Resource Guide

Introduction

Part 1: The Workers' Compensation Process

Part 2: Special Issues In Workers' Compensation

FINALIZATION OF A WORKERS' COMPENSATION CLAIM

A Workers' Compensation claim remains open for 18 years with a non-permanent injury and for the remainder of the claimant's life with a permanent injury. This means that you can continue to receive medical treatment for all established sites of injury for either 18 years, or the rest of your life. An exception to this rule occurs when a claimant finalizes his or her claim with a "Section 32" settlement where they waive their rights to future medical coverage in exchange for a lump sum payment. Section 32 settlements will be discussed further below. There are two types of permanency awards in New York State Workers' Compensation Law. These are "schedule loss of use" and "classification".

Schedule Loss of Use

Permanent injuries to the extremities (fingers, hands, arms, toes, feet and legs), as well as loss of eyesight and loss of hearing, are the subject of schedule loss of use awards. The time to determine whether you are entitled to a schedule loss of use award is generally one year after your accident, or one year after any surgery that has been performed. In general, a permanency determination can be made if your condition has become stable and no further active medical treatment is contemplated.

When it is time to determine permanency we will instruct you to return to your doctor for a permanency exam. (Under special circumstances, we may arrange an appointment for you). The doctor will examine your injured body part based on Medical Guidelines written by the Workers' Compensation Board. If your doctor is not familiar with the Board's Medical Guidelines we will gladly provide him or her with a copy. Based on the examination your doctor will indicate a percentage loss of use.

The Workers' Compensation Law assigns a value to each of the extremities, the ears and the eyes that is equivalent to a number of weeks. These values are:

The values indicate the number of weeks of benefits you would be entitled to on a permanency award, if you had a 100% schedule loss of use. A 100% schedule loss of use is very rare, generally only occurring in cases of paralysis or amputation. Most people have some smaller percentage loss. For example, if your injury was to your arm, and your doctor indicated that you had a 25% loss of use, you would most likely be entitled to 78 weeks of benefits because 78 is 25% of 312. There are several additional factors that can come into play in calculating a schedule award. As such, when the time comes for you to receive a schedule we will show you the medical reports and formula used to calculate your award. Please keep in mind that when you receive a schedule the insurance company is entitled to a credit for any lost wage payments they have already made to you.

Classification

The term "classification" is used for permanent injuries to the back and neck. Under certain circumstances a person can also be "classified" with permanent internal injuries, head injuries, or severe injuries to the extremities. As with schedule loss of use awards, a classification finding is made at a hearing 1 to 2 years after the accident date or surgery and is based on the Workers' Compensation Board Medical Guidelines.

The major difference between a schedule loss of use award and a classification is the right to collect on-going lost wage payments. With a classification you are entitled to lifetime benefits so long as you are medically disabled from work. Your on-going benefit rate with a classification is based on medical evidence of degree of disability. If your doctor says you are permanently partially disabled with a moderate degree of disability, you would receive payments at your moderate, or 50%, rate. If your doctor indicates that you have a permanent disability, but you are able to work, you will not receive on-going benefits or a monetary award. You will however, have lifetime medical coverage for treatment related to the original work injury. At the end of a Workers' Compensation hearing, you may hear the Law Judge say that "no further action" is planned on your case, or an insurance company adjustor may tell you that your case has been "closed". These terms only mean that there are no outstanding legal issues requiring a further hearing. If some issue should arise regarding your lost wage payments or medical treatment we can request a hearing. As was stated above, an established case remains open for 18 years, and if your injury is deemed permanent, you have lifetime protection. The only way to "close" your case on a final and permanent basis is with a Section 32 settlement.

Scars

The Workers' Compensation Law only provides monetary awards for scars on your face. The maximum amount payable for facial scars is $20,000, and this amount is reserved for only extremely serious cases. Most facial scars result in payments under $5,000.00.

Section 32 Settlements

Section 32 of the Workers' Compensation Law permits settlements of all issues relating to a compensation claim. Generally, it is the insurance company who suggests a Section 32 settlement because these settlements result in a permanent closure of the compensation case. In rare circumstances we are able to negotiate a Section 32 settlement that makes a final cash payment and continues medical coverage, but more often, the insurance company will only settle if the claimant agrees to give up all future benefits, both medical and indemnity (lost wage payments), in exchange for a lump sum payment.

If you do decide to accept a Section 32 settlement offer you need to be aware of the following:

Please note that Section 32 agreements can be complicated by several factors. The most common of these is the receipt of Social Security Disability and Medicare or Medicaid benefits. If you receive these benefits, or plan on applying for them, please make sure we know about it when negotiating your Section 32 agreement.