Workers Compensation FAQs

What is “No-Fault” insurance?

No-Fault insurance pays for various expenses for people injured in New York car accidents. It applies to the occupants of a car (also includes pickups, SUVs, and most vehicles, but not motorcycle drivers or passengers), and also to pedestrians and bicyclists who are hit by a car.

Submit your medical expenses and lost wages to the No-Fault insurance company, which is the insurance company for the car you were in (or the car that hit you if you were a pedestrian or bicyclist). They should provide you with the necessary paperwork. We can help you figure out which company to contact.

Make sure your doctors and other health care providers know that your case involves a car accident and that all expenses should be covered by No-Fault. They will need to know the name of the insurance company along with the policy number and/or claim number.

What is a typical attorney fee in a personal injury case?

For most personal injury lawsuits, there is no fee unless you collect money yourself. Buffalo, NY Personal Injury attorneys typically charge a one-third contingency fee. When the claim is resolved, the attorney’s law firm gets reimbursed for expenses paid out of the award and then the attorney receives a one-third fee.

Must I file a personal injury lawsuit within a certain period?

Yes, there is a time limit to bring a personal injury lawsuit — this is called the Statute of Limitations. The New York Statute of limitations for personal injury cases is three years from the actual date of accident/personal injury. A Notice of claim involving municipalities and/or government authorities should be filed within 90 days and a personal injury lawsuit must be filed within 1 year and 90 days.

What is a personal injury lawsuit?

New York personal injury law provides compensation and justice for various types of personal injuries which a victim has suffered. Personal injury law provides compensation for those injuries which resulted from negligence. This negligence could be on the part of some individual, authority, hospital or even New York State authorities. The purpose of personal injury law is to provide financial compensation to the victims of auto accidents, car accidents, truck accidents, medical malpractice and negligence.

What kind of compensation do I get in a personal injury case?

New York personal injury law provides compensation claim for various types of injuries as well as for conscious pain, suffering and trauma. Sometimes, the spouse of a victim can even recover compensation. Some additional damages are also covered such as damage to the vehicle/property, lost earnings, medical bills and several others.

How do I know if I have a good personal injury case?

If you or someone you know sustained injuries due to negligence of some individual or authority then you usually have a case. Before you file a personal injury lawsuit you must consider various factors which can affect the outcome of your personal injury lawsuit. We suggest you call our office so we can help assess your case and let you know what the next step should be.

What are some common types of personal injury cases?

Some common types of personal injury cases in New York include: auto and motorcycle accidents, Truck accidents, construction accidents, slip and fall accidents, wrongful death claims, Nursing home neglect, workplace accidents, dog bite injuries, injuries to children on property.

What is a Wrongful Death lawsuit?

When someone dies through the negligent act of another, a wrongful death claim can result. In a wrongful death case, the personal representative of the estate of a deceased person is authorized to file a lawsuit against those responsible for the person’s death. A wrongful death case can arise from any type of personal injury case including medical malpractice , automobile accidents , construction accidents , airplane accidents and all other torts.

Can I still file a lawsuit when I have a Workers’ Comp claim?

Somtimes. Generally, if someone was injured at work, that person’s only remedy or course of action is to file a Workers’ Comp claim. However, an exception arises when a “third party” (i.e. someone other than your employer or co-worker) is involved in causing your work injury. It is then possible to sue the third party in a personal injury lawsuit. But note, you still cannot sue your employer, only the third party involved.

How is the injured workers’ weekly compensation amount determined?

If you are not working, the amount a workman’s compensation claimant can receive depends on the degree of disability as estimated by medical doctors or chiropractors. Degree of disability is a major area of dispute in compensation cases as insurance company doctors tend to minimize the degree of disability. Often, medical testimony will be taken by deposition to allow the Workers’ Compensation Law Judge to resolve the issue of degree of disability.

If you are totally disabled or 100% disabled — you are entitled to received the highest weekly payment amount, which is 2/3 of your average weekly earnings before your injury.

If I call Steenberg Law Firm to help me with my NY Workers’ Comp case, will I get an experienced attorney?

