Workers’ Compensation Attorneys in Buffalo, NY
A workplace injury can be devastating. Suddenly, you have lost your ability to earn an income, you have the burden of mounting medical bills, and you are facing a diminished quality of life due to your on-the-job injury. Employees in New York State who are injured at work are covered by workers’ compensation insurance, which can provide cash benefits and medical care if you have been injured or fallen ill because of your job.
Lipsitz Green Scime Cambria has been on the front lines of the fight to improve workplace safety and protect the rights of injured workers for over fifty years. The firm has an intimate knowledge of worksites, workplace machinery, and on-the-job activities that can lead to injury. The knowledge, experience, and legal skill of Lipsitz Green’s attorneys have produced a significant track record of results for injured clients. Contact Lipsitz Green Scime Cambria’s workers’ compensation team today to ensure you get all the benefits you’re entitled to.
Workers’ Compensation Benefits Information
You will find valuable information regarding all aspects of workers’ compensation for New York State workers throughout Lipsitz Green’s website. This page provides details on workers’ compensation benefits that are available to injured workers including medical reimbursement, wage replacement, medication coverage, and how your disability classification will impact the benefits you receive. In addition, this page explains: an injured worker’s obligation to demonstrate labor market attachment, when a workplace injury may involve third party liability, as well as common workplace accidents and injuries to be aware of.
Workers’ Compensation Claims Process Information
Workers’ Compensation Benefits
If you are injured on the job and seeking workers’ compensation, you may be wondering what workers’ compensation benefits actually consist of and how those benefits are determined for the injured worker. Workers’ compensation benefits can be divided into two main categories: medical care/reimbursement and wage replacement. The costs of medical care are covered by your employer or your employer’s insurance company. It is important to note that these costs do not fall under the umbrella of medical reimbursement because the doctor will not be collecting a fee from you directly. Under New York Workers’ Compensation Law, you are entitled to reimbursement for certain expenses related to the medical treatment you receive for your injury. Requests for these reimbursements should be sent to your employer’s insurance company. There is no deadline for the carrier to pay your medical reimbursement requests, but the requests are usually fulfilled within 60 days.
Some expenses that are eligible for medical reimbursement include:
- Mileage to and from medical treatment, tests, and trips to the insurance company’s doctor
- Necessary prescription or over the counter medications
- Hospital parking
Expenses that are not eligible for medical reimbursement include:
- Travel to and from the pharmacy and hearings
- Travel to and from unapproved out-of-state medical treatment
- Travel to and from vocational rehabilitation
- Anything that does not have a receipt
- Anything that is not related to your workers’ compensation claim
- Doctors’ appointments without the corresponding medical reports that prove your presence at the appointments
Cash benefits are available for workers if the lost time is more than seven days. The benefits can be up to 2/3 of the worker’s average weekly wage, up to the maximum rate. From 1992 until July of 2007, the maximum was capped at $400 per week. Under the new law, workers injured on or after July 1, 2007 are eligible for increasing rates as follows:
- Workers injured between July 1, 2007-June 30, 2008: Maximum rate – $500
- Workers injured between July 1, 2008-June 30, 2009: Maximum rate – $550
- Workers injured between July 1, 2009-June 30, 2010: Maximum rate – $600
For workers injured on and after July 1, 2010, the maximum rate is 2/3 of the New York State average weekly wage, to be set by the Workers’ Compensation Board, and that rate will be indexed to the NY State AWW every July 1.
- July 1, 2010: Maximum rate is $739.83
- July 1, 2011: Maximum rate is $772.96
- July 1, 2012: Maximum rate is $792.07
- July 1, 2013: Maximum rate is $803.21
- July 1, 2014: Maximum rate is $808.65
- July 1, 2015: Maximum rate is $844.29
- July 1, 2016: Maximum rate is $864.32
- July 1, 2017: Maximum rate is $870.61
- July 1, 2018: Maximum rate is $904.74
A worker who suffers from a serious disability, which may last 12 months or more, may be entitled to monthly Social Security Disability benefits. For additional information about these Federal Disability Insurance Benefits, you can contact us at our office.
