New York City Workers’ Compensation Lawyers

FAQ

Since the New York legislature made substantial changes to the workers’ compensation system, some benefits have changed significantly for workers who were injured after July 1, 2007.

Individuals with non-extremity injuries are now subject to new caps on benefits, based on evolving medical guidelines. The weekly benefits rate for individuals with extremity injuries has also changed.

What does this mean to you? At the Law Office of Robert Koenigsberg, we offer a free initial consultation to explain how these changes in the law could affect you. Contact us today for dependable, experienced representation.

Dedicated to Helping Injured Workers

Since 1996, the Law Office of Robert Koenigsberg has vigorously protected injured workers’ rights in New York City and surrounding areas. While the workers’ compensation laws have changed, the quality of our work has not. We believe our experience has become even more critical to injured workers while the workers’ compensation system continues evolving.

Contact us immediately following a work-related injury and we will explain how to file a claim with the New York State Workers’ Compensation Board, as required under the new law. We will also review the details of your case to understand if a settlement is possible.

Evolving Workers’ Compensation Reform

Attorneys Robert A. Koenigsberg and Maria Makis will carefully explain how the law affects injured workers in a variety of ways, such as:
Lifetime benefits are only available for those with permanent total disabilities. Payments will be based on a sliding scale and capped based on the number of payout years.

Diagnostic providers and pharmacies may be chosen by your employer’s workers’ compensation insurance carrier.

On July 1, 2009, the maximum benefit was increased to $600 per week. After July 1, 2010, this was increased to $739 per week.

The new law allows providers to render services costing up to $1,000 without obtaining prior authorization.

Contact Us Today

Whether you were injured while running an errand for your boss, in a construction accident or in an industrial accident, contact us to discuss your legal options. If you were injured before March 13, 2007, we will explain how your benefits are covered under the old law.
We offer free initial consultations at our law office, which is conveniently located across the street from the Federal Plaza in downtown Manhattan. We look forward to helping you recover.

Free Initial Consultations — Call 646-480-1625 Today

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New York Workers Compensation FAQ

What Do I Do After I've Been Injured?

Not everyone needs a lawyer to obtain workers’ comp benefits. Some injury cases are fairly straightforward. You can fill out the initial application for benefits yourself. Simply visit the New York State Workers’ Compensation website to download the application. If you have questions about the form, the Workers’ Compensation Board will help you. After you are injured, you need to report your injury to your employer as soon as possible, but within 30 days to comply with the statute. You also need to seek medical care. Make sure that your doctor understands workers’ comp and is familiar with any forms he or she needs to complete. It is very important that your doctor documents each injury you have. If you try to get benefits for an injury which was not reported, the insurance carrier may deny it. You may not want to sign any documents from your employer, the insurance carrier or the Workers’ Compensation Board until you have had an attorney review them.

Workers Compensation Law Changes
In 2007, the New York legislature made considerable changes to the workers’ compensation system. Both short- and long-term benefits have been adjusted for individuals who were injured after spring 2007. How Will These Changes Affect You? Every work injury is unique, and every case is unique, as well. We offer a hands-on approach to carefully explain how changes to the law could affect you in several ways, including:

The weekly benefit rate has changed for people with long-term injuries
Lifetime benefits are now only available for individuals with permanent total disabilities
Non-extremity injuries are subject to benefit caps based on evolving medical guidelines
Your employer’s workers’ compensation insurance carrier can choose your diagnostic provider and pharmacy.

Your benefits will depend in part on your employer’s insurance company. In some circumstance, private insurance companies might be interested in settling more quickly than the state insurance fund or self-insured companies. We will review the details of your case and determine if a settlement is possible.


What Money & Benefits Can I Recover?
If you were injured prior to March 13, 2007, $400 is your weekly maximum benefit for lost income. Any permanent partial disability may enable you to receive lifetime workers’ compensation payments. If you were injured on or after July 1, 2007, you may expect to receive as much as $500 in weekly income benefits, depending on your salary. If you were injured on or after July 1, 2008 your benefit could be $550, and if you were injured on or after July 1, 2009, $600. If you were injured on or after July 1, 2010 the maximum rate is now $739 per week.

