Answers to Common Questions about Workers’ Compensation
When you are a doctor and have a patient come to you claiming to have been injured on the job, it can be extremely helpful to have a basic understanding of the workers’ compensation laws and process. Here are some frequently asked questions about workers’ compensation that have medical implications.
Q: What are the requirements to qualify for workers’ compensation?
A: In the state of New York, there are only two requirements—you must have been working and you must have suffered an injury while on the job. Workers’ compensation is generally considered to be “no-fault,” meaning that the negligence of the worker doesn’t mean a claim will be denied. There are limited circumstances where a claim may be denied—where the injury was suffered while off duty, was self-inflicted, happened while the employee was violating company policy or while the employee was committing an illegal act.
Q: Must the injury occur on company property?
A: No. Any injury sustained while you were performing the duties of your job will be covered, regardless of where it happened. If your job requires that you travel, you can seek benefits for motor vehicle accident injuries or even for a slip and fall at a customer facility. As a general rule, if you leave company property on a personal errand, you are not covered. However, if your boss asks you to do a work-related task (pick up lunch for the office, etc.) while running a personal errand, you may have coverage.
Q: Does workers’ compensation cover only work-related accidents?
A: No. Any injury or illness that arises out of work conditions may be covered. Accordingly, a person who is exposed to toxic substances on the job may be entitled to workers’ compensation benefits for any negative health consequences that result. In addition, employees who experience mental health issues, such as depression or anxiety, may recover workers’ compensation benefits if it can be shown that the mental health problems were work-related.
Q: What medical expenses are covered by workers’ compensation?
A: Workers’ compensation pays for any “reasonable and necessary” medical expenses resulting from a work-related injury. This can include examinations, checkups, urgent care treatment, hospitalization, surgical treatment, anesthesia and medications.
Results-Oriented Workers’ Compensation Lawyers in Queens, New York
At Pyrros & Serres, we bring more than 50 years of combined workers’ compensation experience to injured workers in Queens and across the greater New York City area. We built our practice on personal service and attention, taking the time to learn the details of your case, so that we can take the necessary measures to get the outcome you want. Many of our new cases come to us as referrals from doctors, lawyers and satisfied clients.
We take all types of work-related injury claims, including cases involving:
Occupational Disease or Illness | Traumatic Brain Injury (TBI) | Fractures | Hip, Leg, Foot and Toe Injury| Burns | Paralysis | Spinal Cord Injury | Permanent Scarring or Disfigurement | Amputation or Loss of Limb | Hearing or Vision Loss | Back and Neck Injury | Shoulder, Arm, Hand and Finger Injury | Accidental or Wrongful Death
Under the New York workers’ compensation laws, when you have suffered a workplace injury or have contracted a disease related to your employment, you have the right to file a workers’ compensation claim and to get payment for certain medical expenses. What types of medical bills are covered?
General Medical Care
You are entitled to payment or coverage of all expenses related to any necessary medical care directly related to or arising as a consequence of your work-related injury or illness. Workers’ compensation benefits also cover the costs of recovery, including physical therapy and rehabilitation.
As a general rule, any medical professional providing care to you must be preauthorized by the Workers’ Compensation Board, unless the treatment is an emergency. You have a right to payment of or reimbursement for such medical expenses, even if your injury has not resulted in any time lost at work and you have received no cash benefits for lost wages. If you have requested an authorization, but it has been withheld for more than 30 days, with no stated reason, the treating physician may provide care, if necessary to promote or protect you health or welfare.
Tests and Procedures
If you require any x-rays, MRIs or other tests, or need a surgical procedure, physical therapy or special consultation, you must obtain prior authorization, if the costs exceed $1,000. If the workers’ compensation insurance carrier has notified you of a preferred provider of services, you must obtain services from that provider, unless the situation is an emergency or there is no preferred provider within a reasonable distance from where you live.
The cost of drugs to treat you condition are generally covered by workers’ compensation. The pharmacy may directly bill the workers’ compensation insurance company or you may seek reimbursement by sending the bill and a letter from your treating physician, indicating that the medication was a necessary part of your care.
At Pyrros & Serres LLP, we handle all matters related to workers’ compensation and Social Security disability claims for people in Queens, Brooklyn, the Bronx and across the greater New York City metropolitan area. Because of our reputation for effective advocacy, many of our new clients come to us as referrals from clients and other lawyers.
You Want a Lawyer Well-Versed in the Complexities of Workers’ Compensation Law
If you’re an injured worker seeking benefits to cover lost wages or unreimbursed medical expenses, or you’ve developed an illness because of a jobsite exposure to toxic materials, it’s critical that you retain a lawyer with extensive knowledge, skill and experience handling workers’ compensation and workplace injury claims. The workers’ compensation process can be complex, even for legal professionals—the best chance of full financial recovery is with an attorney who understands the workers’ compensation process, who has successfully recovered benefits for other injured workers.
Here are some of the specific ways that a proven workers’ compensation attorney can help you or your client:
Properly developing and presenting medical evidence—One of the principal reasons many workers’ compensation claims are initially denied is because claimants offer insufficient or incomplete medical evidence. An experienced workers’ compensation attorney will know when it’s necessary to obtain an expert medical opinion, to depose medical experts or when medical records are missing something.
