Workers’ Compensation FAQ
Q. What workers’ compensation benefits can I receive?
A. Workers’ compensation benefits include both medical treatment for work-related injuries and monetary benefits for the time you are out of work and remain disabled.
Q. What must I do if I am injured at work or believe my work activities have caused a condition which affects my health?
A. As soon as an incident occurs or you believe your work activities have caused some condition affecting your health, you must notify your employer within 30 days and seek medical treatment. Notification to the employer is best done in writing on an incident report.
Q. What must my doctor do?
A. Under the NYS Workers’ Compensation Law, the doctor is required to submit reports to the NYS Workers’ Compensation Board, and your employer’s workers’ compensation insurance company.
The doctor’s report should be prepared on an approved workers’ compensation form and describe the history of the work activities or conditions that caused the injury or disease. The report must indicate that, in the doctor’s opinion, the injury or disease was caused by the work activities or conditions. The report must also provide a diagnosis, treatment plan and indicate the percentage of impairment resulting from the injury.
Q. How do I pay for treatment?
A. All treatment and prescription medication related to the work injury is paid for by the insurance carrier, including reasonable travel expenses to and from the doctor’s office. Do not pay your doctor for treatment or use your private health insurance.
Q. When and how do I get paid for being unable to work because of my disability?
A. Once the carrier has knowledge of your injury and has received medical reports supporting your injury and disability, the carrier is required to pay benefits under the law unless the carrier is disputing your claim. If your claim is not disputed, you may receive up to two-thirds of your average weekly wage, but no more than the statutory maximum set by law. Your benefits are nontaxable.
Q. Why were my monetary benefits reduced or stopped?
A. If you were examined by the insurance carrier’s doctor, it is likely the report states you have a partial disability or no disability.
When your monetary payments are reduced or stopped, you are entitled to a hearing before a Workers’ Compensation law judge to determine what weekly rate is proper based upon the medical evidence from your doctor and the carrier’s doctor.
Q. Why did the insurance company stop my treatment?
A. There are Medical Treatment Guidelines that your doctor must follow. If the treatment exceeds the amount of treatment in the guidelines or varies from those guidelines, your doctor must file for a variance. If the insurance company denies the request for a variance, the Workers’ Compensation Board will rule on the request.
Q. When can I return to work?
A. This is a medical decision between you and your doctor. Your doctor should advise you whether you have the ability to return to work.
Q. What happens to my case if I return to work?
A. If you return to work, even with a different employer, the law requires you notify the insurance carrier and your attorney.
A law judge can authorize continuing treatment after you return to work to ensure you continue to be able to perform your duties.
If you return to work earning less than the wages at the time of your disability, you may be entitled to some continuing payments.
Beware: A criminal prosecution can result from receiving compensation while working if you intentionally fail to notify the insurance carrier.
Q. What if I need a special type of treatment or surgery?
A. Most types of treatment and surgery are preauthorized under the treatment guidelines. Other types of treatments and surgeries may be authorized upon a request for authorization by your doctor. If the carrier disputes the request, the Workers’ Compensation Board can consider the request and rule on it.
Q. Who attends the hearing at the Workers’ Compensation Board?
A. You should attend all hearings scheduled on your claim. The insurance carrier is generally represented by counsel, and since the hearing is a judicial proceeding, it is recorded by a stenographer provided by the Board.
Q. Should I have a lawyer?
A. You should, at least, consult an experienced workers’ compensation attorney. There is no charge for a consultation at Rosado, Apat & Dudley, LLP.
The proceedings before the law judge may sometimes involve questions of law or fact and an attorney can assist you and your doctor in pursuing your claim.
Q. How do I pay for a lawyer?
A. The law prohibits an attorney from charging you directly for legal services. Any fee earned by an attorney is granted by the law judge at a hearing. The fee is deducted from your benefits and paid to the attorney directly by the insurance carrier.
Q. What other benefits am I entitled to receive?
A. If your injury or disease causes you to be unable to work, you may be eligible for Social Security Disability and a disability benefits pension. Your attorney should advise you concerning the procedures and medical evidence required to apply for these additional benefits.
WHEN YOU KNOW YOUR RIGHTS, YOU WILL BE HELPFUL TO YOUR DOCTOR AND YOUR LAWYER IN PRESENTING YOUR CLAIM AND OBTAINING BENEFITS.
If you have questions about your specific situation, please feel free to set up a free initial consultation with one of our attorneys. Call 800-708-8917 or fill out our online contact form. From convenient offices in Queens, Nassau County (Freeport) and the Bronx, we serve clients throughout the greater New York City metro area.