What Benefits Can I Recover From Facial Disfigurement
Payments for Permanent Disfigurements to the Face, Head and Neck -Under New York workers’ compensation law, you may be entitled to additional benefits, up to a maximum of $20,000, if you suffer a serious, permanent disfigurement to the head, face or neck. Disfigurement may include permanent scarring on the face or may involve damage to the eyes, ears, nose or lips.

What is a Non-Schedule Injury?
A non-schedule injury is a non-extremity injury. These are injuries to the back, neck or head. They are also injuries to the heart, lungs or internal organs. Psychological injuries and mental illnesses can fall into this category as well.

What is a Permanent Partial Disability?
A PPD is a disability that you are not expected to recover from, but is not a complete disability. You may be able to return to some form of work, if not your previous line of work. For example, the loss of use of a finger or a toe would be considered a permanent partial disability.

What is Permanent Total Disability?
A PTD is a disability that you are not expected to recover from, a disability that totally impacts your ability to earn an income in your chosen career or any other career. These could range from mental disabilities to severe neck and back injuries suffered in the workplace.

What Does Schedule Loss Mean?
One-time Settlement for a Permanent Loss -A schedule loss of use award is a one-time settlement for a permanent loss, such as the loss of function of an arm, leg, hand or foot. This award may also be available in cases of hearing or vision loss, as well as in cases involving injuries that have left visible scars on the face or neck. How Large Will the Settlement Be? -Settlements are based on the body part. For example, according to the schedule, the total value of an injured arm may be different than the total value of an injured leg. If your doctor has noted that your loss of use is less than 100%, you will get whatever percentage of the schedule loss of use award corresponds with the percentage the doctor has assigned to your loss.

What is the Second Injury Fund?
The second injury fund is a special fund managed by the state of New York. When a workers’ compensation insurance company has to pay an assessment to the state, part of that assessment goes into special funds, one of which is the second injury fund. When money comes out of special funds, it is coming from the state, not the insurance company directly.

What is a Section 32 Settlement?
There are essentially two Section 32 settlement scenarios. The first is when you agree to give up all rights to future benefits in exchange for the workers’ compensation insurance company providing you with a one-time settlement. The second is similar, except that you may leave one portion of your case opened. Typically, that would be medical benefits, which would continue to be provided as long as they are needed.

What is Temporary Partial Disability?
A TPD is neither a complete disability, nor is it a disability that will impact you for the rest of your life. You are expected to recover from it, but until you do, you may not be able to do your job, although you may be able to do a different job. For example, a pair of broken legs would be considered a temporary partial disability.

What is Temporary Total Disability?
The Definition of Temporary Total Disability -A TTD is a complete disability, one that prevents you from doing your job or any other job. However, it is a disability that you are expected to recover from. A back or neck injury that is expected to be fully repaired by surgery may be considered a TTD.

Vocational Rehabilitation Benefits
Vocational Counselors at the Workers’ Compensation Board -One source of employment advice is the New York Workers’ Compensation Board itself. They have counselors on staff who can work with you. Counselors can help you look for employment opportunities that make sense for you, based on your education, your work background and your medical condition. Vocational and Educational Services for Individuals With Disabilities -Vocational and Educational Services for Individuals with Disabilities (VESID) is an agency run by the New York State Department of Education. This agency offers a wide range of resources that you may be eligible for, including scholarships to help you get the education you need to pursue a line of work that you are interested in and that makes sense for you.

Your Doctor vs The Insurance Company Doctor
In the past, if your doctor said that you were 70% disabled and the insurance company’s doctor said that you were only 40% disabled, there would be a hearing to settle the matter. Currently, hearings are rare. How is a decision made without a hearing? That is the challenge. Hearings are being phased out because the workers’ compensation system is growing ever closer to becoming automated. Except in the rare instance that a hearing is held, cases in which the opinions of the treating doctor and the insurance company doctor differ can be reviewed and decided by clerks at the Workers’ Compensation Board.

Is There a Cap on Benefits?
Under the new workers’ compensation law, there are caps on benefits for people with permanent partial disability to a non-extremity. Now, lifetime benefits are available only for workers who suffer permanent total disability. The state developed guidelines to determine payments for workers with a permanent partial disability; however, there is considerable ambiguity surrounding the issue. Final decisions on how to determine payment amounts are still pending.

