Workers’ Compensation FAQ
**An injury lawyer has created page to assist you in understanding your claim and is intended solely for your information. It does not constitute legal advice and should not be relied on without discussion of your specific situation with a qualified attorney. For help with your Workers’ Compensation claim, or other legal matters, please call an injury lawyer at Lewis & Lewis, P.C. at (716) 854-2100)**
General Questions Regarding the Claims Process
Q: How do I know if I have a Workers’ Compensation claim?
A: If you got hurt at work, you should contact our office immediately. We can help assess your claim and assist in filing the proper paperwork.
Q: Is there a time limit for reporting or filing a claim?
A: Yes. You should report all injuries to your employer in writing as soon as possible. Accident claims should be reported within thirty days of the accident. There is a 2 year limit to filling a claim with the Workers’ Compensation Board. All medical evidence of your workplace injury must be received by the Workers’ Compensation Board within two years of the date of injury. If you sustain another injury at work, you should contact our office as soon as possible to file the new claim.
Q: What benefits are available to me as a result of my Workers’ Compensation injury?
A: You are eligible for medical treatment and lost time benefits related to your injury. The Workers’ Compensation Law does not provide benefits for pain, suffering, loss of enjoyment of life, and other non-economic damages that may be recovered in a personal injury lawsuit.
Q: Do I need an attorney?
A: Our office can assist you in maximizing the benefits that you are eligible for while making sure your rights are protected and your questions are answered. While an attorney is not required, it is strongly recommended that you retain one. The insurance carriers will have their own attorneys fighting for them, you should have an attorney fighting for you.
Q: How will I pay the Lewis & Lewis Injury Attorney?
A: Our office receives fees from the additional money we generate for you. We will never send you a written billing statement. Our attorney fees are explained in our Fee Agreement.
Medical Benefits & Treatment
Q: What medical benefits am I eligible for under the Workers’ Compensation Law?
A: The insurance carrier is required to pay for necessary and causally related medical treatment for established sites of injury. Make sure you report all sites of injury to your doctors so that all injuries and/or diagnoses are documented.
In many cases, the medical treatment available to you is governed by the Medical Treatment Guidelines. Your treating physicians should be familiar with the Guidelines and procedures for requesting medical treatment above and beyond the Guidelines.
In other cases, your treating physicians will need to request authorization for treatment that exceeds $1,000.
Q: What if my treatment and/or prescriptions are denied?
A: You should contact our office immediately. We do not recommend paying for anything out of pocket, as we cannot guarantee that you will receive reimbursement.
Q: How often do I need to see a doctor?
A: While you are out of work, you must see a doctor every 45-90 days. If you are working, you can treat with your doctor as needed, but we recommend seeking treatment at least once every 6 months.
Q: Can I see a doctor for a second opinion?
A: Yes. You are able to select doctors of your choosing, so long as they are authorized to treat Workers’ Compensation patients.
Q: Do I have to attend medical appointments (IMEs) scheduled by the insurance carrier?
A: Yes. Failing to attend an Independent Medical Examination (IME) scheduled by the insurance carrier can jeopardize both your financial and your medical benefits.
Q: Can I receive treatment for injuries outside of New York State?
A: It is strongly encouraged that you treat with medical professionals in New York State. Any medical treatment obtained outside New York must be pre-authorized by the insurance carrier.
Q: What financial benefits am I eligible for under the Workers’ Compensation Law?
A: You are eligible for payments of compensation for causally related lost time so long as you have medical evidence supporting the lost time with a degree of disability. Your lost time benefits are calculated using the Average Weekly Wage (AWW) and the degree of disability assessed by your doctors and possibly the carrier’s doctors.
Q: Are financial benefits guaranteed?
A: No. We have to prove that you are eligible for benefits based on medical evidence from your treating physicians. Based on your degree of disability, we may also have to prove that you are making an active and dedicated effort to return to work.
