Workers’ Compensation After a Workplace Injury
Filing for workers’ compensation after a workplace injury in New York is something we hope you never have to face. Workplace injuries are often painful, as is dealing with an insurance adjuster. The process can quickly become overwhelming without sufficient counsel throughout.
Familiarizing yourself with eligibility and coverage laws can be helpful from the get-go. However, if you find yourself with more questions than answers, speaking with a workers’ compensation lawyer in New York should be your next step. Your attorney will talk through your situation and advise you on your workers’ compensation eligibility and coverage.
If you have been injured at work, you are dealing with a lot. You might not be sure whether you are eligible to receive Workers’ Compensation benefits, or how much. Reach out to the attorneys of Cohen & Jaffe today for help.
Requirements to Qualify for Workers’ Compensation Benefits
Qualifying for workers’ compensation benefits requires proving two things — that you are a qualified employee and that you were injured while performing work for your employer. Necessary medical treatments are paid as long as the following criteria is met:
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You are an Eligible Employee of a New York Employer
Qualified employees covered by workers’ compensation insurance are eligible to receive benefits. This coverage applies to full-time, part-time, and seasonal employees. Insurance policies often begin from the date of your hire.
Workers’ compensation does not apply to independent contractors, such as consultants and vendors. Contract position employees should supply their own insurance policies. In general, workers’ compensation does not cover volunteers.
The Injury Must Have Occurred While Working
In addition to being an eligible employee, the injury claim must have also occurred while you performed work for the company. Injuries that occur during lunch breaks and commutes are not eligible for workers’ compensation benefits. If you were ‘on the clock,’ insurance will cover your work-related injuries.
Injuries Covered by Workers’ Comp in New York
Workers’ compensation insurance covers almost any injury or illness that occurs while you are working. Qualifying injuries can be related to your physical or mental well-being. Examples of types of injuries covered by workers’ compensation include:
- Muscle Sprains and Strains
- Pinch and Crush Injuries
- Slip and Fall Accidents
- Exposure to Toxic Substances
- Repetitive Stress Injuries (RSIs)
- PTSD, Mental Anguish, and Depression
- Pain and Suffering
It is impossible to comprehensively list all qualifying injuries within the scope of this article. Speaking with a workers’ compensation attorney in New York can offer you clarity if you have specific questions about your personal eligibility.
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Types of Benefits Paid by Workers’ Compensation in New York
Every approved workers’ compensation claim is eligible to receive fair compensation. Covered employees can receive cash, medical, or death benefits. The New York State Workers’ Compensation Board (NYSWCB) carefully regulates how insurance companies pay benefits.
Injured employees receive cash benefits to supplement lost wages. Medical treatment is crucial during this period. Remember that the adjuster wants to limit losses to medical necessity while getting you back to work quickly. Here are a few criteria that the insurance adjuster uses to determine your eligibility for cash benefits:
- You will not receive cash benefits within the first seven days of disability.
- If disability extends beyond 14 days, you may receive benefits retroactive to the first day.
If you qualify for cash benefits, you receive payments based upon your average weekly wages for the previous tax year. Your insurance adjuster should use the following calculation to determine your payment:
2/3 of Last Year’s Average Weekly Pay x % of Your Disability = Weekly Cash Benefit ($)
Workers’ compensation sets maximum benefit amounts. The NYSWCB determines cash benefit limits by when the accident occurred. Your attorney can determine if your earnings exceed these benefit caps.
The medical treatments prescribed by your doctor are covered by workers’ compensation insurance. The doctor you choose must be authorized by NYSWCB to perform diagnoses and subsequent treatments. Workers compensation covers the following services from authorized providers:
- X-Ray and MRI Examinations
- Emergency Room Services
- Laboratory Tests and Blood Work
- Medical Treatments for Your Injuries
- Current and Future Rehabilitation
- Prescribed Drugs and Medical Devices
Overall, your necessary medical expenses are covered by insurance. You may even be awarded reimbursement for gas mileage and vehicle maintenance related to your travel for doctor’s visits. Even if you are receiving authorized treatment, it is important to keep in mind that the reimbursement can be denied later.
The accidental death of an employee means that surviving family members may be able to pursue workers’ compensation benefits. Claims of this kind are permitted under the premise that the deceased employee contributed financially to the household. Now that he or she is gone, an entire family suffers as a result.
The maximum death benefit for a deceased employee is $50,000. Surviving family members can usually expect to receive reimbursement for funeral expenses, as well. Residents of Long Island can anticipate up to $12,500 in funeral benefits. Widowers and widows are eligible for a maximum supplement benefit of up to $215 if their loved one’s death occurred before January 1, 1979.
What to do if Your Workers’ Comp Claim in New York is Denied
It is common for the insurance company to issue a partial or total denial of your workers’ compensation claim. Your results depend upon the nature of your injuries as well as your ability to advocate for yourself. Even if your claim is denied, you can file a formal appeal for further consideration by an independent board.
Reasons Adjusters Deny Claims
A workers’ compensation insurance adjuster has two goals. First, he or she can only authorize necessary medical treatment. Second, he or she exists to minimize the insurance company’s financial exposure. Common reasons for denied claims include:
- Not following up with medical treatment
- Your injury did not occur at work
- The insured employer is denying the claim
- You did not report your injury within two years of the accident
Since the adjuster’s intent is different than your own, you might discover that treatments you deem necessary are denied for coverage. Shifting focus from your health to fighting with an insurance company can be frustrating and counter-productive.
Appealing Your Denied Workers’ Compensation Claim
Just because an insurance adjuster denied your claim does not mean you have to give up. The NYSWCB offers a formal appeals process so that you can have your claim reconsidered. The appeal process is legally binding in the eyes of the court. Having a workers’ compensation lawyer on your side can help you achieve the best possible outcome.
Speak with a Licensed NY Workers’ Comp Lawyer
Your health and well-being take priority when recovering from a work-related injury. There are so many things to consider and manage to receive fair compensation. Consider hiring a workers’ comp attorney to help you through the process. He or she will assume total responsibility for achieving the best outcome possible.
Call the Law Office of Cohen & Jaffe, LLP today at (516) 358-6900. Our team of workers’ compensation lawyers in Long Island, NY can help get your bills paid and look for an action to qualify for pain and suffering. You can get in touch with us by submitting a request through our contact form.