Support / Frequently Asked Questions

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Disability Benefits Claim Information
Workers' Compensation Claims
  If an employee returns to work on light duty, is an employer required to pay him/her the same wages earned prior to the injury?
  In the state of New York, are employees who have a compensable (work-related) injury reimbursed for lost time due to visits to the doctor, physical therapy or Workers' Compensation hearings?
  Are Return-to-Work forms (C-11) required when there is lost time due to the same injury, subsequent to their original return to work date?
  How is the compensation benefit rate calculated?
  To what advantage is it for W. J. COX ASSOCIATES, INC. to review medical bills on first-aid and self-pay claims?
  How should an employer handle a questionable injury?
  What constitutes a work-related injury?
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Q: If an employee returns to work on light duty, is an employer required to pay him/her the same wages earned prior to the injury?

A: No. Please remember that the object of bringing back an injured worker on light duty is hopefully to ease them back into the routine of work when they cannot immediately resume full duty. If you bring the injured worker back at light duty and that individual works a full day, in order not to create a claim for reduced earnings, the same wages earned prior to the injury should be paid. This would be suggested in those cases where light duty is required for a short duration.


Q: In the state of New York, are employees who have a compensable (work-related) injury reimbursed for lost time due to visits to the doctor, physical therapy or Workers' Compensation hearings?

A: No. In New York State benefits are not payable for lost time due to appointments with doctors, therapists or hearings. Employees should be encouraged to arrange appointments towards the end of the workday so that they don't lose time from work and you don't lose work hours.


Q: Are Return-to-Work forms (C-11) required when there is lost time due to the same injury, subsequent to their original return to work date?

A: Yes. The C-11 (Notice of Return-to-Work) is used to report a return to work for an injured worker when the return date is not known at the time of completion of the C-2. A C-11 also reports any additional lost time the injured worker may have from that same injury subsequent to the original return to work date. In addition, the C-11 also reports changes in employment status due to the injury, such as light duty, part-time or a change in wages.


Q: How is the compensation benefit rate calculated?

A: The average weekly wage (AWW) is determined by the C-240 (Wage Statement) that you complete. There are a couple of ways to compute the AWW, depending on the number of days worked for a year for each individual, a straight divisor (number of weeks worked), or a multiple (200, 260 or 300).  The maximum compensation benefit rate is 66 2/3 of the AWW subject to the following dates:

$739.83 for accidents or deaths on and after 7/1/2010
$772.96 for accidents of deaths on and after 7/1/2011

Two-thirds of the New York State AWW for accidents or deaths on and after 7/1/2010, reindexed to the New York State AWW annually on 7/1/XXXX thereafter.


Q: To what advantage is it for W. J. COX ASSOCIATES, INC. to review medical bills on first-aid and self-pay claims?

A: Two-fold. First, to make sure the services provided are causally related to the work injury and second, many times providers bill at the commercial rates and charges should be adjusted to the Workers' Compensation Fee Schedule rates.


Q: How should an employer handle a questionable injury?

A: Call us immediately before you complete any forms.


Q: What constitutes a work-related injury?

A: It is an incident that arises out of and in the course of employment. It could also include repetitive type injuries, something that happened over a period of time. Situations that arise as a direct result of horseplay or disciplinary problems generally are not considered "out of employment" if the employees are warned to cease activities and the employer does not permit these actions (employer here also means foreman, supervisor, etc). If the activities are allowed to continue with no reprimands or warnings from you the employer, they can be found to be work related.

Support

W. J. Cox Associates, Inc.
9600 Main St, Suite Three
Clarence, NY 14031-2093

Phone: (716) 759-9606
Fax (716) 759-9607
info@wjcox.com

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