Workers´┐Ż Compensation Insurance: Benefits

Benefits

Workers' compensation benefits include

Income Replacement

An employee will receive up to two-thirds of his or her average weekly salary, but no more than the maximum benefits set by the New York State Workers' Compensation Board, based on 2/3 of the average weekly wage in New York.

The average weekly salary is based on payroll records for the year prior to the date of injury or illness.

Medical Expense Coverage

The injured employee who is eligible for workers' compensation is entitled to all necessary medical care as the nature of the injury or the process of recovery may require (see the workers' compensation brochure referenced at the end of this document for more information).

Permanent Partial Disability

An employee may receive compensation as the result of a permanent partial disability, such as loss of eyesight or hearing, or loss of a member of the body or its use.

Compensation is limited to a certain number of weeks, according to a schedule set by law.

When Benefits Begin

Income Replacement

If the employee's work-related injury or illness results in more than a 7-consecutive-calendar-day absence from work, income replacement benefits begin on the 8th day.

If the injury exceeds 14 consecutive days, the 7-day waiting period is waived and income replacement benefits are paid from the first day the employee was unable to work.

Medical Expenses

Medical expense benefits are paid from the first day the employee has a work-related illness or injury.

When Benefits End

Income Replacement Benefits

Workers' compensation income replacement benefits end when the employee is no longer disabled and his or her physician approves a return to work. They may also end when a benefits maximum is reached for injuries or illnesses.

Medical Expenses

Medical expense coverage is on-going for as long as recovery from the injury or illness requires.

Continuation of Health Benefits

Operating locations must notify central office when an employee terminates from the Research Foundation payroll as a result of a workers' compensation injury or illness. Central office will ensure that the employee's health-related benefits remain in an active status.

If an employee who is totally disabled as the result of a workers' compensation illness or injury terminates from the Research Foundation payroll, the health-related benefits in effect at the time of the disability will continue for the length of time he or she is receiving income replacement benefits or until age 65, whichever comes first.

If an employee is receiving workers' compensation benefits for a total disability at age 65, the employee may be eligible for continuation of health insurance as a retiree.

Payment of Claims

Income Replacement

Workers' compensation income replacement payments are made directly to the employee by the insurance company.

Medical Expenses

Expenses for medical treatment will be paid by the insurance company to the provider of the services.

References

Workers' compensation information is available from the New York State Workers' Compensation Board, Office of Administrative Management Publications Unit, 20 Park Street, Albany, NY 12207. Contact the Workers' Compensation Board at 518-474-6670, or fax your request to 518-473-1415.

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