The cash benefits you receive are determined by the extent of your injury, which is evaluated by your health care provider. The disability classifications to which these benefits are tied are as follows:
- Temporary Total Disability: your ability to work is lost completely, but only temporarily. If you are temporarily completely unable to work, your benefits will be equal to two-thirds of your average weekly wage for one year leading up to the accident provided that this amount does not exceed the legal maximum that was in effect the date of your injury. In 2018, that weekly maximum is $904.74. To see the full list of weekly maximums, click here.
- Temporary Partial Disability: your ability to work is reduced temporarily. In this case, your cash benefits equal two-thirds of your average weekly wage multiplied by your percentage of disability provided this number does not exceed the legal maximum.
- Permanent Total Disability: your ability to work is lost completely and permanently. In these cases, there is no limit on the number of weeks during which you are able to receive payment. According to the Workers’ Compensation Board, you may continue to “engage in business or employment.”
- Permanent Partial Disability: your ability to work is reduced permanently. Depending on the nature of the disability, you may qualify for either schedule loss of use or non-schedule. The severity of your disability is measured once you have reached maximum medical improvement (MMI).
Permanent Disability: Schedule Loss of Use
A schedule loss of use happens when you have permanently lost the use of an upper limb such as an arm or a hand, a lower limb such as a leg or a foot, your hearing, or your eyesight. If your disability is considered schedule loss of use, the law mandates that your compensation will be limited to a certain number of weeks depending on the body part that was injured and the severity of your injury. Any temporary benefits you have received will be deducted from your total schedule loss of use award.
Based on the body part you have injured and the severity of that injury, the law will determine how many weeks of benefits you are eligible to receive. The maximum number of weeks per injured body part is as follows:
- Reduced use of arm: 312 weeks
- Reduced use of leg: 288 weeks
- Reduced use of hand: 244 weeks
- Reduced use of foot: 205 weeks
- Reduced use of eye: 160 weeks
- Reduced use of thumb: 75 weeks
- Reduced use of first finger: 46 weeks
- Reduced use of second finger: 30 weeks
- Reduced use of third finger: 25 weeks
- Reduced use of fourth finger: 15 weeks
- Reduced use of great toe: 38 weeks
- Reduced use of another toe: 16 weeks
Permanent Disability: Non-Schedule
A permanent disability that involves a body part or condition that is not covered by a schedule loss of use award is known as non-schedule. These benefits are dependent on the permanent loss of your ability to work. If you were injured at work before March 13, 2007, you can receive benefits for as long as your disability exists and results in your inability to earn wages at your previous capacity. If you were injured at work after that date, you can receive benefits for a maximum number of weeks based on your inability to earn wages at your previous capacity. The maximum number of weeks is determined as follows:
- Greater than 95% loss of wage earning capacity: 525 weeks
- 91% to 95% loss of wage earning capacity: 500 weeks
- 86% to 90% loss of wage earning capacity: 475 weeks
- 81% to 85% loss of wage earning capacity: 450 weeks
- 76% to 80% loss of wage earning capacity: 425 weeks
- 71% to 75% loss of wage earning capacity: 400 weeks
- 61% to 70% loss of wage earning capacity: 375 weeks
- 51% to 60% loss of wage earning capacity: 350 weeks
- 41% to 50% loss of wage earning capacity: 300 weeks
- 31% to 40% loss of wage earning capacity: 275 weeks
- 16% to 30% loss of wage earning capacity: 250 weeks
- Less than 15% loss of wage earning capacity: 225 weeks
Labor Market Attachment
If you have been partially disabled, you are required to seek gainful employment within your medical restrictions in order to continue to receive your lost wage benefits. If you do not make an effort to obtain employment, you run the risk of losing your benefits. These attempts to gain employment are known as your demonstration of “labor market attachment.” Labor market attachment is required in order to justify your continued receipt of workers’ compensation benefits.
