Workers Compensation

What is Worker’s Compensation?

New York State laws require all employers/companies to carry insurance for their employees for treatment and lost wage benefits in case they get injured at work.  This insurance is called Worker’s Compensation.

 

Do I qualify to receive medical treatment if I was injured at work?

Yes, you do.  It does not matter if it was your fault or not.  If you are injured during your employment, you qualify for medical treatment.

 

Am I suing my employer if I file for Worker’s Compensation?

Not at all.  Worker’s Compensation laws do not allow an employee to sue an employer for being injured at work.  Filing for Worker’s Compensation benefits is much like filing a claim after a house fire or flood damage.  However, if you were injured at work due to negligence of another party other than your employer, such as being rear-ended while working as a taxi driver or falling at a supermarket due to slippery floor while working as a Pepsi delivery man, you may be entitled to personal injury compensation.  In these cases, if a settlement is not reached, your personal injury attorney will most likely begin a lawsuit against the party at fault.

 

What do I do if I was injured?

First, you need to notify your injury to your employer as soon as possible, preferably immediately.  Worker’s Compensation laws require that you notify your employer about on-the-work injury in writing within 30 days of the incident.  However, sometimes employees do not realize they were injured until a few days later after the incident, or they were hoping that the injury would go away in a few days and do not notify of it immediately.  If you realize you were injured at work sometime later after the incident, still notify your employer about your injury as soon as possible.

 

What do I need to be careful of when notifying of my injuries to my employer?

Your employer will want to know when, where, and how you were injured, so have this information on hand.  Make sure you notify of all of your injured body parts to your employer.  A Worker’s Compensation case gets established based on the injured body parts.  An insurance company will establish your case and assign benefits based on specific body parts that were injured.  If you forget to notify your employer or your employer fails to report all injured body parts, you will not qualify to get treatment or benefits for the unreported body parts.

 

I reported my injuries to my employer.  Now what?

Once you report your injuries to your employer, your employer/company is legally bound to report your injury to the Worker’s Compensation insurance company within 10 days.  The insurance company or your employer should be able to provide you with a Carrier Case #.  Also, you should also be assigned a Worker’s Compensation Case #:  These two numbers will be the identifying numbers for your Worker’s Compensation case.  You can provide any healthcare providers you see with these two numbers to receive medical treatment.

 

I am not being provided a Worker’s Compensation Case # or Carrier Case #.  What do I do?

Sometimes an employer is antagonistic toward an employee who is seeking Worker’s Compensation benefits and refuses to file as Worker’s Compensation claim.  Sometimes an insurance company disputes that there had been a work-related injury.  Sometimes an employer does not have Worker’s Compensation insurance and cannot provide an employee with Worker’s Compensation benefits.  In any case, if you were injured at work and you are not being provided with Carrier Case #, you need to seek out a Worker’s Compensation attorney to receive benefits that you are entitled to.

 

How does Worker’s Compensation Board, insurance company, and doctors work together to treat the injured employee?

Worker’s Compensation Board is the regulatory body that oversees the insurance companies that sells Worker’s Compensation insurances to employers and the doctors who treat the injured employees.  Often there is a conflicting opinion between the doctor/patient and the insurance company about how seriously the patient is injured and what kind of treatment and benefit that the patient is entitled to.  Usually the injured employee has a Worker’s Compensation attorney to represent him/her.  When there is a irreconcilably conflicting opinions, the patient’s attorney can request a hearing to bring up the issue in front of a Law Judge.  There could be many month before the injured employee goes in front of a Law Judge after a hearing was requested.   At the hearing, the Law Judge will make a decision about the issue at hand.

 

How much treatment can I get?

Worker’s Compensation Board has established a treatment algorithm called Medical Treatment Guidelines for the most commonly injured body parts.  These Medical Treatment Guidelines are meant to get the injured employee back to work as soon as possible to reduce costs.  One of the complaints that the doctors have with these guidelines is that it does not take into account the physical difference between people.  A 20 years old athlete and a 60 year old sedentary worker respond differently to treatment, and yet the guidelines do not take this simple fact into account.  Therefore if you need more treatment than what the guidelines allow for your injury, your doctor must request additional treatment to the insurance company.

It has been our experience that it is extremely difficult to get authorization for any additional treatment that is beyond the guidelines.  When the doctor’s request for additional treatment for the injured employee is denied by the insurance company, the injured employee’s attorney can request a hearing for a Law Judge to decide on whether or not to allow the additional treatment.

In reality, the Medical Treatment Guidelines is not geared toward prolonged physical therapy or chiropractic treatment.  Rather, it is a short and intensive approach to get the injured employee back to work.  The injured employee should also aim to get back to work as soon as possible by being diligent with the treatment schedule.

 

What if I am severely injured and cannot go back to work?

Unfortunately, sometimes the injury is so severe that the injured employee cannot return to work for many month, or not at all.  The injured employee may be exhausted all treatment options.  When it becomes apparent that the employee’s injuries are permanent, the employee’s attorney can request a Permanent Impairment Rating evaluation from the employee’s doctor.

There are established guidelines from the Worker’s Compensation Board that the doctor can follow to give a Permanent Impairment Rating to an injured employee.  This is not based on the doctor’s opinion but strict data from objective findings.  The attorney tries to get the maximum benefit that the employee is entitled to based on the Permanent Impairment Rating determined by the doctor and their previous salary.

Often, the insurance company requests their own doctor to evaluate the employee and give his/her opinion.  Almost all of the reports from these evaluations performed by the insurance company doctors are inadequate and fabricated, if not outright fraudulent.  However, insurance companies use these reports as a reason to reduce the employee’s benefits.  If the insurance company doctor’s report is particularly egregious, the employee’s own treating doctor may decide to refute the report with a rebuttal.

Also, the insurance company or the employee’s attorney may request to depose both the insurance company’s doctor and the employee’s treating doctor via a phone call.  In a deposition, doctors are interrogated by attorneys from both sides to defend their opinions and conclusions.  It is often an unpleasant experience for the doctors, particularly if they cannot defend their position or if they are not well-versed with the Worker’s Compensation regulations.

Therefore it is very important that the injured worker to be treating with a doctor who is familiar with the Worker’s Compensation regulations and performing Permanent Impairment Rating, and comfortable with depositions.

 

I was injured at work.  Can I come to your office for treatment?

If you have recently been injured and have a Worker’s Compensation Case # and a Carrier Case #, you can come in for treatment.  In certain cases if you are waiting to get the numbers, we may be able to treat you before you receive them.  However, if you were injured at work many months ago and received many months of treatment, your treatment benefit most likely would have been exhausted by now.  Unfortunately with cases like this, there is not very much we could do as any treatment would need to be authorize first, and most of the authorization would likely be denied.

 

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