Workers’ compensation is a type of insurance benefit that provides monetary and non-monetary benefits for workers who are injured or become sick due to their job. In New York State, workers’ compensation beneficiaries receive two types of benefits, one compensating for the medical costs associated with treatment for a workplace injury and the other for wages lost while unable to work due to injury. Workers’ compensation is calculated by taking into account one or both of these benefits.
How to Calculate Workers’ Compensation Benefits
Wage Benefit Calculation
Wage benefits, also called “indemnity” or “disability benefits,” are calculated based on your prior earnings with your employer. In general, an average weekly wage (AWW) is calculated based on your earnings for the 52 weeks prior to your accident/injury date.
There are alternate methods for calculating the AWW if you did not work a full year for your employer and different formulas are used depending on the number of days and hours you worked. Once the AWW is set, your actual payment rate will be based on the percentage of disability reported by doctors.
If the doctors say you are 100% disabled, you receive 2/3 of your AWW. That is called the “total” disability rate. Anything less than the total is calculated by taking the lesser percentage of the total rate. For example, if you are 75% disabled, your payment will be equivalent to 75% of your total, or 100% rate, which is 2/3 of your AWW.
The process often becomes complicated when there are conflicting medical reports. Your doctor may find you 75% disabled and the insurance company may send you to a doctor who says you are 50% disabled. This situation usually results in a workers’ compensation board hearing where your rate is either negotiated or litigated with the help of an experienced workers’ compensation attorney. If you are less than 100% disabled, you may be required to look for work and produce evidence of your job search in order to continue receiving workers’ compensation benefits.
Some workers have union contracts or employment agreements that allow them to receive their full wages while on workers’ compensation. In these situations, the worker typically must use their sick time first. Workers’ compensation awards will determine how much sick time can be reinstated if you are deemed eligible for benefits. Workers who have more than one job may be entitled to an increase in their AWW and overall benefit rate. Workers who are under 25 on the date of injury may be entitled to an increase in their AWW at the time of a permanency award.
Medical Benefit Calculation
Fees for medical treatment are governed by a fee schedule for treatment and associated services. You do not receive payments for your workers’ compensation medical treatment directly. If you are injured at work, you should see a medical provider who accepts workers’ compensation benefits and be sure that the provider submits bills to the workers’ compensation insurance carrier, rather than to your private health insurance. The medical treatment you receive from the workers’ compensation medical provider will be tracked for the purposes of receiving your medical benefit. You should not be charged a co-pay for workers’ compensation treatment and you should not be billed directly because these costs will be handled by your workers’ compensation medical benefit.
Determining Your Total Benefits
Calculating the proper average weekly wage and workers’ compensation rate can be a complicated process. Sometimes, final benefits totals are only determined after litigation and negotiation with the worker’s compensation insurance company. The attorneys at Lewis & Lewis can help you obtain the maximum benefits you are entitled to by helping you accurately represent your income, your injury, and your medical needs.