How to demonstrate labor market attachment
In order to demonstrate labor market attachment, a claimant will need to seek work through one of the following methods. These methods were clarified in a 2010 Board Panel Memorandum of the Decision in the Matter of American Axle, in which Lipsitz Green Scime Cambria represented the claimant. A claimant can demonstrate labor market attachment by:
Independent job search: When you search and apply for work on your own, whether in person, by phone, or online, you are conducting an independent job search. In order to maintain a record of your independent job search, Form C-258.1 should be completed.
Active participation in a job-location service: Labor market attachment can be demonstrated through participation in a job-location service such as One-Stop Career Centers, the New York State Department of Labor’s re-employment services, or an industry-specific job services. If you choose to use a One-Stop Career Center active participation requires:
- Calling for an appointment
- Attending orientation
- Meeting with a counselor to develop a resume
- Registering that resume in the One-Stop system
- Checking with the Center to see if there are any job matches with your resume
- Following up on all referrals and matches
These elements of active participation were laid out in the American Axle matter.
- Vocational rehabilitation: The Adult Career and Continuing Education Services – Vocational Rehabilitation (ACCES-VR) offers vocational rehabilitation in order to prove labor market attachment. You may also be able to use another rehabilitation program approved by the Workers’ Compensation Board.
- Job-retraining program: Vocational rehabilitation counselors and licensed social workers are available through the New York State Workers’ Compensation Board in order to assist with job retraining.
- Educational enrollment: Enrolling full-time at an accredited educational institution in order to obtain employment within your work restrictions is a demonstration of labor market attachment.
When demonstrating labor market attachment, there are two forms that are important to fill out. If these forms are not filled out in adequate detail, you run the risk of losing your lost wages benefits.
- Claimant’s Record of Job Search Efforts/Contacts (Form C-258): This form records your efforts to search for work within your medical restrictions with the assistance of an agency or employment counselor. Page two of this form contains detailed filing instructions.
- Claimant’s Record of Independent Job Search Efforts (Form C-258.1): This form records your independent efforts to search for work within your medical restrictions. Page two of this form contains detailed filing instructions.
Along with these forms, you may be required to provide medical evidence of your disability to a Workers’ Compensation Law Judge.
For more information about labor market attachment, please visit the Workers’ Compensation Board website.
When you suffer a work-related injury or illness, insurance carriers can designate which pharmacies you are allowed to use to fill prescriptions. Insurers are required to notify you of this designation and tell you in writing exactly which pharmacies you can use, as well as how to fill and refill prescriptions. The pharmacies that the insurance provider approves must be a reasonable distance from you or have mail order, but obtaining the necessary medication can still be difficult under these restrictions. In addition, insurance carriers may attempt to controvert your claim in order to avoid paying for treatment and prescriptions at all.
Insurance carriers can attempt to deny covering your work injury related prescription for several reasons, including:
- If the treatment or prescription medication is not consistent with the medical treatment guidelines
- If the medical provider has not provided sufficient evidence that the treatment or prescription medication is related to your injury
Coverage for pain medication in particular is being cut down in the face of the opioid crisis and even those who suffer from chronic pain are having their cases reevaluated. Click here for information on pain medication guidelines. You will find information on the New York State Workers’ Compensation Board’s medical treatment guidelines for injuries involving the neck, back, shoulder, or knee. In addition, details are provided on chronic pain guidelines, which includes opioid treatment.
Third Party Liability
No party is determined to be at fault in a New York State workers’ compensation case. The benefits you receive are not affected by things like carelessness on the job by either the injured worker or the employer. However, if you are injured on the job you may be able to sue a third party for damages. Third parties are companies or individuals, other than a co-worker or employer, who caused the injury.
