Workers Compensation

Workers' Compensation Insurance provides weekly cash payments and the cost of full medical treatment, including rehabilitation, for employees who become disabled as a result of a disease or injury connected with their employment. It also provides payments for qualified dependents (family members) of a worker who dies from a compensable injury or illness.

The New York State Workers' Compensation Board administers the program and processes claims for benefits, reports of injuries, and medical reports from health care providers. The Workers' Compensation Board administers various laws which protect the rights of injured workers. In addition to the Workers' Compensation Law, they also handle the New York State Disability Benefit Law, the Volunteer Firefighters' Benefit Law, and the Volunteer Ambulance Workers' Benefit Law. The Board decides all the issues in a case and gives awards which ensure that the injured workers receive the benefits and medical treatment they are entitled to. Hearings are held before administrative law judges and appeals are held before panels of three Board members.

The Workers' Compensation Law takes away an employee's ability to directly sue an employer but gives the employee the right to medical care and payment for lost wages. The following situations are exceptions and are not handled through the Workers' Compensation Board:

• accidents caused solely due to the intoxication of the injured employee;
• accidents caused by the willful intent of the injured employee; and accidents caused by the intentional actions of the employer, or by actions that were made at the direction of the employer.
• Workers' Compensation claims include not only injuries, but cases involving toxic exposure while at work.
  

Our mission at Lipsitz & Ponterio, LLC is to ensure that each injured worker is treated fairly and reasonably by the compensation insurance carrier under the Workers' Compensation Law. Many compensation carriers choose to ignore the Workers' Compensation Law or "bend" the law to suit their needs and convenience. At Lipsitz & Ponterio. LLC, we only represent the interests of the injured worker, never the compensation insurance carrier. Contact us.

Frequently Asked Questions

1. What type of benefits can I expect to receive from Worker' Compensation?

Once your case is established, you can expect to receive a partial wage replacement based on your average weekly wage, as well as payment of medical expenses. This includes mileage payments to and from your doctor(s) offices, and any co-payments for which you may be responsible. You will not receive any payment for pain and suffering or loss of enjoyment of life.

2. What formula is used to determine my wage replacement benefit?

Your average weekly wage is calculated by averaging your weekly wages for the 52 weeks prior to your injury. You are then entitled to two-thirds of your average weekly wage up to a maximum of $400.00 per week. For example, if your average weekly wage was $600.00 per week, you would be entitled to the maximum benefits amount of $400.00 per week. If your average weekly wage is $1,000.00 per week, you are still only entitled to the maximum of $400.00 per week. If your average weekly wage is $300.00 per week, you would be entitled to a benefit amount of $200.00 per week.

Your benefit amount will also vary depending on your level of disability. The formula described above is used in calculating the wage replacement for an injured worker who is totally disabled. Your benefit amount will be reduced if you have a partial disability and are not totally disabled.

3. How long does it take to establish a Workers' Compensation claim?

There are many factors involved in establishing a Workers' Compensation claim, and no two claims are identical. Some of these factors include whether the compensation carrier is contesting your claim, whether you have a pre-existing injury, and whether your doctor has been filing timely medical reports with the Workers' Compensation Board. In many cases the compensation carrier accepts the Workers' Compensation claim and begins payments immediately. However, in some cases the compensation carrier contests the Workers' Compensation claim, and hearings and litigation are necessary in order to resolve conflicts.

4. Who is entitled to Workers' Compensation benefits when a worker is killed on the job?

The surviving spouse of a deceased worker is entitled to Workers' Compensation benefits for the remainder of his/her life, in addition to any children the deceased worker may have had who were under the age of 18 at the time of the workers' death, or under the age of 23 and attending school. In a case where the injured worker had no spouse and no children under the age of 18, the deceased worker's estate would be entitled to a lump-sum payment in the amount of $50,000.00.