Can I Reopen My Case?
If your case was accepted, you have 18 years from the date of the accident to reopen it. There are a number of reasons you may be able to reopen a workers’ comp case. Some settlements, such as those for schedule losses for example, can be reopened. If your condition has deteriorated since you received your settlement, you may be able to get additional benefits to compensate you for the current percentage loss. You may also reopen a case if you received compensation for lost wages and medical bills, but did not make a permanent settlement. One of the changes to New York workers’ compensation law involves cases of permanent partial disability. If you have an 80 percent permanent partial disability, you may be able to reopen your case within the allowable time frame.

How Voluntary Withdrawal Works
The Consequences of Voluntary Withdrawal -One of the changes to New York workers’ compensation law mandates that workers with partial disability have to look for work, even if they cannot return to their old job. Your employer’s insurance company may try to terminate your workers’ comp benefits by arguing that you are not looking for work. You will be required to prove that you are seeking a job or the insurance company will claim that you have voluntarily withdrawn yourself from the job market. We can fight this carrier defense of voluntary withdrawal. Our lawyers know how to use medical evidence combined with vocational factors to prove the limits of your capabilities or to help you demonstrate to the judge that you have made the necessary efforts to have looked for work.

Big Companies & Workers Compensation Claims
Big Companies and Workers’ Compensation Claims -The intention of workers’ compensation is to help workers who suffer a work injury. Our attorneys believe that, unfortunately, big businesses may have lost sight of this. They are seeing workers’ compensation claims as attacks on their bottom line. When they look and see that they have paid out millions in claims over the course of a year, they react. They fight back, not only to avoid paying your claim but to send a message to your coworkers, and even to us attorneys, that they are drawing a hard line and avoiding paying claims whenever possible. What Does This Mean to You? -If you work for a large national or international business, you want to take extra care in how you proceed. You want to enlist an experienced lawyer who understands how to handle these cases, as any misstep could prevent you from getting workers’ compensation benefits. With 20 years of experience, we know how to handle these cases, regardless of the size of your employer.

Fraud Allegations and Pre-Existing Conditions
Many fraud allegations are the result of a pre-existing condition that was not disclosed at the time of the work injury. For example, a person may have hurt his back on the job. When filling out all of the paperwork and talking to his doctor, he may neglect to mention that he suffered a different back injury eight years before. Perhaps he simply thought this information was not relevant. Perhaps he worried the pre-existing condition would impact his ability to get benefits. Regardless of the reason, there was no intent to commit fraud. The workers’ compensation insurance company may see things differently. Our lawyers know how to handle these issues. What They Consider Fraud May Not Be Fraud at All -Once in a while, we will see a case in which an overzealous workers’ compensation insurance company has a videotape of a workplace injury victim walking her dog or something along those lines, claiming it is evidence of fraud. Of course, an injury that prevents a person from working may not prevent her from walking her dog. We will combat unfair fraud allegations.

Why do you Need a Workers Compensation Lawyer
The truth is that you don’t need a workers’ compensation attorney, at least not at first. You can file your claim on your own. To simplify the process, here’s what happens: You, the injured worker, have to present a medical opinion — your doctor’s opinion — of the value of your case. The workers’ compensation insurance company can either accept that or, more likely, send you to an independent medical examination (IME) where the insurance company’s doctor will evaluate you. Not surprisingly, the opinions of insurance company doctors frequently differ from those of the victim’s doctor. Do you simply accept what the insurance company offers based on its doctor’s findings? If you choose not to accept the insurance company’s offer, which may very well be far less than you need, you will find yourself in a negotiation with the insurance company’s highly trained professionals that may involve thousands of dollars. With so much at stake, do you really want to do this on your own, or would you prefer the assistance of a lawyer?

How Medical Benefits work under Workers Compensation
Medical services are paid for by the employer or its insurance carrier if there is no dispute about a workers’ compensation claim and if the medical services are determined to be directly related to the employee’s work-related injury or illness. In some cases, insurance providers dispute whether medical care was directly related to a work injury or illness.

