Generally speaking, New York Sate Workers’ Compensation Benefits are not taxable. There are situations where because you receive combinations of benefits, such as Social Security Benefits and New York State Workers’ Compensation Benefits, that may effectively create a taxable event. If your other form of benefit is reduced by the compensation payment this can in some instances create a tax on the amount of the credited reduction. It is best to consult your tax adviser when considering tax questions.
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Under the New York State Workers’ Compensation Law, (WCL), the injured worker is not directly responsible for the payment of attorneys fees. The law prohibits an attorney from collecting any money from the claimant. All fees for legal services are controlled by the WCL and must be approved by the Workers’ Compensation Board ( WCB ) . When approved, such fees are paid by the insurance provider aka insurance company and the amount of the fee is deducted from the award issued by the Workers’ Compensation Board. The workers’ payment for lost wages are known as indemnity payments and are reduced by the amount of the approved fee. Such fees are usually limited. The customary fee has been limited to between 10 and 20% of the new money presented in the award notice. The award notice is the formal written decision of the WCB publishing the decision of the trier of fact who is authorized to render a formal decision on the case before the WCB. Fees are not approved for indemnity payments voluntarily made by the insurance provider. The fees are calculated on new money approved in the board decision. In some situations, an attorneys’ fee can be deducted from reimbursements represented in an award of moneys going back to the employer for advance payments of compensation. ( see formal disclaimer in prior blogs).
Under the New York Workers’ Compensation system , injured employees causally related medical care is controlled by various sections of the New York Workers’ Compensation Law , ( WCL). Generally speaking, such care is not the responsibility of the injured worker but rather the responsibility of the employers’ workers’ compensation insurance provider. If the employer fails to obtain or maintain such coverage, the WCL created a fund to cover such treatment responsibilities as well as indemnity issues. This Fund is known as the Uninsured Employers Fund.
There are no deductibles nor co-payments by workers nor anyone else. If the procedure or treatment has been properly provided or properly requested and complies with the WCL the injured worker is exempt from any financial obligation in respect to such care. If the provision of such causally related healthcare fails to meet the standards and procedures for obtaining payment to the health care provider; such care is not the responsibility of the injured worker. The claimant /worker is exempt from any financial responsibly for same. It is illegal for a provider of such causally related care to request or compel payment from the patient.
The real issue has become more vexing since the creation of the newest Medical Treatment Guidelines effective 12/1/2010. These regulation and practices have been promulgated with the stated intent to quicken the process for obtaining medical care under the WCL. At the present time, delays seem to have been created and questions remain regarding these Guidelines and their interpretation as well as authority. The New York State Legislature is presently, reviewing laws on these issues. We’ll see what develops. Further commentary will follow in later blogs.
As always, note my disclaimer, these discussions are merely just that, a discussion and not formal legal advise which should be conducted in a face to face retainer relationship with an attorney or legal representative and would be fact and law sensitive to each separate case presented.
A WISC ( Walk in stipulation calendar) is a special agreement whereby the parties to a compensation case can resolve issues on any part of a New York State Workers’ Compensation case. They require a formal written stipulation where the parties to the claim formally agree to a result on any part of or on the full case. The matters contained in the agreement becomes effective and formal upon approval by the Workers’ Compensation Board, (WCB) . No party can compel the other to accept such an agreement unilaterally but, once obtained, this device is used to expedite a formal decision of the WCB. The WISC devise was created to permit fast resolutions of limited issues not requiring full development of a record and is limited to the four corners of the written agreement. Because it is a “mutual understanding” the WCB tries to permit quick calendar action for these agreements. The contents of such an agreement usually covers treatment, loss of time, permanency, disability, salary disputes monetary awards or any item normally contained in a case without the need for detailed discussion, presentation of evidence or argument. It is just that, a stipulation containing those areas where the parties can agree. Once published by the WCB it becomes legally binding on the parties to the agreement.