Yes. At Steenberg Law Firm, attorney Jeffrey M. Steenberg handles every Workers’ Compensation case. Jeff has handled and litigated every type of work injury case imaginable. Prior to establishing his own workers’ compensation law firm, Jeff worked as an attorney at Connors & Ferris, another large work injury law firm in Buffalo, NY. Since then, Jeff’s case load has almost been exclusively workers’ compensation cases. This has allowed Jeff to specialize in and master New York State Workers’ Compensation laws. Jeff has a tendency to take the more complex workers’ compensation cases that other law firms will not take. Let Jeff’s experience work for you.

What should an injured worker do when they are injured on the job?

When an individual is injured on the job, the first responsibility is to give notice to the employer. Second, they should see their doctor as soon as possible after the accident and report all injuries sustained in the accident. Finally, the injured worker should seek the advice of an attorney about filing a Workers’ Compensation claim.

How is my Average Weekly Wage (“AWW”) determined?

Average weekly wage (AWW) is generally determined by reviewing and average what the injured worker earned on a weekly basis for the year or 12 months prior to the injury. The law provides for a few different methods of averaging the prior earnings. The insurance company will try to calculate the AWW as low as possible, and injured workers’ attorney will calculate the AWW as high he/she can. The higher the AWW is the better for injured workers since the weekly monetary payment rate will increase. Note, since the calculation of the claimant’s AWW is the crucial starting point in determining the amount of money the claimant will get, it is important to consult an experienced workers’ compensation attorney. visit,

Do I need to see my doctor on a regular basis?

Unless your disability is permanent, then you should see your doctor at least every 45 days, preferably once a month. However, if you are not under active treatment, your doctor may not want to see you that often. If you do not go to see your doctor regularly, benefits may be stopped for lack of medical evidence of disability.

When can the insurance company cut or reduce my checks?

If you have not had a hearing yet, there likely is no direction issued by a Workers’ Compensation Law Judge to continue payments at a certain weekly rate, which means the carrier may cut benefits whenever its own doctor’s opinion on the “degree of your disability” justifies a lower rate. If the claimant does not have an attorney, the insurance companies will take advantage by lowering the payment rate arbitrarily. This is a good example of why it pays off to retain a good workers’ compensation attorney.

If Workers’ Comp Judge has directed payments to continue at a certain rate, the insurance company must request a hearing and argue in front of a Judge to lower your payment rate. A few exceptions include if you have returned to work and are now earning equal to or more than what your average weekly wage (AWW) is set at; or your own doctor has issued an opinion that you have no further disability.

Can I work and still receive Workers’ Comp payments? (a.ka. reduced earning payments)

Yes, but returning to work affects the amount that you are entitled to receive and it is important to tell your attorney that you have returned to work. In some circumstances, believe it or not, returning to work can result in an increase in your compensation benefits. When you return to work and receive your wages and still receive workers’ compensation payments, those benefits are called “Reduced Earning Benefits” (RE).

What are some common scenerios of workers’ comp “Fraud” ?

*A claimant who denies any prior injuries to the same body part later injured at work — when questioned by a doctor or the Independent Medical Examiner (insurance companies IME doctor).

*A claimant who denied performing work or work-like activity when questioned in an insurance company questionnaire and it was later determined that the claimant had in fact been helping a friend work on his house.

*A claimant who denied work while “helping out” a friend collect a cover charge at a bar.

*A claimant who was misrepresenting their level of disability or limitations to their own doctor or insurance companies doctor. (Example): A claimant is caught on surveillance using a cane when walking slowly into the doctors office and subsequently caught going for a brisk walk or job outside without the cane later that week.

How can I avoid workers’ compensation “Fraud” charges ?

1.) Do not fill out questionnaires sent by the insurance company. The questionnaires can be (and often are) used as a basis of a fraud charge. There is no legal requirement that you fill out questionnaires received from the workers’ compensation insurance company.

2.) While receiving or requesting workers’ compensation benefits do not engage in any work or work-like activity unless you are on the payroll and report all earnings to the insurance company and your lawyer. Helping a friend or volunteering can and likely will be considered work.

3.) Notify your lawyer when you start working immediately.

4.) When asked to raise your right hand at a hearing to answer questions, always tell the truth and be forthcoming. If the insurance company mentions performing surveillance — this is the time to ask your lawyer to go outside the hearing room and tell him/her what you have been doing. After you testify, it may be too late.

