Off The Record – Workers’ Comp – WC Benefits

Video Transcript

Hi, everybody. My name is Craig Rosasco, senior partner at the law firm of Turley, Redmond & Rosasco. Today we’re going to talk about workers’ compensation benefits, what they are, and what you can expect to receive in filing a claim with your employer.

So let’s take the first easy part of the whole claim, medical coverage. Whatever body part you’re claiming that was injured in the accident, you now have medical protection for the rest of your life, minus certain circumstances if you take a certain type of settlement, but you’ve got medical protection for the rest of your life for that specific body part.

So when you get injured on the job, it’s important you go to the doctor and you advise the doctor, “I have pain here, I have pain here.” Label the parts. Let the doctor know what parts of the body were injured. The doctor will then examine those body parts. And the insurance company, when they get to court, will have to accept whatever is diagnosed in the initial medical report. The law requires contemporaneous medical proof of an injury. So that means you have to see a doctor and get treatment within, let’s say, four to six weeks and it’s got to be diagnosed.

If you come along the turnpike six months later with a new body part and there’s no mention of it previously, you’re going to run into problems. But most importantly, you will remain protected medically into the future, assuming you don’t have any subsequent accidents involving that same body part. You do remain protected medically for the rest of your life. So take that insurance policy, stick it in your pocket, you’re good to go.

Now the other half of the equation is monetary benefits. How do you get paid on the workers’ compensation? Pretty simple formula. What they’re going to look at, they’re going to look at your prior 52 weeks of employment for this employer. They’re going to take your gross earnings, whatever you earn on a weekly basis, and they’re going to average them out, what’s called your average weekly wage. If you’re totally disabled, you’re entitled to two-thirds of that number.

So let’s do an example here. Mike makes $1,200 a week working for the local Ford dealership, okay? His average weekly wage is $1,200. Simple math says two-thirds of that is $800 a week. He goes and sees his doctor. His doctor says he’s totally disabled. That’s a full disability. Full two-thirds of $1,200 is $800. If he goes to the doctor and the doctor says, “You’re 50% disabled,” take two-thirds of the $1,200. That brings you to $800. But remember, $800 is for the 100% disabled person. If he’s only 50%, he’s going to get 50% of that $800 figure. He’s going to be entitled to $400 a week.

There are state maximums currently as of July 1st of 2023. The state maximum in New York, which is tied to the state average weekly wage, is $1,145. In order to get that, you’ve got to have an average weekly wage that’s higher than that, so let’s say $1,700. Two-thirds of $1,700, probably landing right around $1,145 and you get the state maximum.

The benefits are tax-free, but these are all items that you should not take on your own. I strongly recommend you consult an attorney. Reach out to me, 516-745-5666. Happy to help you, walk you through it, and successfully prosecute your claim. We’ll talk to you soon.