Resource Guide

Introduction

Part 1: The Workers' Compensation Process

Part 2: Special Issues In Workers' Compensation

FREQUENTLY ASKED QUESTIONS

What should I do if I get hurt at work?
The first two things you should do are report the accident to your employer and seek immediate medical attention. Once you have reported your accident and have seen a doctor you should contact an attorney at Lewis & Lewis, P.C. For more information on reporting and filing a claim see pages 3-5.
Do I need an attorney?
Although the law permits you to appear at a Workers' Compensation Board hearing without an attorney, it is strongly recommended that you retain one. The insurance company will have a staff of attorneys on its side. In order to compete and protect your rights you should have your own attorney.
How much will I have to pay my attorney?
Our office will be paid from the money we generate for you. Attorneys' fees are discussed on pages 13-14.
How does a Workers' Compensation case get started?
You start your claim by filing forms with the Workers' Compensation Board. See pages 4-5 for more information on filing your claim.
If I can prove a Workers' Compensation injury, what am I entitled to?
You will be entitled to all necessary and related medical benefits and a portion of your lost wages. Workers' Compensation benefits are discussed in detail on pages 5-7.
Can I sue my employer for negligence?
No, but you may have a case against some third party other than your employer. Please see page 18 for a discussion of lawsuits.
Will I get a settlement for my pain and suffering?
No. Workers' Compensation does not provide any monetary award for pain and suffering. Your benefits are limited to medical care and lost wage payments. Please see pages 5-7.
Should I give a statement to the insurance carrier?
No! If you are contacted by an insurance company representative tell him or her that this office represents you and end the conversation. Any information you provide may be used against you.
Will the insurance carrier hire a private investigator?
You should expect that someone will monitor your activities. It is very common for insurance carriers to check to see if you are exceeding the limitations set by your doctors. Please see page 15 for a discussion of investigators and workers' compensation fraud.
How can I get authorization for expensive medical care?
Your doctor must request authorization from the insurance company for any treatment which costs more than $500.00. The authorization process is discussed on page 5-6.
Can I go outside of New York State for treatment?
It is strongly encouraged that you treat with medical professionals in New York State. You may obtain out of state treatment, but any treatment outside of New York must be preapproved by your employer's workers' compensation carrier. Please see the discussion on pages 5-6.
Can I see a doctor for a second opinion?
Yes, you can. For more information on your medical treatment options, see pages 5-6.
Do I have to go to the insurance company's doctor?
Yes. Please see page 8 for a discussion of independent medical examinations.
What medical reports do I need to be successful?
You must have a medical report sufficient to prove that your injury arose out of and in the course of your employment. Your doctor must provide a specific history of how the injury occurred, the exact diagnosis involved, and a specific comment on whether the injury is causally related to your work. More information is available on pages 3-7.
How long will my medical and lost wage benefits last?
In most cases, the insurance company will be responsible for causally related medical benefits for the rest of your life. Lost wage benefits normally extend for 18 years from the date of the injury. In some cases of permanent injury the lost wage payments may last longer than 18 years. See the discussion on pages 11-13.22
Do I have to have a Workers' Compensation Board hearing?
Hearings are scheduled when there are controverted, or disputed, issues on a case. If the
How long after a hearing will I get paid?
Under most circumstances you should expect payment within 10 days from the date of a Workers' Compensation Board Notice of Decision. The payment process is discussed on pages 9-10.
What should I do if my employer does not have work within my restrictions?
If you are in a union, you should contact your representative regarding any possible contract violations. If there are no violations and no work is available, you may be eligible for unemployment benefits. Please see page 17.
What is a schedule loss of use?
A schedule loss of use is an award given for permanency to one of the extremities, the
What is classification?
A classification is a legal determination that an injured worker has an on-going permanent disability. Classification is discussed in detail on page 12.
Do I get paid for scarring?
Workers' Compensation will compensate you for scars on your face only. See page 12.
Can my case be re-opened if I have received a final award?
The answer to this question is almost always, "yes", unless you have entered into a Section 32 settlement. For more information please see pages 11-13.
What is a Section 32 settlement?
A Section 32 settlement is an agreement that resolves your case on a final, permanent basis. These agreements are discussed on page 13.
What are actual reduced earnings?
Actual reduced earnings are paid if you have to take a job at a lower wage due to your disability. Please see page 16.
Will I be reimbursed for out-of-pocket expenses?
You can receive reimbursement for mileage and parking expenses incurred for medical treatment. You will not be reimbursed for travel to hearings or your attorney's office. You may also receive reimbursement for prescriptions. In order to get your money back, you must keep careful records of your mileage and prescription expenses. An expense sheet is included in your Lewis & Lewis folder.