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company that does not have workers compensation insurance then you will be protected by a special fund set up in New York State to protect such workers the Uninsured Employers Fund The Workers’ Compensation Board is the state agency that decides claims filed under the Workers’ Compensation Law The Board has offices throughout New York State The Board functions similar to a court providing Workers’ Compensation Law Judges to decide disputes between injured workers and insurance companies The Board does this either by holding hearings or by issuing written decisions based on paperwork filed by the injured worker the treating doctors the insurance company and the insurance company’s medical consultants Recently there has been a trend to issue Administrative Decisions Often there are many mistakes in these administrative decisions and they must be objected to within a set time period For this reason it is even more crucial to consult with a workers compensation attorney Hearings are held at the Workers’ Compensation Board before a Workers’ Compensation Law Judge The insurance company will be represented by an attorney or other insurance company lawyer who is trained to appear at hearings Court reporters are present to take down what is said at the hearing Many injured workers retain attorneys to represent them in workers’ compensation claims A workers’ compensation attorney is not permitted to charge a fee or to take money directly from a workers’ compensation claimant If the claim results in an award of benefits the attorney will generally request that a fee be approved by the Workers’ Compensation Board The fees vary based upon the jurisdiction and the law judge but is generally 15% of the monies that the attorney obtains over and above what is paid voluntarily by the insurance company INJURIES ILLNESS AND DISABILITY To receive workers’ compensation benefits an employee must prove that he has an injury illness or disability arising out of and in the course of his employment and that adequate notice was given to the employer A claim for an accident must be filed by the injured worker with the Workers’ Compensation Board within two years of the incident or condition that caused the injury illness or disability unless the failure to file is excused for certain limited reasons Notice must be given to the employer within 30 days of the accident There are exceptions to the 30 day requirement if the claim is an occupational or repetitive trauma claim A person may seek workers compensation and also bring a lawsuit against other parties who contributed to causing the injury What is an "accident" To be covered under the Workers’ Compensation Law an accident must arise in and out of the course of the employment "In the course of the employment" means that you must be on the job at the time of the accident By way of example accidents suffered while traveling to and from work are generally not covered subject to certain exceptions for example if you do not work at a fixed location such as a visiting nurse or salesman "Out of the employment" means that the cause of the accident must be work-related In other words just because you are sitting at your desk at work and have a heart attack does not mean you can file for workers compensationthe reason for the heart attack must arise out of the employment For example before sitting at the desk you lifted 10 cases of copy paper or you were under unusual work-related stress that day What is "notice" The law requires the injured worker to give the employer an oral or written report of the accident within 30 days of the accident This requirement is often excused by the Workers’ Compensation Board where it is shown that the employer had knowledge of the accident within the 30-day time period What is causal relationship In order to establish a case the injured worker must have a medical report stating that a work-related accident or condition was the cause of the injury illness or disability Without a medical report stating this the Workers’ Compensation Board will not consider the case OCCUPATIONAL DISEASES Occupational diseases or repetitive trauma claims are also covered by workers’ compensation An occupational disease is a condition which is caused by the specific type of job over a period of time For example a person who works as a typist may after a period of weeks months or years develop a problem with their hands or wrists A person who does heavy lifting on a daily basis may develop a back problem over the course of time as opposed to one specific incident or accident An occupational disease may also result from being exposed to a substance typical to your job over a long period of time An example of this type of occupational disease would be lung disease as a result of working with asbestos or hearing loss as a result of loud noise at work The notice and claim filing time limitations in occupational disease cases are very technical and depend on factors including the date of first medical treatment the date of first lost time from work and the date that you knew or should have known that your problem was work-related It is up to the Workers’ Compensation Board to decide whether any particular