Examples of third parties include:
- Manufacturers of products that are defectively designed, defectively constructed or which do not contain proper warnings – commonly known as Product Liability claims;
- Maintenance companies that have not properly maintained machines or property;
- Owners and general contractors of property where work is being performed;
- Owners who fail to properly maintain their property causing injury to workers who slip and fall or are otherwise injured while on the property;
- Operators or owners of motor vehicles involved in an accident;
- And countless others whose actions or failure to act cause injury to a worker
In addition to dealing with the complicated workers’ compensation system, Lipsitz Green’s personal injury lawyers have extensive experience determining whether there are parties who can be sued to help compensate a worker for injuries. The firm’s has one of the region’s most respected personal injury legal teams, and we know how to fight and win for workers in the courtroom.
Accidents and Injuries
If you are injured at work, your life can change in an instant. Lipsitz Green’s attorneys have a unique perspective on workplace issues due to the firm’s deep roots in the labor movement and extensive experience in product liability and personal injury. No matter your profession or the injury you have sustained, Lipsitz Green Scime Cambria has the experience and knowledge necessary to navigate the complex workers’ compensation process and secure the benefits you deserve. Below are some examples of common accidents and injuries that workers often face, as well as a list of some of the various types of professionals with whom Lipsitz Green’s workers’ compensation attorneys have experience working.
Workplace injuries and illnesses can occur across a variety of professions. Whether you work in healthcare or construction, you are susceptible to being injured at work and it is vital that you know what your options are should this occur. Lipsitz Green Scime Cambria’s workers’ compensation attorneys represent a variety of different types of professionals, including:
- Administrative and clerical workers
- Auto workers
- Bus drivers and transportation workers
- Communications workers
- Construction workers
- Delivery services drivers
- Health care workers
- Operating engineers, including crane workers and large machinery workers
- Sheet metal workers
- Utility company workers
Common Accidents and Injuries
Some of the most common accidents and incidents that people experience on the job include:
- Chemical exposure
- Crane accidents
- Forklift accidents
- Heavy equipment accidents
- Heavy lifting
- Repetitive motion
- Scaffolding accidents
- Slip and fall accidents
- Welding accidents
- Work-related car accidents
These accidents can cause a variety of injuries for which you could be eligible for workers’ compensation. Some of these injuries could include:
- Amputation: Worksite machinery, material collapses, construction vehicles, and powered hand tools can all cause an injury leading to amputation. If you have lost the use of a body part due to an on-the-job injury, contact a workers’ compensation attorney as soon as possible to discuss your benefit options.
- Burns: Chemical, electrical and thermal burns can be extremely dangerous. Severe burns can cause skin damage, internal injuries, shock, infection, and cardiac arrest. Whether you have experienced a burn due to chemical exposure, electrical contact, or contact with a hot object or steam, treating a burn as soon as possible is vital to your health and safety.
- Carpal Tunnel/repetitive stress injuries: Repetitive stress injuries such as carpal tunnel syndrome are caused most often by repetitive motion, but can also be caused by sustaining a position for too long or by heavy exertion. The Workers’ Compensation Board has laid out medical treatment guidelines for carpal tunnel syndrome.
- Electric Shock: Electric shock is an extremely serious occurrence that can cause anything from minor pain to severe burns, permanent injury, and even death. Electricians, mechanics, and other laborers are at a higher risk for electric shock and electrocution.
- Head injuries: Traumatic brain injuries are some of the most serious injuries that can occur on the job. Whether you have suffered a concussion, a skull fracture, or another type of TBI, it is important to seek medical attention immediately.
- Hearing loss: Every year, about 22 million American workers are exposed to hazardous noise levels on the job. In addition, over 30 million American workers are exposed to chemicals that can be harmful to the ear and damage your hearing.
- Knee injuries: Strains like heavy lifting, falls, and banging your knee on equipment can all contribute to on-the-job knee injuries. If these actions are repeated, they can even lead to chronic knee pain. The Workers’ Compensation Board has laid out medical treatment guidelines for knee injuries.
- Mid and low back injuries: Back injuries such as herniated discs or spinal fractures are some of the most common workers’ compensation claims; in 2007, back injuries made up almost 20% of all claims. The Workers’ Compensation Board has laid out medical treatment guidelines for mid and low back injuries.
