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The Law Offices of Frank J. Dito, Jr.

Workers' Compensation Lawyers: The New York workers' compensation law firm with the attorneys, skills and resources to get you the workers compensation benefits that you have earned and deserve serving clients injured at work in Staten Island, Brooklyn, Manhattan, Queens, the Bronx, Long Island and the rest of New York.


What does it mean to “Abey” my workers’ compensation case?

The workers’ compensation board will allow you to refile your case and order that an Examiner is to review the case by a specified future date.

What does it mean when the workers’ compensation judge said he would “abey” an Issue?

The workers’ compensation judge postponed a decision on an issue in your case until a later date. The reason is that you or your lawyer may expect that additional pertinent information may or will become available.

What is a “work related accident”?

A work related accident is an “event, arising out of and in the course of employment that results in personal injury to a worker.” If you were hurt at work, you most likely had a work related accident and would need to file a claim under the workers’ compensation law.

My workers’ compensation claim form asks for my “accident date.” What does that mean?

When the workers’ compensation board refers to an accident date, it means either (a) the date the accident occurred or (b) the date of onset of the symptoms assigned to an occupational disease. The accident date is officially established by a Workers’ Compensation Law Judge.

What is Accident, Notice and Causal Relationship (ANCR)?

In order for you to have a workers’ compensation claim, you must meet certain conditions. Specifically, you must establish that you had a work related accident; that you notified your employer of the accident within the time allowed by the workers’ compensation law; and that your injury is causally related to the work related accident.

I went to a scheduling hearing and the judge said he was going to adjourn it. What does that mean?

The WCJ postponed or suspended your hearing until a future time, without making any findings.

What does it mean that my case was “Adjudicated?”

It means that the workers’ compensation judge made a decision or a ruling on your case.

I lost my workers’ compensation case. Can I Appeal?

Yes, you may file an appeal. If you disagree with the decision, you may ask a higher court to reverse or overturn the decision. Appeals from a workers’ compensation decision go to the Appellate Division, Third Department, which is located in Albany, New York.

I reinjured myself at work. I hurt myself years earlier and I worked for a different employer than I do now. The Judge said that he was going to apportion my case?

When two or more parties are responsible for the disability of the same claimant, the WCB will evaluate the relative contribution that each source made to the claimant's permanent disability.

What does it mean “Arising Out of and in the Course of Employment?”

In order to file a workers’ compensation claim you must have an injury that "arises out of and in the course of" your employment. An accident that “arises out of your employment” is one that results from a hazard of the employment. An accident that occurs at a time, place and under circumstances related to the employment is an injury that occurs “in the course of your employment.”

I haven’t been working since my accident. Who pays my attorney’s fees?

The money for your attorney comes from any money that you receive at your hearing. Such fees are approved by the Workers’ Compensation judge.

My attorney was asking about my Average Weekly Wage (AWW). What is he asking about?

Your average weekly wages is used to calculate your total disability benefit rates. Defined at 1/52nd of the injured worker's average annual earnings (200-300 times average daily wage, depending on work schedule), based on the prior year's payroll data. If you were a new worker when you were injured, the workers’ compensation board will use the average wage of a comparably employed worker to determine your disability benefit rates.

My attorney said that my case is being reviewed by a “Board Panel.” What is a “Board Panel?”

A “Board Panel” is a usually comprised of three Workers' Compensation Board members, at least one of whom must be a lawyer, that reviews requests to amend decisions made by Workers' Compensation Law Judges, reopens closed cases and considers applications for lump sum non-schedule adjustment awards.

My attorney told me that the case was on the Calendar today. What did he mean?

The calendar is the list of the cases scheduled to be heard on a given date at a workers’ compensation board hearing location.

What is a workers’ compensation case?

A workers’ compensation case A reported work injury or illness which has been assembled and assigned a case number (indexed) by an indexing unit of the Workers' Compensation Board.

What does my workers’ compensation Case Number?

Your case number is a unique identifier assigned by the Workers' Compensation Board at the time a case is filed. Your case number consists of 8 characters and the format is DYYSSSSS, where D is a code for the WCB district office in which the case was indexed (0,1=Brooklyn; 2=Hempstead; 5=Albany; 6=Syracuse; 7=Rochester; 8=Buffalo; 9=Binghamton); YY represents the last two digits of the year of indexing; and SSSSS is a 5-digit sequence number, beginning with 00001 on January 1.

