Workers Compensation — How to File a Workers Compensation Claim
Workers who are injured on the worksite should report the injury as soon possible. This can prevent issues and delays in receiving workers’ compensation benefits.
Workers’ compensation benefits typically include medical treatment and vocational rehabilitation services and disability payments. The amount and duration of these benefits varies from state to state.
Medical Treatment
Workers’ compensation claims cover medical treatment for injuries sustained on the job. This kind of insurance covers doctor visits, hospital stays and imaging studies (xrays) as well as rehabilitation costs.
To promote objective healing and help achieve goals of returning to work, the New York State Workers’ Compensation Board develops medical treatment guidelines (MTGs). These guidelines are frequently updated in accordance with medical advances and physician recommendations.
These guidelines are designed to ensure that injured workers receive the same treatment as other workers who suffer from work-related injuries and illnesses. These guidelines ensure that the appropriate treatment is provided to every illness or injury, and that there are no unnecessary medical costs.
If the doctor decides that treatment outside of MTGs is necessary the doctor can seek a variance from the insurance carrier, requesting an exception specifically to the MTGs. The process is lengthy and may take months to complete.
If the treatment is needed the employer or insurer should take every step to provide the treatment. Failure to do so can cause a dispute between the insurer and the injured employee which is often resolved through an evidentiary hearing before an administrative law judge.
Typically, treatment should be provided by a licensed health care provider in the area who is licensed to treat claimants for workers’ compensation. In urgent situations, a non-licensed or uncertified doctor may be able to provide the treatment needed for injuries sustained by a worker provided they have been notified of the incident and the required initial report of injury has been submitted by the supervisor or employer.
Many physicians are certified in workers’ comp and will charge a reduced rate for treating injured employees. This is especially helpful to patients who have sustained serious injuries.
Many medical professionals can provide medical treatment for injured employees, in addition to doctors. They include physical therapists, occupational therapists , chiropractors and others.
The New York State Workers’ Compensation Board suggests that injured workers and their representatives contact their attorneys before they receive any medical treatment. This could be the only method to ensure that injured workers receive the highest quality care in some instances.
Charges
Workers compensation costs can differ according to the state of the employee and state. These expenses include medical costs and vocational rehabilitation costs, legal costs, and settlement costs.
The majority of these expenses are covered by the insurance policy. Certain of these expenses might be for the employee, their spouse, and/or dependents.
Employers must have workers’ compensation insurance in the majority of states. This protects employees from lawsuits and other damages that result from workplace accidents such as injuries or illnesses. The policy covers workers who are killed on the job and offers indemnity for medical treatments or wage replacement, as well as death benefits.
Workers Compensation insurance is vital however it can be costly. A worker’s compensation claim could cost a company around $1 per hour of lost work.
The losses could show up in the bottom line which could result in an erosion in productivity and profitability. It can also impact the business’s reputation which could affect future business contracts and qualified employees.
Apart from workers’ compensation companies can also incur additional indirect costs related to employee injuries. These indirect costs can comprise expenses like the duration of time an employee is away from work, as well as the cost of hiring the replacement worker.
Another indirect cost is the cost of fixing or replacing equipment or property that was damaged during an injury-causing incident. This can be an expense that is significant to any business, but it is particularly prevalent for businesses with heavy-duty machinery and equipment.
Additionally, Occupational Safety and Health Administration (OSHA) fines associated with a high rate of incidents can be an additional expense for the employer. These fees are typically activated when an organization’s accident or fatality rates are assessed.
These direct and indirect expenses can be cut by creating an environment of positive work and reducing claims by employees for compensation. It also helps create a more profitable environment and increase morale of employees.
Time Off Work
The loss of income due to an injury that is caused by work can be devastating. You may be eligible for workers’ compensation benefits to help pay the gap until your rehabilitation is complete.
There are numerous types of time off that can be used by employees, including vacation and sick leave. Certain types of leave are covered by federal or state laws while others are voluntary.
The use of vacation and sick leave are a great tool for companies because they allow employees to take time away from work when they are sick or have to take care of relatives. Some employers offer personal time that can be used to attend medical appointments, car checkups or even for occasions (e.g. parent-teacher conferences).
Certain states have laws that require employers to provide paid sick leave, however this is not always the case. Some companies may be able to opt out from offering this kind of leave. This can be helpful for businesses that do not have the funds to cover this type of leave.
Another option for employers is to provide flexible time. Employers can provide flex time to employees. This lets them get paid time off, and the employer can make up for the difference by increasing their working hours or increasing their wages.
Certain states also require employers to offer vacation or sick time. This can encourage employees to take time off when they are sick or caring for family members.
If your employer doesn’t provide one of these options, it’s best to consult with a lawyer about the best way to use your rights under the law. If you are being asked to take paid time off for medical treatment, or for any other reason, a skilled lawyer can assist you in understanding and safeguard your rights.
Some employers also give employees the opportunity to take time off for work they’ve done over the time limit, which is known as time off in lieu, or TOIL. Some employees make use of this time to attend medical appointments or other kinds of treatment. Some also be juries members or to perform other activities that they choose.
Appeal
If you are denied workers compensation benefits You have the right to appeal the decision. Within 30 days of the day the judge made a negative decision, you are able to appeal to your state’s workers compensation board.
Appeals are an integral component of the claims procedure and can be an important instrument to help you get the benefits you are entitled to following a workplace accident. A skilled attorney can help you navigate the appeals process and ensure you receive the full amount of benefits to which you are entitled.
Many injured workers are denied a workers’ compensation claim or have their claims drastically reduced by the insurance company. This can be devastating for injured workers and is usually performed to save their employer and the insurance company money.
The appeals process begins with a hearing in front of the workers’ compensation judge. It is typically an open hearing, however it can also be conducted by videoconferencing.
The judge will listen to your and your lawyer’s concerns about your workers’ comp claim during this hearing. The judge will examine medical records, wages and other evidence to determine if you are eligible to receive workers compensation benefits and what the amount of that benefit should be.
Additionally to that, the judge will review any disputed issues about your injury. The judge will then decide on the benefits you are entitled and how long they should last.
If you do not agree with the judge’s decision, you can appeal the decision to a higher court. Typically, you can appeal to the appellate division of your state’s court within 30 days of the decision of the workers compensation board.
Appealing can be a challenge however, your workers’ compensation attorneys will be determined to get you the best result. A skilled attorney will go over your case and explain to the appeals court the reasons you should be able to get a better results.
If you require assistance in a workers’ compensation appeal, call an experienced New York workers’ compensation law firm today. The Turley, Redmond & Rosasco team is comprised of experienced workers’ compensation lawyers who can help you receive the maximum amount of workers compensation benefits to which your rights are entitled.