Development and introduction of vocational evidence—It’s not enough to show that you’ve suffered injury. You also need to show what the physical requirements are for your job and why you can’t meet them. This may require testimony about your daily activities or about current safety or training programs at you place of employment.
Negotiating a settlement, if appropriate—Unless your attorney has handled quite a few workers’ compensation claims, he or she won’t have a realistic idea of the value of your claim. An experienced workers’ compensation lawyer will be able to quickly look at your disability rating, whether it partial/total or temporary/permanent, and incorporate the costs of past and future medical expenses to determine the full extent of your losses.
Results-Oriented Workers’ Compensation Attorneys in Queens, New York
At Pyrros & Serres, we bring more than a half a century of combined workers’ compensation experience to injured workers in Queens and across the New York City metropolitan area. We built our reputation on personal service and attention, always taking the time to learn the details of your situation, so that we can tailor our representation to get the outcome you deserve. Many of our new cases come to us as referrals from our colleagues in the legal profession, from satisfied clients and from medical professionals.
We handle all types of work-related injury claims, including cases involving:
Occupational Disease or Illness | Hip, Leg, Foot and Toe Injury| Burns | Paralysis | Spinal Cord Injury | Permanent Scarring or Disfigurement | Amputation or Loss of Limb | Hearing or Vision Loss | Accidental Death | Back and Neck Injury | Traumatic Brain Injury (TBI) | Fractures | Shoulder, Arm, Hand and Finger Injury
When you have been hurt on the job and have filed a workers’ compensation claim, it’s pretty common for your employer’s workers’ compensation insurance provider to require that you submit to a medical examination by a doctor chosen by the insurer. It’s important that you understand that you have a number of rights with respect to that examination and it’s important that you know what your rights are.
When you receive the medical exam letter, it can be intimidating and confusing. The letter, which will make reference to an “independent medical exam,” will typically ask you to appear for the examination and to bring a variety of documents or records. Contrary to what the letter suggests, though, the examination will be conducted by a doctor chosen and paid by the insurer, who has a vested interest in making conclusions and diagnoses that are favorable to the insurance company.
Your Rights at the Medical Examination
The letter you receive will indicate whether the doctor plans to videotape the examination. However, regardless of whether the doctor chooses to do so, you always have the right to videotape the exam—you can also audiotape the doctor’s appointment. In addition, there is no rule that requires you to notify the doctor in advance that you will be taping the proceedings. If the letter says you must, ignore it. If you appear for the examination and the doctor says you cannot videotape the exam, you should politely decline to go through the examination.
Why would you want to videotape a medical examination? Because, as we were able to do in a case we handled recently, you may be able to successfully have the insurance company doctor’s report ruled inadmissible, if it has no bearing on your injury or your claim.
Workers’ Compensation Hearings – What Happens and Why Are They Scheduled?
When you’ve been injured on the job, one of the first things you’ll do is notify your employer and file a claim for workers’ compensation. In some situations, your claim will be approved without the need for a hearing and your benefits will start within a couple weeks. In most situations, though, you’ll receive a notice that a hearing has been scheduled.
Why You Will Have to Appear at a Hearing After Filing a Workers’ Comp Claim
There are a number of reasons why you’ll have to appear at a hearing after you’ve filed a claim for workers’ compensation:
Your employer or the workers’ compensation insurance provider may be challenging your claim, arguing that you weren’t hurt on the job
The insurance company doctor may have concluded that your injuries don’t prevent you from doing your job
There may be a dispute about your wages or the amount to which you are entitle
At the workers’ compensation hearing, the parties will produce evidence regarding all the issues being contested. You can provide the judge with documentation regarding your pre-accident wages, so that you are awarded the appropriate amount of disability income under the law.
It’s important to understand that your employer and the workers’ compensation insurer will both likely have legal representation at the hearing. In addition, you can’t expect that the judge will take the time to walk you through the process and ensure that your rights are protected. That’s why it’s important to have an experienced workers’ compensation attorney at your side.
Contact an Experienced Workers’ Comp Attorney
At Pyrros & Serres LLP, our attorneys handle all matters related to workers’ compensation claims for people in the Bronx, Brooklyn, Queens and across the greater New York City metropolitan area. Call our office at (718) 626-7730 to schedule a consultation to find out how we can help with your workers’ comp claim.
In New Jersey, if you’ve been injured on the job, you have a right to seek benefits to cover your disability, as well as medical expenses. But what if no one actually saw the accident? Can you still recover workers’ compensation benefits if there were no witnesses to your injury? The answer is yes.
There are typically two types of evidence in a legal matter—direct evidence and circumstantial evidence. Direct evidence includes anything a witness had access to directly, either through sight, sound, smell, taste or touch. Circumstantial evidence, on the other hand, involves facts that support a finding, but without any direct access to an event.
We were involved in a workers’ compensation claim where an employee died of a heart attack at his desk at work. No one had been present when the man died. However, through circumstantial evidence, we were able to show the man had been under significant stress on the job. We successfully argued to the workers’ compensation judge and the Workers’ Compensation Board that the reason the man died was related to his job.
At Pyrros & Serres LLP, we provide comprehensive counsel to people with workers’ compensation and Social Security disability claims in Brooklyn, Queens, the Bronx and across the greater New York City metropolitan area. Because of our reputation for effective advocacy, many of our new clients come to us as referrals from clients and other lawyers.