What Does Workers’ Compensation Cover?

The majority of employers in New York State must provide workers’ compensation coverage to their employees (WCL §2 and 3). While there is a select group of people who are not covered, most can rest assured that if a work place injury does occur, they will receive benefits. Employers may secure workers’ compensation coverage through the New York State Insurance Fund, a private insurance carrier, or by self-insuring. Who an employer is insured through does not affect the benefits you are entitled to collect if you have suffered a work place injury.

Compensation for Lost Wages

Benefits are not paid for the first seven days of a disability, unless it extends beyond 14 days. If the disability extends beyond 14 days, you may receive benefits from the first work day you missed. The amount of weekly compensation you receive is based on your average weekly wage for the previous year. The following formula can be used to calculate benefits.

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

Depending on the date of your accident, the weekly maximum benefit differs. For a full schedule of benefits, click here.

Compensation for Medical Costs

Necessary medical care is provided no matter how short or long the length of disability. Medical supplies and care are paid for by the employer or the employer’s insurance. Except in an emergency situation, the health care provider must be authorized by the Workers’ Compensation Board. Failure to receive treatment from an authorized provider may cause you to lose out on benefits.

Any treatment or supplies less than $1000 does not require prior authorization. You’re entitled to have any medical payments reimbursed through your employers’ insurance. Some of the costs that may be eligible for reimbursement include:

  • X-Rays
  • CT/MRI – these scans may be covered if your doctor orders the testing. If the scans cost will exceed $1000 you must obtain prior authorization
  • Doctor’s visits – all necessary visits to your doctor are covered under your workers’ compensation benefits. All bills should be submitted though the workers’ compensation insurer
  • Medical supplies – this includes crutches, canes, wheelchairs, scooters, or other necessary devices.
  • Prescription drugs – the prescription and bill for all drugs and medications will need to be submitted to the insurance provider.
  • Rehabilitation costs
  • Mileage/fuel allowance – mileage and transportation allowances must be claimed by providing the name, address, and date of appointment with a provider. If you use public transportation to travel to your appointment, you should save the receipts to submit them.

Permanently Disabled Workers

Once your medical condition has stabilized to the point of Maximum Medical Improvement (MMI), your doctor will determine if your work-related injury has left you with a permanent disability. If you are 100% disabled, you will receive two-thirds of your average weekly wage for as long as you remain disabled. Your degree of disability will determine the percentage of weekly wages you will receive.

Death Benefits

If a work-related injury leads to the death of an employee, workers compensation benefits will be paid to their spouse, dependent child, or other dependents. The same formula will be used to determine the benefits that the dependent will receive. New York workers’ compensation also covers reasonable funeral expenses.

If you have been injured on the job, you have up to two years to file a workers’ compensation claim to receive benefits. An attorney at Erwin, McCane, and Daly can work with you to file the claim and give you an idea of the benefits you can expect to receive. Schedule your initial consultation today.