Employers Workers Compensation Issues
When the New York State Legislature passed the workers’ compensation reform bill in March of 2007, they revamped a large bureaucratic system that had remained essentially unchanged for the better part of a century. They also created a lot of confusion and uncertainty in the process. Because our practice has been focused on protecting injured workers’ rights for more than a decade, we are able to offer employers unique insights into the workers’ compensation system and the requirements that it imposes on them. Under the new law, many things have not changed. You still report a workplace injury or accident in much the same way as you did before. However, businesses that fail to comply with certain provisions in the law can, and have been, shut down by the state. There are also stiff penalties and fines in place for underreporting. If you are a smaller employer and do not have workers’ compensation insurance for your employees, an injured worker can seek to obtain benefits for lost income, qualified medical expense and permanent disabilities from you — personally. If you have concerns in any of these areas, it is better to talk with a lawyer sooner rather than later.

Workers Compensation and Third Party Settlements
If you are considering settling your third-party lawsuit, you must realize that compensation recovered will likely be reduced to reimburse your employer’s workers’ compensation carrier for benefits paid. Your employer (and your employer’s worker’s compensation insurance company) may also be released from any future liability for your medical expenses, time away from work or other expenses related to your work injury. If your employer becomes aware of your personal injury settlement after it is finalized, you could lose your right to receive any workers’ compensation benefits — including lost wages and medical benefits that have already been paid.

Workers Compensation Medicare Liens
When you receive Medicare benefits following a workplace accident, it is important to understand that Medicare has a right to file a lien against any future workers’ compensation settlement or third-party liability settlement. When your workers’ compensation case (or personal injury case) is settled, Medicare may be reimbursed for previously provided medical benefits from your settlement proceeds. An experienced Brooklyn workers’ compensation attorney is necessary to navigate the complexity of this legal process.

What is Loss of Wage Capacity?
Injured workers in New York especially those with permanent impairments may want to know what workers’ compensation they are entitled to. Under new New York workers’ compensation laws, a worker’s “loss of wage earning capacity,” a number decided by a judge, is now based on the severity of the medical injury and various other factors. These factors are as follows: -Vocational history -Degree of medical impairment -Functional capacity at the workplace The new formula was created in order to provide a more accurate way to determine who is eligible for Permanent Partial Disability (PPD) awards. Additionally the process requires at least two “forms” that must be filled out to determine a worker’s loss of wage earning capacity. They are the “vocational data form” and the “functional capacity form.”

Maximum Medical Improvements
According to the New York Workers’ Compensation Board (WCB), the definition of Maximum Medical Improvement (MMI) is as follows: “An assessed condition of a claimant based on medical judgment that[:] (a) the claimant has recovered from the work injury to the greatest extent that is expected and (b) no further change in his/her condition is expected. A finding of maximum medical improvement is a normal precondition for determining the permanent disability level of a claimant.” Getting to this point generally is not a quick process, and we highly recommend our clients seek our legal counsel before speaking to their employer’s insurance company. It is very critical to your case that you are at the appropriate stage where any permanent impairments can be determined.

What Starts a Settlement
The following is a general timeline of how a workers’ compensation claim can get to the settlement and negotiation point. It is important to keep in mind that every case is different with its own unique circumstances and to consult with one of our experienced attorneys: Part One: Investigation of Your Work Injury — Once you have obtained counsel, your lawyer will discuss with you the facts surrounding your work injury and determine if they have merit. This may mean looking at medical records and witness statements. Part Two: Getting Medical Care for Your Work Injury — This is the most important time in our eyes as we want to make sure you get the proper medical attention that you need. Your doctor will evaluate your injury, provide any treatment and ultimately make a final decision when you have reached the point of Maximum Medical Improvements (MMI). Once you have reached MMI, it is at this time settlement can be discussed. You have been “released” and workers’ comp benefits cease at this time. Part Three: Negotiations Toward Settlement — Your physician will then give you a disability rating so that your attorney can start negotiating with your employer and its insurance carrier toward a reasonable settlement. Part Four: Workers’ Compensation Litigation — If settlement negotiations are unsuccessful, it is likely your attorney will advise you of your chances in litigation and the likely outcome.

Can There be Negotiations?
Negotiations happen during settlement talks. This can occur once an injured worker has reached the point of Maximum Medical Improvement (MMI), where he or she has received all the medical care he or she can to heal or rehabilitate and he or she is not likely to get any better. At this point evaluations can be made by the physician to classify permanent disabilities. Your employer’s insurance company will want to negotiate this, and our attorneys are highly skilled in negotiations. In addition, negotiations can happen in all types of ADR (Alternative Dispute Resolutions) cases. We have extensive experience with all types of situations in which negotiations come into play.