Mar 29, 2004 12:37 PM
Workers’ Compensation is a form of insurance, paid for in advance by your employer, which entitles you to full medical coverage, and part of your salary, for job-related injuries and illnesses.
Q: What does WC provides?
A: Workers’ Compensation benefits can provide urgently needed financial support to workers and their families - payments are made when a worker is injured, made sick or killed on the job.
Q: Why file for Workers’ Compensation?
A: There are 9 good reasons to file:
1. It is the only way to ensure that your rights and long term benefits will be protected in the likelihood of a work related injury.
2. By law, WC is your employer’s insurance company’s responsibility. The premiums have already been paid.
3. You don’t have to stop working to receive full medical benefits.
4. Unlike health insurance, your WC payments and medical care may continue even if you get a new job, retire, or leave the state. And, if you can never return to work, benefits can continue for life.
5. You are entitled to WC no matter whose fault the injury/illness was. (Exception: where injury is due solely to intoxication from alcohol or controlled substance or by willful intention of the injured employee to harm oneself or another).
6. If you use up sick leave because of your injury, you may get it "reimbursed" to you when you file WC.
7. You generally cannot sue your employer for job-related injuries.
8. Your injury may occur again (especially back injuries) and if your case wasn’t established the first time, you may have difficulty getting benefits.
9. You may be eligible for additional monies which are only available if you file for WC.
Q: What are the basic benefits?
A: Benefits can include: All medical expenses even if you do not lose any time from work (tests, hospitals, medicines, physical therapy, equipment, and even a home care attendant if essential, and transportation cost to doctors. Temporary benefits if you lose wages. These are about 2/3 of your gross wages (capped at $400/week). Additional money if you have permanent damage to a limb or facial scars or loss of hearing or eyesight.
Q: Who are the UFT members covered by WC today?
A: Most full-time and part-time workers in the state are covered - Paraprofessionals, Lab Specialists, Nurses, Vocational Teachers, Occupational and Physical Therapists are covered while teachers are covered under injury in the line of duty.
Q: When/How are you covered?
A: You are covered whenever you are on school property. If you are out of work 7 days or less, no benefits are paid for lost wages but your medical costs will be covered. But the 7 days do not have to be consecutive days of absence. They can accumulate over time. Your eligibility for loss wages begins the 8th day. If your doctor keeps you out of work for 15 days or more your wages payments will be retroactive to day one. If you are a DOE employee there is a form (OP198) that can be submitted to cover the first 5 consecutive days that you are absent.
Q: When should I file a claim?
A: Under the law you have 30 days to report the incident to your employer, but you should report any incident immediately. The DOE policy is to report in 24 - 48 hours, however Workers' Compensation law permits reporting in 30 days and 2 years to file a claim with the New York State Workers' Compensation Board - there are however exceptions to these deadlines so, file your injury report immediately. Consult a WC Attorney!
Q: How do I file a claim?
A: Tell your supervisor that you hurt yourself, immediately, and fill out an accident report. See a doctor as soon as possible or go to the emergency room in emergencies and make sure to tell the person seeing you that your problem is work related. Fill out the C-3 form to start a WC claim, this form goes to the WC Board which will then issue to you a WCB#. Q: What are the Forms needed to file for Compensation?
A: There are internal DOE forms: Accident Report; WCD23; OP-198; OP-200. The NYSWC forms are: C-2; C-3; C-4 (see Workers’ Compensation Forms).
Q: Do I have to Miss Days from Work to File?
A: No, you do not have to lose any day from work to file for WC - notify your supervisor immediately about injury and fill out the accident report as well as the C-3 form.
Q: Where can I get help in filing for Workers’ Compensation?
A: Call the Workers’ Compensation project at the UFT at
(212) 510-6460. You will get guidance thru the WC process, referrals will also be made as well.
Q: Can I go to any doctor?
A: You should go to a workers’ compensation authorized physician, one who has the experience and will ask question about your injury and how it relates to your job. Your doctor must be willing to testify at WC hearings. Contact your union who will assist in making referrals. You may also call (800) 781-2362 for a listing of WC doctors. (The pyhsician must fill out and submit the WC C-4 form).
Q: Do I need a lawyer to file for Workers’ Compensation?
A: No, you can file a claim on your own, but legal representation is recommended. You do not need to pay a lawyer’s fee when you win your case, a WC judge decides what fee should be paid to lawyer out of your award. Again, your union can assist in making referrals. The union has a special arrangement with a large reputable WC legal firm and our members receive special attention.
Q: What is an Occupational Disease?