I slipped on something on the floor at work. Is that the Cause of Accident?

Yes. The cause of accident is an object, substance or condition that directly contributed to the occurrence of your accident.

What is Causation or a Causative Factor? 

Causation means what was the cause of the accident happening. The fact of being the cause of something produced or of happening. The act by which an effect is produced.

How do I file a Workers’ Compensation Claim?

A claim is filed on a prescribed Form C-3 for workers' compensation for your work related injury, occupational disease, disablement, or death. You must file a claim within a two-year period from the occurrence of the accidental injury, or your knowledge of occupational disablement, or death. Failure to file your claim may prevent your eligibility for compensation benefits unless the employer has made advance benefit payment or fails to raise the issue, in which event the claim filing requirement is deemed waived.

What is the Claims Information Systems or CIS?

The Claims Information System is the system used by the Workers’ Compensation Board's Claims Unit to record basic case information such as the parties of interest, current issues and scheduled hearings.

The judge closed my case at a hearing. What does that mean?

When you close a case, it is removed from further consideration. A judge will normally decide to close a case based on the judge's determination that no further rulings by the Board will be necessary in the case. A Board Panel may also close a case.

I received a letter saying that my case is referred for Conciliation. What does that mean?

Conciliation is a Workers' Compensation Board process established to resolve issues involving non-controverted claims in an expeditious and informal manner in which it is expected that you will receive no more than fifty-two weeks of benefits. If through concillation, you fail to reach an agreement, the case will be scheduled for a formal hearing.

The decision I received says that my case is continued. What will happen next?

The case will remain open and any additional matters will be resolved at a future hearing.

My claim is controverted. What does that mean?

If your case is controverted, it means that your employer is disputing how your accident or injury occurred. You may not receive benefits during the time your employer is disputing your claim. Usually, the issue must be tried before a workers’ compensation law judge where you will testify , along with any witnesses for or against your claim.

What is a C-2?

A C-2 is a Workers’ Compensation Board form titled "Employer's Report of Work-Related Accident or Occupational Disease." It is to be filed with the board by your employer within ten (10) days after an accident occurs. The form includes a section identifying the case and principal parties and additional sections labeled "Accident," "Injured Person," "Nature of Injury," "Cause of Accident," and "Fatal Cases." Failure to make timely C-2 filings subjects employers to potential administrative and criminal penalties.

What is a C-3?

A C-3 is a Workers’ Compensation Board form titled "Employee's Claim for Compensation" that is completed by you and submitted to the Board within two years of the accident or onset date. The C-3 form contains information describing you, your employer, where and when the accident happened, your injuries and benefits received.

What is a C-4?

A C-4 is a Workers’ Compensation Board form titled "Attending Doctor's Report," that provides information about your injuries. This form is to be filed by your doctor within two days of your initial treatment, with additional reports during continued treatment, including a final report.

What is a C-7?

A C-7 is a Workers’ Compensation Board form titled "Notice that Right to Compensation is Controverted." The insurance carrier must file this report with a certain time limit if they are claiming that the claim is controverted. The form contains basic information about the parties and the reasons why right to compensation is controverted.

What is a decision?

A decision is a determination of a Workers’ Compensation Judge or Board Panel arrived at after consideration of an issue at a hearing. The decision may contain approval for your continued medical treatment, monetary awards that the insurance carrier is required to pay as well as future hearing dates.

What is a dependent?

A dependent is a person eligible to receive death benefits in a fatal injury case. Surviving widows and children under age 18 years are eligible for benefits without proving dependency. Grandchildren, brothers and sisters under age 18 and parents and grandparents may all be considered dependents.

What is a Workers’ Compensation District?

A District is one of the seven regions of New York State that have offices of the Workers' Compensation Board. The seven regional offices are located in Albany, Binghamton, Brooklyn, Buffalo, Hempstead, Rochester and Syracuse.

What is a Workers’ Compensation Board Examiner?