What “other” benefits may I receive while I am receiving workers compensation benefits?

1.) Social Security Disability Insurance Benefits. These benefits may be payable if your injury has made, or can be expected to make you totally disabled for at least one year. As a general rule, if you have been totally disabled as a result of your on the job injury for 6-9 months, you should consult with your attorney at Steenberg Law Firm about Social Security Disability Insurance Benefits.

2.) Unemployment Insurance. But only if you are partially disabled and ready, willing and able to work within your restrictions. If you are eligible to collect both workers’ compensation and unemployment insurance benefits, the total amount cannot expect 100% of your unemployment average weekly wage. You must tell the unemployment insurance division that you receive workers’ compensation benefits.

3.) No-Fault Benefits. If your on the job injury involved the use or operation of a motor vehicle, you may be entitled to no-fault benefits in addition to workers’ compensation benefits. In such a situation, it is important that you promptly file a no-fault application after you injury.

4.) Disability Pensions. If you belong to a retirement plan, you may be entitled to a disability pension.

What is an Independent Medical Exam (IME) ? Must I attend?

Yes, unfortunately, you must and should attend the IME appointment. The insurance company has the right to have you examined periodically by a doctor of its choosing at a time and a place that is convenient to you. If you fail to attend an insurance company doctor’s examination, payments may be suspended. Usually, if you miss the first IME appointment, you can simply reschedule without much of an issue. However, if you miss the second appointment, the insurance company almost always temporarily suspends your weekly payments until you attend another IME appointment and/or attend a workers’ comp hearing and request for the Judge to resume weekly payments. If you have further questions, please give us a call (716) 558-2000.

How do I get reimbursed for Mileage for traveling to and from my doctors appointments?

You should keep records of each time that you visit a doctor or other medical provider such as a physical therapist, chiropractor, IME doctor..etc. Note: no mileage reimbursement is paid for traveling to the Workers’ Comp Board for hearings or to a pharmacy to pick up prescriptions). You should periodically submit directly to the insurance company a list showing the date of the appointment, who you went to see, and the round-trip mileage. You should also submit copies of receipts for drugs or other medical supplies that you have paid for directly.

However, if you are a Steenberg Law firm client, all you have to do is write down the above information on a “C-257 form” and give the form to your attorney. Your attorney will submit the completed C-257 form to the insurance company for you. If you need another C-257 form, please give us a call.

Never submit your only copy to an insurance company. Always keep a copy of anything that you submit to an insurance company for payment. The Workers’ Compensation Board does provide a form to be used for filing a request for reimbursement. Visit the Worker’ Compensation forms page and scroll down to find the C-257 form.

How long can I receive my bi-weekly Workers’ Comp checks?

If your workers’ comp case results in a “scheduled loss of use” (SLU) award, payments generally end when you receive the SLU award. The SLU award applies mostly to injuries to extremities, such as: arms. legs, hands, feet, fingers, toes and also hearing and vision loss. This SLU award is normally paid in a “one lump sum” check.

However, if you are classified as having a permanent partial disability (PPD), payments can continue indefinitely if you were injured at work before 3/13/2007, as long as you are not working, or are working but making less money than before your injury. For injuries after 3/13/2007 — the length of time you receive benefits after you reach permanency will likely be capped. Once the Judge makes a finding on permanency, the remaining years left to receive your weekly monetary payments can range from 4.8 years to 10.1 years. The Judge will determine what your “Loss of Wage Earning Capacity” (LWEC) is which equates to a certain amount of weeks/years you can receive weekly payments until your monetary benefits are capped or come to an end. As you can see, the issue of permanency is crucial, if you have questions call our attorneys at (716) 558-2000. To learn more about how your “LWEC” is determined, visit our workers’ compensation page.

Am I entitled to an award even if I do not lose time from work?

An individual may be entitled to an award for any permanent loss of use of an extremity, such as an arm, a leg, fingers, toes, even if they do not lose any time from work. An individual may also be entitled to an award if they have a permanent loss of vision, permanent loss of hearing, or any permanent facial disfigurement.

What is a “Schedule Loss of Use” Award?