- Neck injuries: Neck injuries can be caused by several different situations at work, including repetitive motions, car accidents, slip and falls, and even emotional stress. The Workers’ Compensation Board has laid out medical treatment guidelines for neck injuries.
- Non-acute pain: Workplace injuries can have lasting effects, including chronic pain. The Workers’ Compensation Board has laid out medical treatment guidelines for non-acute pain. These guidelines are meant to assist physicians in proper prescription of opioids in order to help workers manage their chronic pain.
- Shoulder injuries: If your job requires lifting heavy objects or repetitive overhead work, your shoulder injury may be eligible for workers’ compensation. Accidents such as blunt trauma to the shoulder or falling onto your shoulder while at work could also qualify you. The Workers’ Compensation Board has laid out medical treatment guidelines for shoulder injuries.
- Vision loss: Occupational vision loss can be caused by prolonged exposure to bright lights, chemical exposure, accidents that impact your face, and even extended computer time.
In addition to accidental injuries, which can be caused by one time accidents or repeated exposure to dangerous or stressful conditions, it is possible for workers to contract occupational diseases. Occupational diseases are illnesses that are contracted or aggravated, either over time or after a single instance, due to the nature of your work. These diseases are not just caused by exposure to toxic substances such as asbestos; for example, carpal tunnel syndrome that is developed through repetitive motion is also considered an occupational disease. Hearing loss and vision loss also qualify as occupational diseases. Other diseases included for coverage under the New York Workers’ Compensation Law include:
- Arsenic poisoning
- Carbon monoxide poisoning
- Cataracts in glassworkers
- Chrome ulceration
- Compressed air illness
- Disability from blisters or abrasions
- Disability from bursitis or synovitis
- Dope poisoning
- Epitheliomatous cancer
- Lead poisoning
- Mercury poisoning
- Methyl chloride poisoning
- Miners’ diseases (cellulitis, bursitis, ankylostomiasis, tenosynovitis, and nystagmus)
- Phosphorus poisoning
- Poisoning by benzol or certain derivatives of benzene
- Poisoning by carbon bisulphide
- Poisoning by formaldehyde
- Poisoning by nickel
- Poisoning by nitrous fumes
- Poisoning by sulphuric, hydrochloric, or hydrofluoric acid
- Poisoning by wood alcohol
- Radium poisoning
- Respiratory, gastrointestinal, or physiological nerve and eye disorders
- Silicosis and other dust diseases
- Zinc poisoning
If you are a member of a union and you have sustained a work injury, discuss your options with your union representative. Your representative may be able to provide you with information about a specific process you should follow. Lipsitz Green has a strong working relationship with several unions across the area; check with your union representative to find out who best to contact regarding your legal rights following an on-the-job injury.
It is important to know that filing a workers’ compensation claim does not protect your job if you need to take time off of work to recover. This is especially true if you are not part of a collective bargaining agreement. If you do lose your job while you are out on workers’ compensation, consult an attorney as soon as possible. You may be eligible for unemployment or Social Security Disability.
Over 50 Years of Fighting for Workers’ Rights
The Lipsitz Green workers’ compensation team has a long and rich history of successfully battling for injured workers. The firm’s attorneys have the experience and legal skill to guide you through the complex workers’ compensation and Social Security disability systems, helping you avoid missteps and getting you all the benefits you’re entitled to.
The firm represents the Western New York Workers’ Compensation Coalition and handles workers’ compensation matters for many prominent labor organizations. Since its founding over 50 years ago, the firm has stood by the sides of injured workers until they can stand on their own.
Contact Lipsitz Green Scime Cambria today to guide you through the workers’ compensation process and help ensure you get all the benefits you are owed.
Prescription Coverage Denial
Lipsitz Green Scime Cambria works quickly to reinstate your insurance coverage of prescriptions after a sudden denial of coverage.
Labor Market Attachment
Lipsitz Green Scime Cambria will provide you guidance on maintaining labor market attachment to help ensure you maintain your benefits.
Lipsitz Green Scime Cambria will fight guideline limits on your chiropractor treatments.