Suffering a workplace injury can leave an employee feeling confused and vulnerable. Many have questions about the New York workers’ compensation program. Injured workers wonder how compensation covered payments get calculated. A workplace injury can quickly throw an employee into a downward financial spiral without money for medical expenses and lost wages. That’s why understanding workers’ compensation payments calculation is so important. How are workers’ compensation costs calculated?
If you want to receive the benefits you deserve, start here. Learn more about the New York workers’ compensation system and how the state calculates compensation payments.
What Are Workers’ Compensation Payments?
New York Workers’ Compensation is a no-fault insurance program that benefits injured individuals. Most New York employers must provide workers’ compensation insurance, which provides injured workers with medical and lost wage benefits.
It doesn’t matter who caused the injury, as long as the accident wasn’t the result of horseplay or intoxication from drugs or alcohol. You’ll still qualify for benefits in most cases, but understanding the workers’ compensation payments calculation process is key. Knowing how much support you can receive while working.
New York workers’ compensation benefits include medical expenses and a portion of an full time employee’s lost wages, including:
- Temporary total disability – Benefits for employees who cannot work or earn an income temporarily, giving them access to partial wage replacement benefits.
- Temporary partial disability – Workers who lost some ability to work and earn an income may be eligible for weekly benefits based on the percentage of disability and their average weekly wages.
- Permanent partial disability – When employees suffer permanent impairment to a part of their body, they may be entitled to PPD benefits outlined in the statute for schedule and non-schedule losses.
- Permanent total disability – Long-term benefits may be available when an individual cannot return to the workforce.
- Survivor benefits – If a job-related accident causes a fatality, weekly cash benefits and funeral or memorial expenses may be available for surviving family members.
These benefits can help financially stabilize an injured worker’s situation. They can focus on recovery from their injuries or illnes without worrying about how they’ll cover daily and medical expenses.
Key Factors That Affect Payment Amounts
You may be entitled to workers’ compensation benefits if you get hurt in New York. However, your compensation can vary depending on several key factors. Issues that affect workers’ compensation payments can include:
- Injury severity – A worker’s injury can significantly impact payments for medical expenses and whether the worker qualifies for additional benefits such as total or partial disability.
- The degree of a worker’s disability – Benefit amounts may also vary depending on an individual’s degree of disability and whether they can return to work in a limited capacity or at all. Disability classifications factor into benefit calculations.
- Scheduled and non-scheduled losses – New York workers’ compensation insurance also offers a schedule of loss of use award, which is an additional cash payment if a workplace injury causes the permanent loss of particular body parts or functions. Non-scheduled benefits involve a permanent disability not covered by an SLU award. Money for these injuries is based on the permanent loss of earning capacity.
- Average weekly wage – New York workers’ compensation wage replacement benefits can also vary based on an individual’s average weekly wage.
- Medical evidence—Seeking immediate treatment for injuries and sticking to a doctor’s treatment plan may also affect workers’ compensation amounts. Without medical documentation of the injuries, an insurance provider can reduce benefits, dispute a claim, or deny it.
To maximize your workers’ compensation claim, you need to know the factors that can affect your benefits and follow your doctor’s medical advice and treatment plan.
How to Calculate Your Workers’ Comp Wage Replacement Benefits
Calculating workers’ compensation wage replacement is relatively straightforward. The New York workers’ compensation system provides a formula that allows individuals to estimate their average weekly wage benefits quickly. In New York, the average weekly wage is based on an individual’s earnings for 52 weeks before the injury date. This wage must be based on workers’ gross earnings, not their take-home pay.
Please read more about VA benefits taxation here: Are Veteran (VA) Benefits Taxable In New York?
Average Weekly Wage
This wage information comes from a worker’s employer. The employer must fill out a form that provides the worker’s total gross pay before taxes and other deductions. Even if an individual worked fewer than 52 weeks in the prior year, the employer must complete the form as completely as possible. Calculations may also require additional salary information from previous employment.
Wage Replacement Calculation
A wage replacement benefit is typically 2/3 of the average weekly wage multiplied by the percentage of disability based on medical evidence. For example, the wage replacement formula for an individual who falls into the classification of temporary partial disability is 2/3 of the average weekly wage multiplied by a temporary total disability benefit of 25 percent if that person is medically considered 25 percent disabled. New York also outlines minimum and maximum weekly benefits, meaning a weekly benefit cannot be less than the minimum benefit amount of $150.00. The weekly benefit cannot exceed the maximum benefit set by the Commissioner of Labor to the Superintendent of Insurance on March 31 of each year.
The state may outline the formula used, but other issues can affect workers’ compensation wage replacement. When an employer agrees to continue paying an injured worker, that individual cannot recover wage replacement from workers’ comp insurance. Depending on the circumstances, if an individual works more than one job for different employers, the person may be entitled to compensation for both salaries.
An Experienced New York Workers’ Compensation Attorney Is Ready to Help
Receiving the workers’ compensation benefits you deserve can be challenging. You need the advice and guidance of an experienced New York workers’ compensation attorney. At Fusco, Brandenstein & Rada, P.C., we help injured workers exercise their legal rights and fight to recover the benefits they deserve. We build solid workers’ compensation claims and negotiate with workers ‘ compensation insurance companies for our clients.
Our team is here to help you understand your rights and take the first step toward securing the necessary benefits. If you need help pursuing the benefits you need, contact our office online or call us at 516-496-0400. We want to set up a free consultation to discuss your situation and help you understand your options.