A Schedule Loss of Use award, known as an “SLU,” is an additional cash payment. The purpose of this SLU award is to compensate you for any ‘loss of use or ability’ in a body part as a result of your work injury. If you do not get back the same level of use in an injured body part, you may be entitled to an SLU award. An SLU award may be offered if you injured one of the following body parts: Arm, Leg, Hand, Fingers, Foot, Toe, Eye (Loss Vision), Ear (Hearing Loss) & Facial Scars (Facial/Neck/Scalp scars). Call Steenberg Law Firm for more info.

How are attorneys’ fees paid in workers’ compensation cases?

In workers’ compensation cases, the injured worker does not pay the attorney directly. Since the attorney works for the injured worker, any attorney’s fee comes from the award to the injured worker, but is paid by the insurance company. All fees must approved by the Workers’ Compensation Board.

How do I settle my workers’ compensation case?

A claimant can attempt to settle their workers’ comp case with the insurance company. There are different types of settlements. Generally, an individual will settle the claim for a lump sum of money in exchange for giving up only their rights to weekly benefits and related medical treatment coverage. In another type of settlement, an individual can retain their medical benefit and settle the indemnity portion of their claim.

Is there a time limit on when I must file my workers’ compensation claim?

If an individual sustains an accident at work, the individual must report the incident, in writing, to their employer within 30 days, and a claim must be filed with the Workers’ Compensation Board within 2 years of the date of accident.
With regard to occupational injuries, a claim must be filed 2 years from the date the injury was known to be related, or should have been known to be related to the work activities.

After my work injury, does my employer have to accommodate my work restrictions?

No. Unless you employer has declared in writing that they will accommodate an injured employee’s work limitations. This may be done in an individual employee contract or employee handbook.
Exceptions to this rule are employers who obligate themselves to either hold an injured worker’s position open, or accommodate an injured worker’s limitations through an employee benefit program (usually outlined in an employee handbook) or through collective bargaining (union) or individual employment.

If I am out of work due to my work injury, can my employer fire me without cause?

Most likely, yes. Unless you fall into a few exceptions, you are subject to New York State’s “employment at will” doctrine which allows an employer to terminate an employee with or without cause. However, you may have protections if you belong to a union that has fought for certain rights through collective bargaining. Also, if you have an individual employment contract with your employer, then you may have additional rights therein.

If the workplace causes the death of a loved one, can family get benefits?

There are also benefits for an individual’s family, or dependents, when the workplace causes the death of a worker. The Estate is entitled to death benefits whether there are dependents, such as a spouse or children, or if there were no dependents at all. The insurance company is also responsible for any burial costs up to certain limits, depending upon the county the decedent lived in.

When should you apply for Social Security Disability benefits?

Social Security disability cases can take a long time to complete. Generally, you must be out of work, because of your disability, for (12) twelve consecutive months. However, it is best to apply after being out of work for (9) consecutive months.

What types of injuries/impairments are considered disabling?

An individual can be disabled for any type of reason. It could be due to a disabling accident, a mental disability, a genetic condition, disease, or any other type of disabling condition. An impairment can be from brain damage, dementia, Diabetes, Fibromyalgia, depression, anxiety, Complex Regional Pain Syndrome, Carpal Tunnel Syndrome, chronic pain, chronic fatigue, impairments to the hands, etc.

What are the fees for having a lawyer represent me?

A lawyer at Steenberg Law Firm will only be paid if your claim is approved. Typically, fees are 25% of the retroactive benefits to a maximum of the statutory limit, which is currently $6,000.00. If an attorney wins your claim and there are no retroactive benefits, the fee request will be based upon the time spent working on the file and the expertise that was required. Thus, we suggest that you let an experienced attorney at our firm handle your Social Security Disability claim, as there is no fee unless we are successful in winning your claim.

I have a Workers’ Comp claim, can I also file a Personal Injury lawsuit?

Maybe. Generally, if someone was injured at work, that person’s exclusive remedy or course of action is to file a Workers’ Comp claim only. However, an exception arises when a “third party” (i.e. someone other than your employer or co-worker) is involved in causing your work injury. It is then possible to sue the third party in a personal injury lawsuit. But note, you still cannot sue your employer, only the third party involved.

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