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A Work Related Injury Attorney Helping Clients Recover Workers’ Compensation Benefits Throughout New York City and Long Island
Workers’ compensation is a lifeline after being injured on the job. Your employer’s workers’ compensation insurance plan reimburses you for medical expenses and lost wages associated with your injury. If you lost a family member in a job-related accident, workers’ compensation also pays death benefits. A work related injury attorney at Turley Redmond & Rosasco can help you access these crucial benefits. Our workers compensation lawyers cut through the red tape to recover the maximum amount of compensation you are entitled to receive. Contact us today to learn more about your due compensation. We have offices throughout Long Island, including Nassau County and Suffolk County.
Workers Compensation as Medical Benefits
Workers’ compensation allows you to receive immediate medical care for your job-related injuries regardless of whether you also qualify for any other type of benefit. In other words, your medical bills are covered even if the workplace injury did not result in a disability or require you to take more than seven days off from work.
Medical benefits pay for your hospital care, doctor’s examinations, diagnostic tests, surgical procedures, medications, physical therapy and other treatments and rehabilitation related to your workplace injury. The insurance carrier commonly requires diagnostic tests, including x-rays, CT scans and MRIs, to prove the nature and extent of your injury.
It is important to note that you should not be charged for your medical care or pharmaceuticals. Instead, your employer or its insurance carrier should be billed.
Cash Benefits and Settlements
A serious workplace injury can prevent you from returning to work for days or weeks, a prospect that few people could endure without financial assistance. Alternatively, you may be in a position to return to work, but not at your full capacity.
Cash benefits provide the necessary funding to pay your bills while you are out of work. How much cash you receive each week is calculated using this formula:
2/3 x your average weekly wage x % of your disability = weekly benefit
For example, if you make $500 per week and have a total disability, you will receive $333.35 each week in cash benefits (.6667 x $500 x 1.00 = $333.35). If your disability is at 50 percent, you will receive $166.67 each week (.6667 x $500 x .50 = $166.67).
The weekly payments are capped, meaning your benefits cannot exceed the maximum benefit amount regardless of your average weekly wages. For instance, the weekly maximum established by the New York Workers’ Compensation Board for accidents between July 1, 2017 and June 2018 is $870.61.
Unfortunately, you are not paid for lost wages if you miss less than eight days of work. Also, your cash benefits are not available until you are off from work for 14 days, at which point you may be paid for the entire time you missed.
Section 32 Lump Sum Settlement for Injured Employees
Workers who have suffered a serious or career-ending injury may elect a lump sum settlement of their workers’ compensation claims. Such a settlement is also known as a Section 32 settlement agreement.
However, Section 32 settlements must be negotiated with the workers’ compensation insurance company, and there is no guarantee even if the client desires such an agreement. A lump sum settlement must be perceived as mutually beneficial to both the claimant and the insurance company.
This means that it is more important than ever to have your own experienced workers’ compensation lawyer negotiate on your behalf to be sure that an insurance company is giving you full value on your settlement. A Section 32 buyout settlement is different than a Schedule Loss of Use (SLU) award in that it generally closes a workers’ compensation case forever.
One of the benefits of taking a Section 32 settlement is that it frees you from fighting with the insurance company over medical treatment or continuation of wage benefits. You can receive one large tax-free “lump sum” of money to use as you wish, without ever having any future contact with the workers’ compensation system. You may choose to buy a boat or take the vacation you have always dreamed of. Or you may simply need to pay off bills that have accumulated since your injury. Either way, it is one way to put this case behind you and move on to the next chapter in your life.
On the other hand, by taking a cash “buyout” option, you are often signing away your future rights to both weekly payments and medical benefits. Sometimes you can take a lump-sum Section 32 settlement just for the weekly cash benefit portion of your claim, while still leaving your claim open indefinitely for medical care. Generally, you cannot reopen the claim after a Section 32 settlement. You must consider all that you may be giving up before you take a Section 32 lump sum benefit.
Each work related injury attorney at Turley Redmond & Rosasco, L.L.P. has extensive experience with Section 32 lump sum settlements for serious injury or permanent disability. We can help you determine if you are a good candidate for a Section 32 settlement. If you are, we can negotiate with the workers’ compensation insurance company to get you the maximum settlement possible. The insurance company and employer will have their own lawyers whose job is to minimize your settlement. Over the years, we have negotiated many six-figure settlement agreements, including one for over $650,000.(See Success Stories.)
You will eventually have a hearing at the New York State Workers’ Compensation Board to approve your Section 32 settlement agreement. A work related injury attorney will represent you at that hearing to make sure there are no issues that might cause a judge to disapprove your hard-fought settlement.
Why Would You Have to Pay Back Workers’ Comp?
Once you’ve obtained your workers’ compensation benefits or a settlement, the last thing you want to hear is that you owe some of those benefits back to your workers’ compensation insurer. But, unfortunately, there are several instances in which you would have to pay back workers’ comp, including the following:
Overpayment of Benefits
Workers’ compensation insurance adjusters are only human, and humans make mistakes. And if they (or you) don’t catch those mistakes and they result in overpayments, you may have to pay a portion of your benefits back. But mistakes are not the only reason why you might have to pay back workers’ comp benefits. Other reasons include:
- Errors in calculation: Workers’ compensation benefits are calculated using a precise formula that takes into account the worker’s wages and degree of injury. Miscalculations in that formula can result in overpayments that the claimant might be required to repay.
