INJURED ON THE JOB?
An Employees Guide to NYS
Workers' Compensation Benefits
- Excerpts from NYS Workers'
Compensation Board Pamphlet
HOW
TO FILE A CLAIM
Report the injury, in writing, to the
employer promptly, within 30 days of the accident. If you have lost
time from work, obtain Board Form C-3, employee's claim for the
compensation from the nearest board district office (you may do this
by phone). Mail a completed C-3 to the district office nearest you.
You must file a claim within 2 years of the accident. You'll be
notified by mail if a hearing on your case is necessary.
WHO'S COVERED?
• Workers in all employments
conducted for profit.
• Employees of counties and municipalities
engaged in work defined by the law as hazardous.
• Public school
teachers, excluding those employed by New York City, and Public
School Aides, including New York City.
• Employees of the State
of New York, including some volunteer workers.
• Domestic workers
employed 40 or more hours per week by the same employer (including
full-time sitters or companions, and live-in maids).
• Farm
workers who's employers paid $1200 or more for farm labor in the in
the preceding calendar year.
• Any other worker determined by the
board to be an employee.
WHO'S NOT COVERED?
• Clergy and members of
religious orders.
• People engaged in a teaching or non-manual
capacity in or for a religious, charitable or educational
institution.
• People employed in certain maritime trades,
interstate railroad employees, federal Government employees and
others covered under Federal Workers' Compensation Laws.
• People
(including minors) performing yard work or casual chores in and
about a one-family, owner-occupied residence. Casual
means—occasionally, without regularity, without foresight, plan or
method. Coverage is required if the minor handles power-driven
machinery, including a power lawn mower.
• Certain employees of
foreign governments.
• New York City police officers,
firefighters, and sanitation workers. Uniformed police officers in
other municipalities may also be excluded.
• Certain real estate
salespersons who sign a contract with a broker stating that they are
independent contractors.
• Sole proprietors, partners, and
one/two person corporate officers with no employees (although
coverage may be obtained voluntarily.)
NOTE: the employer is required to post notice of compliance
with the workers' compensation law.
CASH
BENEFITS
Cash benefits are not paid for the first seven days
of the disability, unless it extends beyond fourteen days. In such
cases, 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 earned $400 per week and is totally (100%) disabled
would receive $266.67 per week—a partially disabled claimant (50%)
would receive $133.34 per week. The weekly benefit cannot exceed the
following maximums, which are based on the date of the
accident:
| SCHEDULE OF BENEFITS |
| Date of
Accident |
|
Weekly
Maximum
total/partial |
| July
1,1992 and after |
|
$400 /
$400 |
| July 1,
1991- June 30, 1992 |
|
$350 /
$350 |
| July 1,
1990- June 30, 1991 |
|
$340 /
$280 |
| July 1,
1985- June 30, 1990 |
|
$30 / $150
|
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.
|
SUPPLEMENTAL BENEFITS
Supplemental benefits
were made available to claimants thought to be most affected by
rising costs. The combination of weekly benefits, death benefits and
supplemental benefits cannot exceed $215/wk. This is the rate that
was in effect on January 1, 1979.
Two
categories of claimants/beneficiaries are eligible for
supplemental benefits by making application to the board:
•
Claimants classified permanently totally
disabled as the result of an injury or disability incurring on
the job prior to January 1, 1979.
• Widows
or widowers receiving death benefits as the result of the
death of their spouse occurring prior to January 1,
1979
DEATH BENEFITS
If the worker dies from a
compensable injury, the surviving spouse and/or minor children, and
lacking such, other dependents as defined by law, are entitled to
weekly cash benefits. The amount is equal to two-thirds of the
deceased workers' average weekly wage for the year before the
accident. The weekly compensation may not exceed the weekly maximum,
despite the number of dependents.
If
there are no surviving children, spouse, grandchildren,
grandparents, brothers or sisters entitled to the compensation, the
surviving parents or the estate of the deceased worker may be
entitled to payment of a sum of $50,000. Funeral expenses may also
be paid, up to $6,000 in metropolitan New York counties; up to
$5,000 in all others.
SOCIAL SECURITY BENEFITS
A worker who becomes
seriously disabled, either permanently or for a continuous period of
not less than 12 months, as a result of a medically determinable
physical or mental impairment may be entitled to the payment of
social security benefits. For more information, write or call the
nearest Social Security Office.
MEDICAL CARE
The injured or ill worker who is
eligible for Workers' Compensation will receive necessary medical
care directly related to the original injury or illness and the
recovery from his/her disability. The worker is free to choose any
physician, chiropractor, podiatrist, or psychologist (upon referral
from an authorized physician).
Outpatient clinic of a hospital or
health maintenance
organization
SERVICES
COVERED:
Medical
Osteopathic
Dental
Podiatric
Psychological
(by referral)
Chiropractic treatment
Surgery
Hospital
Care
Laboratory Tests
Prescribed Drugs
Authorized
Nursing
Services
Surgical Appliances
Prosthetic
Devices
Note: In certain instances advance authorization from
the employer or carrier is required. |