A: A disease that is caused or partly caused by the specific type of job you do. For example, lead causes lead poisoning; asbestos dust causes mesothelioma; repetitive arm motion can cause tendonitis or carpal tunnel syndrome. An occupational disease may take years to develop.
Q: Can I file for WC for an Occupational Disease?
A: Yes, medical documentation must show correlation between injury and job related tasks. Doctor should be familiar with occupational disease. Q: What is a Workers’ Compensation Hearing?
A: A chance to go before a judge at the Workers’ Compensation Board. (However, workers are not generally required to speak at these hearings, if they are represented).
Q: What is "Independent Medical Evaluation" IME?
A: The insurance company usually has the right to require you to go to their doctor for an evaluation (not treatment). This is called an IME, but it is not really "independent" because it is the insurance company’s doctor. Q: How do Workers’ Compensation & Disability differ?
Tell your doctor and legal representative as soon as you get the appointment. (In rare cases, you do not have to go; consult your attorney).
Women: have the right to be examined by a female doctor or to bring a female to the examination.
It is critical to see your doctor after the IME appointment and before your next hearing.
A: New York State Disability is generally for off-the-job injury or illness. Many benefits you need are not covered by disability. (There is an exception: If you have received a written rejection of your WC claim from the insurance carrier, and you have been disable from working for more than five days, you may apply for NYS Disability Benefits and you may continue to pursue your WC claim, at the same time.
Q: How do I move my case along faster?
A: Prompt filing - you must file a C-3, the school files a C-2, and your doctor a C-4.
Q: When do I receive a check?
A: After prompt filing, it usually takes several weeks before you receive any check. This is issued by the New York City Law Department.
Q: What if my case is Controverted ( Initially denied)?
A: When you receive the C-7 rejection notice you can now apply for disability benefits (if you are, or will be out of work). Get help from your union to fill out the DB 450 (disability) form (as soon as you get the C-7).
Q: If I have to Stop Working for a While, What can I Live on?
A: Call the Union they will make referrals to SSI, Disability, unemployment as well as assist in financial hardship cases.
Q: Who pays for Medical & my Compensation?
A: The insurance carrier of the DOE IS THE New York City Law Department, they will issue you a carrier case # which pays for medical and compensates for the time loss from work. The school must file a C-2 in order to generate this #.
Q: How do I Protect my Job?
A: It is against the law to be discriminated against for filing a WC claim or testifying at a hearing. Also, your Union contract may have provisions which provide additional job security in cases of work-related injuries. Workers’ Compensation (WC) Forms
C-2 In accidental injury cases, a report that the employer is required to fill out (within 10 days) to notify WC Board of injury. You should NOT participate in filling out this form. File a C-3.
C-3 Form filled out by worker to start a WC claim.
Goes to: WC Board, you, your legal representative.
C-4 Form doctor fills out, usually every 4-6 weeks, about your condition. Used to determined your level of benefits so it’s important that doctor fill in carefully.
C-257 Expense Reimbursement Form: for out-of-pocket expenses relating to your injury.
DB-450 Disability Claim Form: filled after your WC claim has been rejected (controverted).
The chart below explains four different benefits for injured workers.
Workers’ | Disability | Social Security Disability (SSDB) | Unemployment (UI) |
| For job-related injuries or illnesses Paid by employer’s WC insurance carrier | For off-the-job injuries or illnesses that keep you from working. Disability benefits can also be paid if the WC insurance carrier decides to fight your case Paid by employer’s disability insurance carrier or your Union or the state of NY
| Doctor expect you to be able to work 12 months or more Paid by you and employer as part of your social security (FICA) tax You can get WC and SSDB but combined can not exceed 80% of average weekly wage. Two years after your date of diagnosis, you may be entitled to Medicare benefits | For laid off workers Paid by employer to NY State Dept. of Labor
|
| Pays: 100% of all medical | Pays: No medical | Pays: About 50% of your wages - the total of your WC and your unemployment payments can not exceed 100% of your average weekly wage after taxes You may be entitled to both unemployment and WC if you are ready and able to work (at a job you can do with your limitations, such as a light duty job) but you can’t find one Usually lasts 26 weeks | |
| Pays: About 66% of lost wages (about the same as your after-tax paycheck) | Pays: About 50% of lost wages You must have worked 30 days Usually a 26-week maximum
| ||
| Pays: Additional money and benefits Payment can continue as long as your condition does, even if you change job or lose health insurance. If your condition means you can never return to work, you are entitled to payment for the rest of your life. |