claim for an occupational disease was filed timely COMPENSATION BENEFITS The amount of compensation that an injured employee may receive while out of work depends on two things One is average weekly wage What your average weekly wage is generally depends on what you earned with your employer in the year before your accident although adjustments may be made if you were under the age of 25 when injured if you did not work for a full year for the employer before your accident or if you had more than one job The most that an employee can receive in workers’ compensation is two-thirds of his/her average weekly wage up to the maximum compensation rate as of the date of accident It also depends on the date of your accident The weekly benefit cannot exceed the following maximums however which are based on the date of accident: If you can return to work but your injury prevents you from earning the same wages you once did you may be entitled to a benefit that will make up two-thirds of the difference Schedule of Benefits Date of AccidentWeekly Maximum Total / Partial July 1 1985 – June 30 1990$300 / $150 July 1 1990 – June 30 1991$340 / $280 July 1 1991 – June 30 1992$350 / $350 July 1 1992 – June 30 2007$400 / $400 July 1 2007 – June 30 2008$500 / $500 July 1 2008 – June 30 2009$550 / $550 July 1 2009 – June 30 2010$600 / $600 July 1 2010 – June 30 2011$73983 / $73983 July 1 2011 – June 30 2012$77296 / $77296 July 1 2012 – June 30 2013$79207 / $79207 July 1 2013 – June 30 2014$80321 / $80321 July 1st of each succeeding year2/3 of NYSAWW* * NYSAWW is the New York State Average Weekly Wage which is the average weekly wage of the state of New York for the previous calendar year as reported by the Commissioner of Labor to the Superintendent of Insurance on March 31 of each year Note: The benefit rate a claimant receives (determined by his/her date of injury) does not increase if new maximum benefits are adopted into law Cash benefits are not paid for the first seven days of the disability unless it extends beyond fourteen days In that case the worker may receive cash benefits from the first work day off the job Necessary medical care is provided no matter how short or how long the length of the disability Claimants who are totally or partially disabled and unable to work for more than seven days receive cash benefits The amount that a worker receives is based on his/her average weekly wage for the previous year The following formula is used to calculate benefits: 2/3 x average weekly wage x % of disability = weekly benefit Therefore a claimant who was earning $400 per week and is totally (100%) disabled would receive $26667 per week A partially disabled claimant (50%) would receive $13334 per week While it is not illegal to work at reduced earnings and collect workers’ compensation benefits it is illegal to conceal or fail to report work activity to the workers’ compensation insurance company Therefore all work after an injury whether at reduced earnings or not should be reported promptly MEDICAL TREATMENT Once a compensation case is accepted by the insurance company or established by the Compensation Board medical expenses related to the accident are covered Only doctors and chiropractors who are coded by the Workers’ Compensation Board may treat compensation patients Doctors and chiropractors are not permitted to bill a compensation patient directly but must send their bills and reports to the insurance company and the Workers’ Compensation Board If there is a dispute regarding a medical bill the insurance company must file a form with the Compensation Board advising it of the dispute The bill will then be addressed at a hearing or sent to arbitration but while it is pending the health care provider must wait to be paid A workers’ compensation claimant should never pay a health care provider for a medical bill for treatment related to the workers’ compensation case If a doctor or chiropractor requests a test or procedure which will cost less than $500 no advance approval from the insurance company is required If the test or procedure will cost $500 or more the insurance company is entitled to obtain an opinion from one of their own medical consultants as to whether the test is necessary The insurance company is required to obtain the examination within 30 days of the date it receives the request for authorization from the treating doctor INJURIES TO AN EXTREMITY If you have injured an extremity such as an arm leg finger or toe if you have a facial scar or if you have a hearing or vision loss as the result of an accident on the job you may be entitled to an award of compensation even if you lose no time from work With awards of this type weekly benefits paid while you are out of work may be deducted from your final compensation award Depending on the type of injury you may only be entitled to compensation for time out of work or lost earnings In either event you must see a doctor at least once every six weeks in order to prove that you are still disabledUnCategorized The state of Florida is home to breathtaking features that attract people year round from all over the world which contain over one hundred miles of useable trails. 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