The examiner will perform examining work, apply knowledge of law and of Board rules, regulations, policies and procedures to compensation and disability benefit cases. Examiners may determine whether a case should be indexed, provide information for judges to make decisions, request additional information for the claim, refer appropriate cases to concillation and prepare formal notices based upon the judge's directions.

My attorney said that workers’ compensation is my “exclusive remedy.” What does he mean?

Under workers’ compensation, you give up the right to sue your employer in exchange for medical care and payment for your lost time and injuries. In New York State, if you were hurt at work, you must complete your treatment according to the workers’ compensation law.

How is my extent of disability determined?

A single-digit numeric code used by the WCB's Research and Statistics unit to characterize the disability classification assigned to a case closed with indemnity benefits. The codes are:
0 = Death case
1 = Permanent total disability
2 = Permanent partial disability (PPD) - Schedule award only
3 = Facial disfigurement award only
4 = Schedule PPD and facial disfigurement award
5 = Temporary disability only
6 = Temporary disability and facial disfigurement award
7 = Non-schedule PPD - Lump sum settlement
8 = Non-schedule PPD - No present loss of earnings
9 = Non-schedule PPD - Carrier to continue payments

I am scheduled for a final adjustment hearing. What can I expect?

A final adjustment hearing is held in cases involving the loss or loss-of-use of a member or organ of the body in which the principal issue at the hearing is the extent of loss or loss-of-use, such as a scheduled loss of use. The hearing will normally involve possible testimony of your doctor and the insurance carrier’s doctor.

What is a workers’ compensation hearing?

A hearing allows for all interested parties to be present before a Workers' Compensation Law Judges for the purpose of ascertaining the rights of the parties. The parties have the right to present evidence, including witnesses, to determine their legal rights. The Workers’ Compensation Board, upon receipt of an application for review of a judge's decision, may also hold hearings.
My lawyer told me I am going to receive financial benefits from my injury. What types of financial benefits are there?

There are six types of award are permitted by the WCL for non-medical loss:
• temporary total disability benefits , for periods when you have been unable to work;
• temporary partial disability benefits, for periods when you have been unable to work your normal hours or at your normal pay;
• facial disfigurement awards are subject to a judge’s discretion for facial disfigurement resulting from your work-related accident;
• permanent partial disability benefits are awards for loss of physical function or for periods of partial wage loss after a claimant has been classified as having a permanent partial disability;
• permanent total disability benefits are for loss of your wage earning capacity after you have been classified as having a permanent disability; and
• death benefits, which are compensation benefits awarded to a spouse, children or other family members following a work-related death.

My claim has been indexed. What is an indexed claim?

An indexed claim is when your claim case folder which has been assembled and assigned a case number by the workers’ compensation board.

I was told that I have to wait 14 days before I can receive my lost time. Is this true?

Yes. If your disability lasts longer than 14 days, you will receive benefits from the first day of your disability. If you return to work with 14 days from your injury, you will not receive any lost time from workers’ compensation.

What is a lump sum settlement?

A lump sum settlement is a negotiated and Board-approved agreement between a claimant with a permanent partial disability and the insurer(s). As a result of the agreement the claimant receives a sum of money which would represent the future compensation for his/her permanent partial disability, and your case is considered closed. Under WCL .15(5-b), granting of a settlement by the Board requires that (a) the right to compensation has been established and compensation has been paid for at least three months, (b) the continuance of disability and of future earning capacity cannot be ascertained with reasonable certainty, (c) there has been a physical examination of the claimant prior to approval, and (d) the Board considers the settlement "fair and in the best interest of the claimant." In practice, lump sum settlements are usually final, but the law provides for your case to reopen if the Board finds that there has been a change in your condition or degree of disability not contemplated at the time of the settlement.

I have been told that I have reached “maximum medical improvement or MMI. Am I able to receive additional medical treatment?

Yes you may still receive medical treatment. Maximum medical improvement is an opinion of a doctor that you have recovered from your work injury to the greatest extent expected and that your condition is not likely to change. A finding of maximum medical improvement is normally followed by a determination of the permanent disability level of a claimant.

What are medical benefits?

Medical benefits are medical treatment provided under the Workers' Compensation Law to injured workers as a result of injuries arising out of and in the course of their employment.

What is medical treatment?

Medical treatment is medical care administered by a physician or other medical provider.

