My Case Is Established, Now What?

Once your case is accepted or established, you are entitled to two things:

• Medical Care Causally Related to your injury, and
• Lost Wage Benefits.

Medical

The law provides that you are entitled to medical care that is causally related to the injury or illness. You may also be entitled to medical care for conditions that are consequential to the original injury or illness. For example, if you injured your knee and fall down in rehab injuring your hand while breaking your fall, you are entitled to medical for your hand as well as your knee.

You are entitled to choose your own doctors in most circumstances, as long as the medical provider is authorized by the New York State Workers’ Compensation Board. A list of authorized providers can be found at the New York State Workers’ Compensation Board website. You do not need a referral in a Workers’ Compensation case.

The medical provider is obligated to report their findings on the New York Workers’ Compensation Board’s prescribed forms, often referred to as “the Family of C-4’s.” The medical provider must also adhere to the Medical Treatment Guidelines, seeking variances and approvals as necessary.

As part of the medical benefits, you are entitled to prescriptions and reimbursement for medical goods like crutches or bandages. In addition, you are entitled to mileage to and from the doctor or physical therapist, as well as parking costs, even after you return to work. This does not include mileage to and from the Workers’ Compensation Board, a meeting with your lawyer, or the pharmacy to fill your prescriptions.

Lost Wages

Lost Wage payments (referred to as “benefits” or “awards”) are typically commenced within 2-3 weeks after the injury. The law says that the insurance company or Employer does not have to pay benefits for the first 7 days of lost time, unless you are out of work for more than 14 days. If you are out of work more than 14 days, benefits start as of the first date of lost time.

The amount of the benefit is determined after your Average Weekly Wage is calculated and is based upon your degree of impairment or Reduced Earnings. Lost Wage benefits are typically paid bi-weekly but based upon your weekly rate.

Lost Wage benefits continue while you are out of work or return to work earning less than you did at the time of your injury. This is referred to as “Reduced Earnings.”

Lost Wage benefits stop or change when:

• You return to work,
• You are awarded a Schedule Loss of Use,
• A Permanency finding is made,
• Your case is settled, or
• You are found to have committed fraud under Section 114-a of the Workers’ Compensation Law

You should also advise your attorney and the Workers’ Compensation Board.