WORKERS' COMPENSATION BASICS
The Workers' Compensation Law was passed by the New York State Legislature in 1914 as a compromise between employee and employer interests.  As part of the compromise, employees gave up their right to sue their employers for negligence resulting in injury.  In return, employees would receive payment from workers' compensation without regard to fault as long as the accident or injury was related to work.

WHAT IS COVERED
To receive workers' compensation benefits, an employee must prove that he had an accident in the course of his or her employment, that he gave adequate notice to his employer of the accident, and that his injury and disability were caused by the accident.  A claim for an accident must be filed with the Workers' Compensation Board within two years of the accident, unless the failure to file is excused for certain limited reasons.

Occupational diseases are also covered by workers' compensation.  An occupational disease is a medical condition that develops over a period of time that is characteristic of a certain occupation.  For example, an automotive mechanic may, after a period of weeks, months, or years, develop a problem with the hands or wrists.  The problem may be related to repeated twisting and bending of the wrists, which is characteristic of the work of a mechanic.

AMOUNT OF COMPENSATION
The amount of compensation that an injured employee may receive while out of work depends on two things.  One is average weekly wage.  The most that an employee can receive in workers' compensation is two-thirds of his/her average weekly wage up to the maximum compensation rate for the date of accident.

If you were injured after July 1, 1992, the maximum compensation rate is $400 per week.
The amount of compensation to which a person may be entitled also depends on his or her degree of disability.  A person may be either totally or partially disabled. Total disability is an inability to do any kind of work whatsoever.  Partial disability means that a person can do some type of work, even if they cannot do the type of work they were doing at the time of the accident.   For example, a concert pianist who loses a finger may be totally disabled from his work as a musician, but is only considered partially disabled because he still has the ability to do other kinds of work.

A person who is partially disabled may receive compensation in an amount less than the maximum rate.  There are different degrees of partial disability, and the precise rate to which a person is entitled depends on the degree of their disability.

MEDICAL TREATMENT
Once a compensation case is accepted by the insurance company or established by the Compensation Board, medical expenses related to the accident are covered.  Only doctors and chiropractors who are coded by the Workers’ Compensation Board may treat compensation patients.  Doctors and chiropractors are not permitted to bill a compensation patient directly but must send their bills and reports to the insurance company and the Workers' Compensation Board.  If there is a dispute regarding a medical bill, the insurance company must file a form with the Compensation Board advising it of the dispute.  The bill will then be addressed at a hearing or sent to arbitration, but while it is pending the health care provider must wait to be paid.
If a doctor or chiropractor requests a test or procedure that costs less than $500, no advance approval from the insurance company is required.  If the test or procedure will cost over $500, the insurance company is entitled to obtain an opinion from one of their own medical consultants as to whether the test is necessary.

If you have any questions, contact us.