What does it mean to modify a decision?

When a decision is modified, it partially changes a previous decision from a workers’ compensation judge or board panel decision.

What is a motion calendar hearing?

In a motion calendar hearing where no controversy or outstanding issue exists, the board will prepare a proposed decision and notify the parties. A hearing will be held only if one of the parties objects to the proposed decision.

What is a non-compensated case?

A non-compensated case is a closed case which there was never an award of non-medical benefits.

What is a non-schedule permanent partial disability?

Non-fatal injuries that do not involve schedule permanent partial disabilities or cosmetic facial disfigurement and in which the claimant retains some earning capacity are assigned permanent disability benefits based on the claimant's actual or presumed wage loss, with benefits to continue for the duration of the wage loss disability.

My employer said that I never gave him notice of my injury. I did tell my supervisor. Is that notice?

Yes. Notice is a written notification from you to your employer, indicating that you were injured at work. You must provide notice to your employer must be given no later than 30 days after the accident. You may also speak to your supervisor about your work related injury.

What is an occupational disease?

An occupational disease is a disease arising from employment conditions for workers where the disease occurs as a natural incident for their particular occupations. To be considered an occupational disease, there must be some link between the disease and some distinctive feature of the workers' job.

What is occupational disease, notice and causal relationship?

In order to claim an occupational disease, you must meet certain conditions. Specifically, it must be established that you have a recognized occupational disease and that you have given timely notice of your disease and that there exists a causal relationship between your work-related activities, your exposure and subsequent disability.

What is an occupational illness?

An occupational illness is any abnormal condition or disorder, other than one resulting from an occupational injury, caused by exposure to environmental factors associated with employment; it includes acute and chronic illnesses or diseases which may be caused by inhalation, absorption, ingestion or direct contact.

What is an occupational Injury?

Any injury, such as a fracture, sprain, amputation, etc. - which results from a work accident or other exposure involving a single accident in the work environment.

I am unable to work the hours I used to before I was hurt. My lawyer said that I have a reduced earnings claim. What is a reduced earnings claim?

A reduced earnings claim is a compensation rate based on your partial wage loss or your partial loss of earning capacity because of your medical condition resulting from your work related injury.

My employer said at a hearing that I was “overpaid” benefits. What does that mean?

Your employer or their insurance carrier is notifying the workers’ compensation judge that they have paid you more money than the judge awarded. They are asking for a “credit” against any future awards.

Can my workers’ compensation case be reopened?

Yes. A workers' compensation case that was closed can be reopened to determine your eligibility for further benefits.

I was told that since my injury happened more than 7 years ago and my case has been closed, my benefits would come from the reopened cases fund. What is the fund?

The reopened cases fund was established to assume liability for any additional awards in workers’ compensation cases in which the application to reopen the case occurs more than seven years from the date of injury and more than three years from when your case was closed. The Fund is financed through assessments made periodically against all insurance carriers.

My lawyer filed a request for further action because I was denied medical treatment. What will happen next?

When you file a request for further action, you are asking the board for their help in obtaining medical or economic relief. The board may issue a proposed decision after reviewing your claim or schedule a hearing where the judge may rule on your request.

A decision in my case was rescinded. What does it mean?

A Board Panel issued a decision which voids a Workers' Compensation Law Judge decision. Decisions to rescind are usually issued without prejudice in order to allow the parties to present evidence or testimony not previously presented to a Workers' Compensation Law Judge.
 
What is a review bureau? 
 
A review bureau processes requests for reopening's of closed cases and objections to Workers' Compensation Law Judge decisions.

What is a request for review?

A request for review is essentially a request to have a Board Panel review a Workers' Compensation Law Judge decision. It is similar to an appeal.

What is a permanent partial disability?

Maximum benefit week schedules in the WCL are generally used in determining lifetime benefits for injuries to major body parts. Injuries amounting to less than total functional loss are awarded a percentage of the scheduled weeks, and there are also provisions for additional weeks required for a longer healing period based upon your injury.

I am receiving payment from special funds. What is the special funds?

The special funds is established under the workers’ compensation law to assure continued payments of benefits associated with workers’ compensation claims, usually by transferring all or part of the liability to the Fund.

My company received a stop work order. Can I work anyway?