Failure to have updated medical evidence containing a degree of disability can result in a suspension of your financial benefits. In some circumstances, failing to look for work within your physical restrictions can also result in a suspension of your benefits.
Q: What if I was working more than 1 job when I was injured?
A: We may be able to increase payments to you if you were working more than 1 job at the time you were injured. If you have not already advised us of your additional jobs, please do so immediately.
Q: Will I get a settlement?
A: Settlements are not guaranteed under the Workers’ Compensation Law. If you are interested in settling your case, please contact our office to discuss settlement options. Unfortunately, if the carrier is not interested in settling your claim, we cannot force them to settle; however, you may be entitled to an award for permanency if you have suffered permanent damage.
Settlements are permanent and once you settle your case, it can never be re-opened.
Workers’ Compensation Hearings
Q: Will I have to attend a hearing?
A: In many cases, hearings are scheduled to address unresolved issues in a case. You should attend every hearing unless our office specifically indicates that you do not need to attend the hearing. If you are unable to attend a hearing, you should contact our office prior to the hearing.
Q: What happens at the hearings?
A: Our office will work with the carriers’ representatives to resolve the outstanding issues in your claim. If we are not able to negotiate a resolution, we will make arguments to the Administrative Law Judge or the case will be scheduled for further development of the record (testimony of you, employer witnesses and/or doctors).
Q: When can I expect to get paid after a hearing?
A: In most cases, payment is due 10 days after the date of the Notice of Decision – not the date of the hearing. If you do not receive your check, you should contact our office and we will follow up.
If you believe a check is late, you should photocopy the envelope and check prior to cashing the check. Our office can review the documents to determine if you are eligible for a penalty.
Q: Can the Judges’ decisions be appealed?
A: Yes. Any party can appeal a Judge’s decision within 30 days of the decision being filed. If the insurance carrier appeals the decision, it is likely that financial and/or medical benefits can be withheld pending resolution. Unfortunately, appeals can take a year or more to be decided.
Q: What is a Schedule Loss of Use (SLU)?
A: If you injured an extremity (arms or legs) or suffered a loss of hearing or vision, you may be entitled to a Schedule Loss of Use Award. Your doctor will provide a percentage for the loss of use you have sustained as a result of your injury. Your doctor’s percentage is based on the Permanent Impairment Guidelines. Our office will review the percentage assessed by your doctor to determine if an additional award or money is due to you.
Q: What is a classification?
A: If you injured your back or neck or have a combination of injuries, you may be classified with a permanent disability. With a classification, you may be entitled to ongoing weekly payments based on your degree of medical impairment and your loss of wage earning capacity. At classification, a determination is made as to how many weeks you are entitled to ongoing financial benefits.
Q: What if I have scars from my injury and/or surgeries?
A: You may be entitled to a monetary award for scars on your face only. The monetary award can range from $1.00 to $20,000.00 depending on the scarring. The award is set by the Administrative Law Judge.
Returning to Work
Q: How long can I stay out of work?
A: It depends, and every case is different. For temporary impairments, as long as there is evidence of a causally related degree of disability at least every ninety (90) days there may be an argument that you are entitled to benefits. If you are less than 100% (totally) disabled, then you will be required to look for work within your restrictions. Please note that in order to be considered 100% disabled, you must be 100% disabled from any and all work. If your doctor says that you are 100% disabled from your regular job, but able to perform some other type of work, you are not 100% disabled overall.
Q: What if my doctor says I am less than 100% disabled?
A: If your doctor reduces your degree of disability to anything less than 100%, you are required to seek work within your physical restrictions. You should find out what your restrictions are from your doctor.
You should first contact your employer to see if they can accommodate your restrictions. If your employer cannot accommodate your restrictions, you are required to look for alternate work within your physical restrictions.
Q: What if I do not look for work?
A: If your doctor finds you less than 100% disabled and you do not look for work, your benefits can be suspended.
Q: What if I find a job within my restrictions, but I am making less money?