( As stated throughout these blog discussions; they are provided for educative and informative purposes and are not intended to be a substitute for formal legal advise on a specific issue or state of facts and should be reviewed in a formal legal relationship with an attorney or legal representative. The discussions as presented do not create a formal attorney client relationship. All situations vary and are usually fact and law dependent which also may vary or be effected by the law in existence at the time of the occurrence. )
A Comp ( Workers’ Compensation) Hearing is a statutory right whereby a claim for benefits from an on the job injury or occupational disability is presented. The nature of the ” Hearing” has in recent times been under attack. Traditionally, a hearing has been the presentation “in person” before a trier of fact, usually a law judge but not always with a presentation of the claim through documentation and/or oral evidence. All parties to the claim have the right to representation by someone who will promote their interpretation of the facts and issues. The workers’ compensation board (WCB) has issued various policy statements as to what constitutes the elements necessary before a formal hearing can be scheduled. In short form, the preliminary elements required are the filing of a formal written claim known as a c-3. The filing of medical reports most commonly known as a c-4 with an opinion from the health provider alleging that the condition presented was caused by a work situation and the filing by the employer usually by submitting a form known as a c-2 containing the employers’ information, if any, about the claim . This should be followed by a formal employer position document or response in the form of a c-6, c-7 or c-9. Not all claims require continued involvement by “a trier of fact” unless a dispute over the compensability of the claim or further treatment is questioned. Employers and their insurance carriers may make voluntary payments regardless but, the claimants rights are not formally protected by the full scope of the Workers’ Compensation Law (WCL) until formally established by a written finding known as a decision of the WCB. In cases where continuing claims are presented; the case is set for presentation of the claim subject to the Workers’ Compensation Law (WCL) as well as the rules and regulations of the WCB.
As stated in this blog previously, a full and complete discussion regarding a specific case or your rights concerning a specific fact pattern should be conducted in person with a representative so that it can be fully evaluated. This blogg is merely presented as general information and can not be considered a formal legal opinion on any specific case.
Generally yes but; the Workers’ Compensation Law prohibits any agreement to release a claimant’s rights under the New York State Workers’ Compensation Law ( WCL) unless approved by court order, (i.e., a decision of the Workers’ Compensation Board.) Therefore, any agreement concerning the nature and scope as well as benefits available or applicable emanating from a job related injury, occupational disease etc, written or otherwise, between an employer or their insurance company and an individual worker whether disabled or not, without formal acceptance through a written decision of the Workers’ Compensation Board is ineffective, illegal and can not be enforced. The Compensation Law permits settlements known as section 32 Agreements and Wisc settlements. These are formal agreements presented to the Workers’ Compensation Board (WCB) which when approved, can become binding on all parties subject to the specific limitations and rules found in the law. Agreements entered into between individuals and their companies outside of the compensation law may be binding in other forums for example under the terms of a union negotiated benefit or a third party action but will not limit the workers’ rights and enforcement under the authority of the WCL until and unless it is approved by the WCB.
Workers’ Compensation in New York State is mandatory insurance coverage for most workers. With few exceptions, any worker who is injured, disabled or effected by their work environment is protected by this coverage. Such protection involves medical treatment and indemnity payments for lost wages. In some cases, in addition to lost time from work, indemnity payments may also apply for permanent limitations known as schedule loss of use with court directed awards for same. In other cases, permanency my entitle such workers to continuing medical payments and treatment with further awards for continuing loss of wages or reduced earnings subject to law changes and applications dependent upon the date of the accident. Rates for losses and limitations are subject to case law, statutory law and their interpretations. It is usually best to consult a lawyer about your specific issue for individual applications that effect your injury or problem.
This will be a forum for discussion of Workers’ Compensation Issues. We all await oral argument before the New York State Court of Appeals on pressing issues. We are also looking forward to answers to questions that have been caused by the recently issued December 1, 2010 Medical Treatment Guidelines. Possibly, the New York State Legislature will resolve some of these questions. We expect injured workers with permanent disabilities to have their treament rights protected and will see what the court does on this issue. This will undoubtably effect long island workers, suffolk county residents and all disabled workers. Doctors and treatment by various practitioners including chiropractors, physical therapists and orthopedics have been limited by the present position of the Workers’ Compensation Board and its many recent decisons. Hopefully there will be an end to speculation. We would all like to know , that condions and agreements entered into before the recent changes to the Medical Treatment Guideline are not eliminated or changed by permitting a retroactive application of the new Guidelines.
I would like to thank you for stopping by here at Eliot S. Levine & Associates we are just starting up our blog. This blog will offer Q & A information in regards to New York State Workers’ Compensation.
Besides handling New York State Workers’ Compensation matters, please be advised that we also provide services for Social Security Disability, New York State Retirement, and Accidents.