Yes. You must file a claim with the Workers’ Compensation Board within two years of the accident. Just because your employer knows you have an injury, does not fully protect you. The best practice is to contact an attorney to assist you in filing a claim timely. Failure to file a claim within the proscribed period will lead to the Workers’ Compensation Board denying your claim.
There is a seven day “waiting period” before you can receive cash benefits. Benefits become payable on the eighth day and, if your disability exceeds 14 days, you are eligible for compensation on day one.
No. You should never pay an attorney directly for assisting you with a workers’ compensation claim in New York. An attorney may request a fee from your award if he or she helps you to obtain an award of compensation. All fees must be approved by the workers’ compensation board and are paid directly to the attorney by the insurance company or self-insured employer. If no award is made to you, no fee is payable.
No. A settlement is a negotiated payment to compensate an injured worker typically for future lost earnings and is not reduced by past paid benefits. Such settlements are governed by a specific provision of the Workers’ Compensation law. Schedule loss of use awards, however, (loss of use of an extremity such and hand, foot, arm or leg) are typically reduced by amounts previously paid by the insurance carrier.
If my doctor wants me to have a specific treatment, is there anything I need to do to get pre-approval?
The need for pre-approval depends on the injury and type of care requested. Such issues are governed by the Medical Treatment Guidelines published by the Workers’ Compensation Board which went into effect in 2010. Your doctor must determine whether they feel pre-approval is necessary and, if so, submit the proper request to the insurance company. You should discuss such issues with your doctor. Some doctors are not familiar with these guidelines and our office can assist in directing your physician with the proper procedure in your case.
If your medical provider indicates that you have a partial disability, the law requires that you demonstrate that you are “attached to the labor market”. This mean that you have to show that you are trying to find work within your physical limitations. While you may not be able to return to your particular job, there may be other work that you are physically and vocationally qualified to perform. To satisfy the Board’s requirements, you can perform an independent job search, work with a qualified vocational counselor or seek vocational retraining. The law on this subject is complex and you should consult with one of our knowledgeable attorneys about your particular situation.
The Workers’ Compensation Medical Treatment Guidelines provide for limitations on certain care, including chiropractic. Depending on the type of injury, these guidelines will require that additional care beyond “recommended treatment”, be supported by a showing of functional improvement. Alternately, your chiropractor must show that you have had an “exacerbation” or worsening of your condition which requires care to bring your condition back to baseline. If you are found permanently disabled, you may be limited to 10 (ten) visits per year for “maintenance care” but you may also qualify for additional care if you have a spontaneous worsening of your condition.
If your injury occurred on or after March 14, 2007, then your payments may be subject to a limitation relative to payments for permanent injury. Such limitations do not apply to older claims. The Workers’ Compensation Law provides that, after reaching maximum medical improvement, your payments will be subject to a limitation based upon your “loss of wage earning capacity”. The higher your loss of earning capacity, the more weeks you can be awarded. The range of payments after being found permanently disabled is between 4.33 years and 10.10 years. If you have a loss over 81%, you may be able to apply for additional benefits in your last year of eligibility. If you have a 100% loss, these limitations may not apply. It is important for you to speak with a knowledgeable attorney about these issues.
If you are receiving wage replacement benefits, your check may not always arrive on the same day of the week. The Workers’ Compensation law requires that this insurance benefit be paid “periodically”. An installment of compensation is not late unless it is 25 days past due. However, if the Board has made an award to you for a past due benefit, such payments are under strict time lines. Such payments must be issued within 10 (ten) days of the filing date on the decision awarding the benefit. If you have a question about your benefits, we urge you to contact our office.