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When an employee is injured in the course of his/her employment and requires medical treatment, and/or loses wages as a result of the work related injury, workers' compensation benefits are paid by NYSIF on behalf of the injured worker's employer.
You are entitled to “medical benefits” and “compensation benefits.” Medical benefits may include hospitalization, doctor services, dentist services, physical therapy, chiropractic treatment, x-rays, laboratory tests, nursing service, durable medical goods and prescribed drugs. Compensation benefits are subject to statutory maximums, currently $550 per week (effective July 1, 2008). An injured worker may collect compensation benefits to replace lost wages due to job related disablement. Compensation benefits are not paid for the first seven calendar days of the work related disability, unless the disability extends beyond fourteen calendar days.
If an injured worker dies from a job related injury, the surviving spouse and/or minor children or, lacking such, other dependents as defined by law, are entitled to death and survivor benefits. The amount is equal to two-thirds of the deceased worker’s average weekly wage for the year before the accident, subject to statutory maximums, currently $550. Death benefits are shared by all surviving dependants. Funeral expenses are payable up to the statutory maximum, currently $6,000 in the metropolitan New York counties and up to $5,000 in all other New York counties.
If you are injured on the job, you should immediately tell your supervisor and your employer when, where and how you were injured. Your employer will file Form C-2, “Employer's Report of Work-Related Accident/Occupational Disease,” with the Workers' Compensation Board (WCB) and your employer's workers' compensation insurance carrier.
You will file Form C-3, “Employee’s Claim for Compensation,” with the WCB. Providing a copy of your C-3 to your employer's workers' compensation insurance carrier is helpful because it describes what happened in your own words and identifies the treating medical providers you have chosen. New York State law requires Form C-3 to be filed with the WCB within two years from the date of accident, or from the date the medical condition is known or should have been known to be caused by an occupational disease.
The WCB manages records and hearings for claims made by claimants by using a unique WCB number for each individual case. The WCB case number is different from the “carrier case number.” A “carrier case number (CC#)” is a unique identifier created by insurance carriers to identify, process and pay your claim. NYSIF’s “carrier case number (CC#)” is also referred to as “NYSIF’s case number,” or your “claim number,” or your “lossId.”
NYSIF’s case number typically has eight digits and a hyphen (-) followed by three digits. The last three digits typically represent the claim unit assigned to handle your claim. Example: NYSIF case number is: 12345678 – 249. The claim unit assigned to handle your claim is unit 249. Claimants should always use their NYSIF case number when contacting NYSIF.
Always include the NYSIF claim number when communicating with NYSIF and always use the WCB case number when communicating with WCB.
When claimants submit reimbursement requests to NYSIF for prescription and durable medical equipment, they must include a copy of the prescription from the prescribing doctor and the purchase receipt. For transportation and mileage, they must include dates of the medical appointments, medical providers' names and addresses where treatment was rendered, receipts for tolls and public transportation paid and total amount of miles traveled.
Always include your name, the NYSIF case number and the date of correspondence in all communication with NYSIF. Retain copies of all correspondence and receipts sent to NYSIF. You are not entitled mileage and transportation expenses for attending a Workers' Compensation Board (WCB) Hearing.
If you receive continuing compensation benefits as awarded by the WCB at a hearing , expect us to issue the next payment no later than 2 weeks after the last “paid to date.” Example: If a check was issued on 12/06/05 for the “paid from date” 11/25/05 and “paid to date” 12/09/05, your next payment would be issued several days before or no later than 12/23/05. If you are receiving voluntary payments from NYSIF ( before or after a hearing takes place which doesn't mandate continuing benefits ): those payments are based on the carrier receiving continuing medical evidence of disability, so they may not be issued in precisely 2 week intervals and/or on the same day within the two week period.
Under NYS Workers' Compensation Law, advance authorization approval must be obtained from NYSIF when medical services, such as specialist consultations, surgical operations, physiotherapeutic or occupational therapy procedures, and any diagnostic tests exceed $1,000.
Your doctor or treating medical provider must submit to NYSIF a medical report that includes date of report, diagnosis, comments regarding causal relationship, what is being requested, and the doctor's signature.
If the request is based on the result of a diagnostic test, NYSIF must be provided with a copy of the test results. Your treating medical provider should write the NYSIF claim number on the report. Medical providers should always include the claimant's name, the NYSIF case number and the date of correspondence in all communication with NYSIF.
Yes, the employer or insurance carrier is entitled to have the injured worker examined by a qualified physician. Refusal to submit to an exam may affect the injured worker's claim.
An insurance carrier contesting a claim must file Form C-7, “Notice That Right to Compensation is Controverted,” with the WCB within 18 days after the disability begins or within 10 days of learning of the accident, whichever is greater. The carrier must state the reasons why the claim is not being paid. The issue is resolved by a WC Law judge at a pre-hearing conference or a hearing.
If an injured worker's claim is controverted, the injured worker has the right to make a claim for disability benefits.
If a controverted claim is determined to be compensable, the amounts paid to the injured worker by the disability benefits carrier will be awarded to the disability benefits carrier as reimbursement.
In a case where the carrier has made payment without waiting for a judge's decision, it may suspend or modify the payment based on payroll or medical evidence submitted to the WCB.
A person who willfully misrepresents the circumstances surrounding his or her case in order to obtain benefits is guilty of a felony.
Workers' compensation coverage is primary to NYS no-fault automobile insurance benefits. An injured worker injured in the course of employment while operating, or as a passenger or a pedestrian, in contact with a motor vehicle, typically will be covered by the employer’s workers' compensation insurance for medical and compensation benefits.