How Are Workers’ Compensation Benefits Paid?

How Are Workers' Compensation Benefits Paid?

With very few exceptions, New York employers must purchase workers’ compensation insurance for employees. This coverage pays for medical care and related expenses if you suffer an injury on the job. Insurance pays some benefits directly to medical care providers and others directly to employees to replace lost income. Our experienced workers compensation attorneys at Cellino Law can help you file a claim and recover the maximum amount of benefits possible.

Workers Compensation Attorneys Help You Get Benefits After an Injury

The process of filing a claim for workers’ compensation in New York can be complex. You may need documentation of your injury, the medical care necessary to treat it and your inability to return to work right away. In some cases, you will need proof of a partial or full disability to secure additional benefits. Any disputes filed by your employer or their insurance carrier can further delay benefits, which results in additional stress and financial strain for you and your family.

Hiring a workers’ comp benefit attorney can facilitate the claims process and help preserve your rights after a workplace injury. Our experienced lawyers will walk you through each step of the process, from gathering evidence to receiving benefit payments. Additionally, if your injury resulted in a permanent disability or disfigurement, we can help you secure lump-sum payments for those.

How Often Are New York Workers Compensation Benefit Payments Made?

Many New York insurers pay workers’ compensation benefits on a weekly schedule. This allows you to continue paying bills and living expenses while you are out of work because of an injury. In some cases, benefits may be in the form of a lump-sum payment.

When Do Payments Start?

There is a waiting period before your unemployment benefits start since there are no benefits for the first week of missed work unless your injury causes you to miss two or more weeks of work. In those cases, your benefit payment period starts on your first day of missed work.

Payments for approved claims begin within 18 days of the injury or within 10 days of your employer becoming aware of the injury. Payments can be significantly delayed if the insurance company disputes your claim. In those cases, you must wait for a judge to review and approve the claim before receiving any benefits. The judge’s decision is final unless one of the involved parties files an appeal.

What Are the Different Types of Workers Comp Benefits?

Once approved, your workers’ comp claim can trigger three main types of payments. You receive two of them (lost wages and compensation for a disability) directly. The insurance company pays medical providers directly for their services.

Lost Wages

Payments for lost wages are one of the most important components of workers’ compensation insurance. They reduce the impact of missing work because of a work-related injury or illness. Weekly payment amounts are a percentage of your earnings from the year preceding your claim.

If your employer continues to pay your wages while you are out of work, it may affect your eligibility for benefits. Your employer may file for reimbursement from his workers’ compensation insurance provider.

Medical Care

This is another critical component of benefits. It pays for you to visit a doctor for treatment. According to the New York Workers Compensation Board, you may choose your doctors and specialists from their list of approved providers. Benefits typically pay for the following types of services related to the treatment of your injury:

  • Doctor appointments
  • Emergency dental work
  • Medical devices
  • Optometry visits 
  • Prescriptions
  • Surgery
  • Tests and medical imaging

You may also be eligible for reimbursement for travel expenses related to medical treatment. Be sure to save any applicable receipts for submission.

You should not pay out-of-pocket for medical care costs (other than travel). Providers receive payment directly from the insurance company. In cases where worker’s comp denies individual medical claims, you may wish to file an appeal. Having experienced workers compensation attorneys at your side can help facilitate the appeal.

Disability and Death Benefits

New York worker’s compensation also pays cash benefits for loss of use of specific body parts, disfigurement and death. These one-time payments vary based on the body part affected and the rate at which it affects your ability to work. Insurers pay survivor benefits to the surviving spouse, minor children or other dependents. Payments include weekly cash benefits and up to $12,500 in funeral or memorial service expenses.

How Are Benefit Payments Calculated?

Calculations for lost wage and weekly survivor benefits use the following formula:

weekly benefit amount = 2/3 x (average weekly wage) x (% of disability)

The average weekly wage amount uses your wages reported over the 52 weeks prior to your injury. You must also have medical verification of your disability and its effect on your ability to work.

Minimum weekly benefits are $150 for accidents occurring up to 1/1/2024. Accidents occurring after that time are eligible for a minimum weekly benefit of $275. Maximum weekly benefits are up to $1,145.43 but can vary depending on when your accident occurred. Awards for disfigurement can be up to $20,000 depending on their severity and when they occurred.

What Happens if My Claim Is Denied?

One of the conditions for receiving workers’ compensation benefits in New York is that your injury keeps you out of work for more than seven days. The other condition is when an injury causes you to accept reduced pay due to different duties or reduced hours worked. If you suffered an injury at work and you meet those conditions, you should be eligible for workers’ compensation benefits.

However, if the judge denies your claim, you must file an appeal to the state Workers’ Compensation Board within 30 days of the decision. It is advisable to retain a workers compensation attorney before filing an appeal, although you are not required to have an attorney represent you during the appeal process.

All appeals must include specific information about your application, hearing and injury. Workers compensation attorneys provide this on a current Application for Board Review, known as Form RB-89. Any new evidence that was not introduced in the initial hearing must include a sworn affidavit explaining why it was not presented earlier.

All parties to the claim must receive completed applications and rebuttals during the appeal. This includes employees, employers and any affected insurance companies or funds. Failure to provide this documentation can result in a denied appeal.

Because of the specific rules governing the appeals process, it is usually advisable to have an attorney representing you. He will complete all steps and file all forms as required by state laws. This gives you a better chance of a successful appeal than if you file on your own.

If you win your appeal, then benefits are retroactive to when the injury occurred. However, if you file for and receive disability payments while the appeal plays out, the amount of those payments can lower the amount of workers’ compensation benefits you receive.

Have Experienced Workers’ Compensation Attorneys on Your Side

You do not have to file a workers’ comp claim on your own. Our experienced workers’ compensation attorneys at Cellino Law are available to assist you with the initial claim and any required appeals. We’ll work to help you secure the maximum amount of compensation possible. Schedule your free consultation at our convenient Manhattan office today.

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