No. A stop work order means that a business must cease all operations immediately until the Stop Work Order is officially removed. The law states that a business may be issued a stop work order if it does not have workers' compensation coverage in place.

I am told that I will receive symptomatic treatment. What is symptomatic treatment?

Symptomatic treatments are medical treatments aimed at providing relief from the symptoms of a disease or injury, rather than providing a permanent remedy to the underlying condition.

What is a tentative rate?

A tentative rate is a weekly rate assigned by the Workers' Compensation Board for the insurance carrier to pay you indemnity payments, while awaiting the final outcome of the determination of any outstanding issues relating to your final benefit rates.

My lawyer said I have a possible third-party action. Does this mean I can bring a lawsuit for personal injuries?

Yes you may be able to bring a lawsuit. A third-party action refers to lawsuits against any other negligent party, including equipment manufacturers, facility owners and other non-employer parties whose products or services contributed to your accident. Under the workers’ compensation law, you are unable to sue your employer, but lawsuits may be started against third parties for product defects, slippery floors, etc.

What does it mean to have a “total disability?”

Total disability under the workers’ compensation law means that you lack the ability to work in some substantially gainful occupation without serious discomfort or pain and without further injury to your health or danger to life.

What is a trial calendar hearing?

A trial calendar hearing is a hearing on your claim before a workers’ compensation law judge. It is designed to allow the introduction of evidence and/or witnesses and the presentation of arguments by the parties.

If my employer didn’t have workers’ compensation insurance, what can I do?

You may still be eligible for workers’ compensation benefits. The workers’ compensation board has established an “uninsured employers’ fund” which provides for the payment of workers' compensation cases where the employer was not insured nor self-insured and has not paid previously awarded workers' compensation benefits. In some circumstances, you may be able to bring a personal injury lawsuit against your employer for his failure to have workers’ compensation insurance.

I was injured at work when I was 18 and my doctor says I can’t work again. How does the board figure out how much money I will lose?

The workers’ compensation law will assign an artificial wage rate to you or other young claimant, to help determine how much money you would have lost over your lifetime.

What is a waiting period?

For the first 7 days after your injury, lost wage benefits are not available to you unless your disability exceeds 14 days. If your disability from your injury exceeds 14 days, wage benefits are payable from the first day of your disability.

What is the workers' compensation board?

The board is the agency charged with administering the Workers' Compensation Law. The thirteen member Board is responsible for determining all issues involving claims under the WCL. Members are appointed to seven-year terms by the Governor of New York, by and with the advice and consent of the Senate. The Governor designates the Chair and Vice-Chair.

What is a workers’ compensation law judge?

A WCB Judge is appointed by the Chair of the Workers' Compensation Board to hear and determine claims and to conduct such hearings and investigations and make such orders, decisions and determinations as may be required in the adjudication of the claims. A Judge's decision is deemed the decision of the Board unless the Board modifies or rescinds such decision.

I was hurt at work and can’t go back to my job because of my injury. How much money will I receive while I am not working?

Cash benefits are not paid for the first seven days of your inability to return to work, unless your inability extends beyond fourteen days. If you are unable to return to work for more than fourteen days after you were first hurt, you will receive cash from the first work day off of the job. Your medical care will be paid for no matter how short or how long the time of your inability to work.

The cash amount that you will receive is based on your average weekly wage for the previous year. The workers’ compensation board uses the following formula to calculate benefits:
2/3 x average weekly wage x % of disability = weekly benefit
If you were earning $400 per week and you are totally (100%) disabled, you would receive $266.67 per week. If you were partially (50%) disabled, you would receive $133.34 per week. However, your weekly cash benefit cannot exceed the following maximums amounts, which are based on the date of accident:

Schedule of Benefits
Date of Accident Weekly Maximum
Total / Partial
July 1, 1985 - June 30, 1990 $300 / $150
July 1, 1990 - June 30, 1991 $340 / $280
July 1, 1991 - June 30, 1992 $350 / $350
July 1, 1992 - June 30, 2007 $400 / $400
July 1, 2007 - June 30, 2008 $500 / $500
July 1, 2008 - June 30, 2009 $550 / $550
July 1, 2009 - June 30, 2010 $600 / $600