- Failure to provide updates: Workers who fail to notify their workers’ compensation insurers of changes to their condition or that they have returned to work or are otherwise earning unreported income may have to repay any benefits attributable thereto.
- Misreporting wages: Workers’ compensation benefits are 2/3 of the injured worker’s average weekly wage multiplied by the percentage of their disability. Misreporting or miscalculation of the worker’s average weekly wage can cause the worker to need to repay benefits calculated using the misreported figure.
If you’ve been told that you need to repay benefits due to an error or any other reason, you should contact an experienced attorney who can assist you in fighting the request.
Third-Party Lawsuits (Subrogation)
The general rule of workers’ compensation claims is that claimants may not pursue personal injury claims against their employers. That’s because workers’ compensation is a fault-agnostic system; injured workers give up their right to pursue tort claims against their employers in exchange for a fixed set of benefits regardless of who was at fault for the accident. However, there is an exception where a third party was partially or totally at fault for the accident. For example, if you were involved in a car accident while traveling between construction work sites, you might be able to pursue a third-party claim against the at-fault driver.
While you may be able to obtain greater damages in a personal injury action (including pain and suffering damages), there is a caveat — if you receive damages or a settlement in a personal injury lawsuit, your employer or workers’ compensation insurance provider is entitled to reimbursement for benefits paid to you. This is a process known as “subrogation” and is one of the primary reasons why you would have to pay back workers’ comp. In some cases, an insurance company with a right of subrogation may take over the injured worker’s third-party claim, but the insurance company is required to hold any damages or settlement amounts for the benefit of the injured worker.
Double Billing of Workers’ Compensation and Private Insurance
Double billing is a form of workers’ compensation fraud wherein the claimant submits the same bill to both their workers’ compensation insurance and their private health insurance. This scenario could arise, for example, where the injured worker wanted to speed up the expense approval process by billing a work-related injury to their private insurance before billing it to their workers’ compensation insurer. Unfortunately, this practice is illegal and not only one of the reasons why you would have to pay back workers’ comp, but could also be used as a basis for your workers’ compensation insurer to deny your claim.
Returning to Work Prematurely
Workers’ compensation benefits include both medical benefits and lost wage benefits. Medical benefits are designed to compensate injured workers for their medical expenses, while lost wage benefits are designed to replace a portion of injured workers’ wages while they are out of work recovering. If you return to work before you are fully healed and begin earning wages, your workers’ compensation insurer may stop paying benefits, and you may be required to pay back any lost wage benefits you received during that time. You might also have to pay back a portion of your benefits if you have been working a different, less-demanding job without reporting your wages. To avoid situations like these, coordinate your return to work with your employer, your healthcare team, and your workers’ compensation insurer.
Social Security Disability Offset
You might be surprised to learn that you can receive both workers’ compensation and Social Security disability benefits. But, just as with recovery through third-party lawsuits, there is a catch. Your monthly combined benefits cannot exceed 80% of your average current earnings before you had a disability; if they do, the excess amount is deducted from your Social Security disability benefits.
Later Discovery of Misconduct
As we’ve established, workers’ compensation is a fault-agnostic program. It pays benefits to injured workers even if the worker was 100% at fault for their injuries. Of course, as with most other workers’ compensation issues, there is an exception: Workers’ compensation benefits generally are unavailable if the workplace injury was the result of prohibited horseplay or other intentional misconduct. So if you suffer an injury on the job, receive workers’ compensation benefits, and the truth emerges later that you were engaged in misconduct at the time of your accident, that’s another reason why you would have to pay back workers’ comp.
Fraud or Misrepresentation
Workers’ compensation fraud is rare, but it does happen. Fraud occurs when a claimant makes an intentional misrepresentation or omission for the purpose of receiving benefits. Some of the most common types of workers’ compensation fraud include:
- Fabricating or exaggerating symptoms
- Claiming non-work-related injuries (including pre-existing conditions) as work-related injuries
- Working while collecting benefits without reporting income
- Falsifying mileage reports to receive greater compensation for commuting to medical appointments
- Double billing workers’ compensation insurance and private health insurance
In addition to being a reason why you would have to pay back workers’ comp, fraud and misrepresentation can lead to criminal penalties.
Death Benefits for Loved Ones Can be Earned by a Work Related Injury Attorney
As the spouse of the deceased employee, you are entitled under New York law to collect a percentage of your loved one’s earnings each week. These workers’ compensation death benefits are also available to minor children, parents, siblings, grandparents or grandchildren depending on the circumstances. If there are multiple dependents, the benefits are divided among you – the amount you receive is determined by your spouse’s income for the previous year, not the number of people who are eligible.
In addition, you may be able to receive a payment from the state to help cover the costs of your family member’s funeral. We explain what the qualifications for these benefits are and show you what you will need to submit to the state.
In sum, the children and spouse of a worker who died on the job are entitled to death benefits equal to two-thirds of the worker’s average weekly wage during the year prior to the accident. These workers’ compensation benefits are also subject to the weekly maximum, regardless of how many surviving dependents make a claim. Workers’ compensation also pays for funeral expenses up to $12,500 in the New York counties and $10,500 in all other New York state counties.
Let a Work Related Injury Attorney in New York Help You Secure Your Rightful Benefits
The sooner you apply for workers’ compensation, the sooner you can receive your benefits. Contact the work related injury attorneys at Turley Redmond & Rosasco today for your free consultation. We have offices in Ronkonkoma and Garden City.
