Workers’ compensation will pay for medical care as long as necessary to treat a work-related injury. And your disability benefits may last indefinitely if you have a total and permanent disability. Otherwise, your disability benefits will end at some point. When they end depends on a variety of factors, including whether you can work, the body part you injured, the impairment rating you received and more.
Further, an insurer may request a hearing to contest a claim within 10 days of becoming aware of an accident or within 18 days of the disability, whichever is greater. If the insurer already started to pay benefits before the Judge made a decision, it can suspend or modify payments based on payroll or medical evidence that the Workers’ Compensation Board receives.
When Disability Benefits Stop
You will receive temporary total disability benefits if you are unable to work after the seventh day of disability. If you are unable to work more than 14 days, then the first seven days become payable. These pay two-thirds of your average weekly wages. Once you return to the job, your benefits will stop.
If you return to a lower-paying position while you’re recovering, you may transition to temporary partial disability that pays two-thirds of the difference between previous wages and current wages. Likewise, once you return to your previous wages, the benefits will stop.
If you receive an impairment rating upon reaching maximum medical improvement, you may continue to receive benefits via permanent partial disability benefits for a set number of weeks, depending on the body part you’ve injured (if it’s listed as a Scheduled Loss of Use injury like an injury affecting an upper or lower extremity, hearing or sight) and the impairment rating your doctor gave you. You will multiply the impairment rating by the number of weeks assigned to the body part to determine the number of weeks you receive benefits.
If not listed as a Scheduled Loss of Use injury, like a back, heart or brain injury, the number of weeks you receive benefits is dependent on your loss of earning capacity.
What options do I have if I think I should continue receiving benefits?
If your employer’s insurance provider contests your claim or you dispute cessation of your benefits, you can submit evidence and appear at initial hearings in front of the Workers’ Compensation Law Judge. The Judge reviews medical records, evidence of injury, testimony and other evidence to make decisions about whether you are eligible to continue receiving benefits.
After the Law Judge issues his or her ruling of the contested claim, you can appeal to a three-person panel of the Workers’ Compensation Board if you are unsatisfied with the Judge’s ruling. A workers’ compensation insurer does not have to make weekly benefit payments while a case is being reviewed by the Board Panel. However, it must pay benefits if the Panel upholds your right to benefits, even if the insurer appeals the Panel’s decision further through the court system.
Markhoff & Mittman is committed to protecting injured New Yorkers’ rights. Contact our office to set up a consultation to discuss your case.