A: If you are making less money after returning to work, you may be eligible for Reduced Earnings benefits if we have medical evidence to support a claim that your reduction in earnings is related to your Workers’ Compensation injury. The insurance carrier can be directed to make up some of the difference in your pre- and post-injury earnings.
Q: What should I do if I return to work?
A: Any time your job status changes, you should immediately notify our office. This includes returning to work and being taken out of work. Our office should also be advised of any self-employment earnings or volunteer work as this may affect your benefits.
Q: Does having a Workers’ Compensation injury save my job?
A: No. Unfortunately, your employer is not required to hold your job while you are out of work due to a workplace injury. Depending on your employer or union, you may have additional rights.
Contacting the Insurance Carrier
Q: Should I contact the insurance carrier?
A: NO! You should never contact the insurance carrier. Our office will help address your issues or concerns. The insurance carrier may be attempting to obtain information from you that may jeopardize your benefits.
Q: What should I do if the insurance carrier or its representatives contact me?
A: You should direct the insurance carrier or its representatives to our office. We will provide them with the necessary information. Again, they may be attempting to obtain information that may jeopardize your benefits.
Q: What if the insurance carrier mails questionnaires or other documents requesting information?
A: Any time the insurance carrier mails you a questionnaire that requires your signature, you should complete the document and MAIL IT TO OUR OFFICE. Our office will review the document to ensure your answers do not jeopardize your benefits.
Other Sources of Benefits
Q: Can I apply for New York State Disability?
A: New York State Disability is for non-work related injuries. Workers’ Compensation covers injuries that happened at work. However, if the insurance carrier is fighting your claim, you can apply for New York State Disability. If we are successful in having your claim established, a portion of your Workers’ Compensation award may be reimbursed to the disability insurance carrier.
You cannot receive New York State Disability and Unemployment Insurance at the same time.
Q: Can I apply for New York State Unemployment Insurance?
A: You may be eligible to receive Unemployment benefits if your doctor is reporting a degree of disability less than 100%.
You can collect Unemployment benefits and Workers’ Compensation benefits at the same time; however, you should notify the Department of Labor of your exact Workers’ Compensation benefit awards as it may affect your unemployment benefits.
Q: Can I apply for Automobile No-Fault Insurance?
A: You may be eligible for No-Fault benefits if your work accident arose out of the use or operation of a motor vehicle. You may qualify if your injury occurred in a Motor Vehicle accident or if you were working in/on/around a motor vehicle. Our office can assist you in obtaining these benefits.
You can receive No-Fault benefits and Workers’ Compensation benefits at the same time.
Q: Can I apply for Social Security Disability (SSD)?
A: You may be eligible for SSD if you miss or expect to miss 12 months of work as a result of your injury. If you have questions about eligibility for SSD and the application process, our office can assist you. Please call our office and ask to speak to a member of the Social Security Department.
You can receive SSD benefits and Workers’ Compensation benefits at the same time. If you are getting both benefits, you should notify the Social Security Administration of your Workers’ Compensation Award to avoid any overpayment.
Q: Can I apply for Supplemental Security Income (SSI)?
A: You may be eligible for SSI. In addition to having a disability, you must also demonstrate financial need. You must have limited assets and income. A member of our Social Security Department can answer any additional questions you may have and assist you in obtaining SSI benefits if you are eligible.
You can receive SSI and Workers’ Compensation benefits at the same time, depending on your income levels. You must notify the Social Security Administration of your Workers’ Compensation benefits.
Q: Can I sue my employer?
A: No. In New York State, you cannot sue your employer for an injury at work.
In certain, limited, circumstances, you may have a lawsuit related to your case. This includes, but is not limited to, injuries that resulted from Motor Vehicle Accidents and some construction site accidents.
It is important to advise our office of all the facts and circumstances surrounding your injury so we can carefully screen your case for a third party lawsuit.
Q: What happens after a settlement has been negotiated and an agreement has been reached?
A: The Workers’ Compensation Board explains the settlement process for Workers’ Compensation claims here.