Brett Corley asked 3 months ago
Workers Compensation – How to File a Workers Compensation Claim
Workers who are injured on the worksite should report the injury immediately. This will help avoid delays and issues when receiving workers compensation benefits.
Workers compensation benefits typically include medical treatment, disability payments and vocational rehabilitation services. These benefits can vary in duration and amount from one state to the next.
Medical Treatment
If you’re injured while working medical treatment is an essential element of your workers’ compensation claim. This type of insurance covers doctor visits, hospital stays and imaging studies (xrays) as well as rehabilitation costs.
The New York State Workers’ Compensation Board creates medical treatment guidelines (MTGs) to encourage objective healing and return-to-work goals. The guidelines are regularly updated to reflect changes in the medical field and the recommendations of doctors.
These guidelines are designed to ensure that injured workers receive the same treatment as other workers with work-related injuries and diseases. They also help ensure that the treatment is appropriate to the specific condition or injury and that there isn’t any overtreatment or unnecessary medical costs.
If a doctor concludes that medical treatment is not necessary under the MTGs, he/she can request a variance from the insurer by requesting a specific exception to these MTGs. This can be a lengthy process which can take several months to be completed.
Employers and insurers should take every step to provide the necessary treatment in the event that it is required. Inability to provide this treatment could result in a dispute between the insurer and the injured employee, which is often resolved through an evidentiary hearing before an administrative law judge.
The treatment should usually be administered by an accredited local health provider who is licensed to provide workers’ compensation claims treatment. In emergencies an unlicensed or uncertified doctor may be capable of treating injuries suffered by workers provided they are notified of the incident and completed the appropriate first injury report.
Many doctors are certified in workers’ compensation and will provide lower rates to treat injured employees. This is particularly beneficial for patients who have sustained serious injuries.
Many medical professionals are on hand to provide treatment for injured employees, in addition to doctors. These include occupational therapists, chiropractors and physical therapists.
The New York State Workers’ Compensation Board suggests that injured workers and their representatives speak with their attorneys before they receive any medical treatment. In some instances, this may be the only way to ensure a worker is getting the best treatment possible.
Costs
The cost of a workers compensation claim can be wildly different according to the individual worker and the state in which they are employed. These expenses include medical payments and vocational rehabilitation expenses, legal fees and settlement costs.
The majority of the expenses are covered by your insurance policy. However certain expenses are paid by the employee themselves, or their spouse and/or dependents.
In the majority of states employers are required to carry workers’ compensation insurance. This protects employees from lawsuits and other damages that could arise from workplace accidents like injuries or illnesses. The policy protects workers who are killed on the job and offers compensation for medical treatment as well as wage replacement and death benefits.
Workers’ compensation insurance is important however it can be costly. A worker’s compensation claim may cost a business approximately $1 per hour of work lost.
These losses could be reflected in the bottom line of the business which could result in a loss in profitability and productivity. It could also impact the reputation of the business which could impact future business contracts and skilled workers.
In addition to workers’ compensation, an organization may also have other indirect costs that are related to employee injuries. These indirect costs can comprise expenses such as the amount of time employees are away from work or the cost of hiring the replacement worker.
Indirect costs include the cost of replacing or repairing equipment damaged in an accident. This is an expensive expense for any company, and it is common for companies with heavy-duty machinery or equipment.
The Occupational Safety and Health Administration (OSHA) fines that are associated with a high incidence rate can be an additional expense for the employer. These fines are usually activated when an organization’s accident or fatality rates are inspected.
Instilling a positive workplace culture and minimizing workers’ compensation claims can reduce these direct and indirect expenses for the business. It also creates an environment that is more profitable for the business and boost employee morale.
Time off from Work
The loss of income resulting from an injury that is caused by work can be devastating. You may be eligible for workers compensation benefits to help cover the gap until your healing is complete.
Employees are able to take a variety of time off, including sick and vacation time. Certain of these leave types are covered by the laws of the state or federal government while others are available as an option.
Businesses can make use of vacation and sick leave to their advantage. Employees can take time off to care for family members or help themselves. Some companies also offer personal time off that can be used to manage things such as doctor’s appointments, car checkups, and events (e.g., parent-teacher conferences).
Certain states have laws that require employers to offer paid sick days, but this isn’t always the situation. Companies that don’t have enough money to pay for this kind of leave may be able to refuse to offer this type of leave.
Another alternative for employers is to offer flex time. Employers can provide flex time to employees. This allows employees to take some paid time off. The employer can cover the difference by increasing the hours or increasing their salary.
Certain states also require employers to offer sick or vacation days. This could encourage employees to take a break when they are sick or need to care for family members.
If your employer does not provide these options, it’s a good idea to speak with an attorney to determine how to use your rights under the law. If you are being asked to use paid time off to receive medical treatment, or for any other reason, an experienced attorney can help you understand and protect your rights.
Employers may also offer employees the opportunity to take time off for work that they’ve done above their contracted hours, which is called time off in lieu, or TOIL. Some employees take advantage of this time to attend medical appointments or other kinds of treatments. Some also serve on juries or other duties they choose.
Appeals
You are entitled to appeal a denial of workers’ compensation benefits. You can appeal to the workers’ compensation board within 30 days of the date when the judge decided against you.
Appeal is a vital element in the claim process. They can assist you to receive the benefits you are entitled to following a workplace accident. An experienced attorney can help you navigate the appeals process to ensure that you receive all the benefits to which have earned.
Many injured workers are denied workers compensation or have their claims reduced significantly by their insurance company. This can be a devastating situation for an injured worker and is usually only for the purpose of saving their employer and the insurance company money.
The worker’s compensation judge will decide on the appeal. This hearing is usually conducted live, however it may also be conducted using videoconferencing.
In this hearing, the judge will hear from you and your lawyer regarding your workers’ compensation claim. The judge will scrutinize your medical records, wage records, and other evidence to determine if your qualified for benefits under workers’ compensation. If so, what amount should it be?
In addition to that, the judge will look into any disputes regarding your injury. The judge will then decide what benefits you are entitled to and how long the benefits should last.
You can appeal the decision to a higher court if you disagree with the judge’s decision. Usually, you can appeal to the appellate division in your state’s court within 30 days of the decision of the workers compensation board.
The appeals process can be challenging but you can depend on your workers’ compensation attorneys to be adamant to ensure that you get the most favorable outcome. An experienced attorney will review your case and present to the appeals court why you should get a more favorable results.
If you need assistance with a workers’ comp appeal, contact a seasoned New York workers’ compensation law firm today. The Turley, Redmond & Rosasco team of workers’ compensation lawyers has the expertise and resources to assist you in obtaining the full amount of workers’ compensation benefits to which you are entitled.