Every day people are injured while working in the course of their employment in the state of New York. The workers’ compensation system allows for people who are injured on the job to seek financial compensation for the wages they lose due to lost time resulting from work-related injuries. In general, when a person is injured while working, if the claim is determined to be causally related to an individual’s employment, a person will receive weekly indemnity benefits that are based upon that person’s average weekly wage (AWW).
The Role of Average Weekly Wage.
The amount of an injured person’s indemnity benefit will be based upon that person’s AWW and the degree of his or her injury. In some instances, a person will suffer a permanent injury to one of his or her extremities that may forever affect the use of that extremity and in turn diminish the use of that extremity. Under New York’s Workers’ Compensation Law a person may be entitled to a quantified amount of money as compensation for the permanent loss of use in one or more of his or her extremities; such as award is called a Schedule Loss of Use or SLU award.
If a person suffers a quantifiable permanent loss of use to one or more of her extremities such as her: arms, legs, hands, feet, fingers, eyes, and/or toes they may be entitled to a SLU award. In order for a SLU award determination to be analyzed and rendered, the issues involved in the injured person’s workers’ compensation claim must have been fully litigated and the injury or injuries must have reached maximum medical improvement.
Maximum Medical Improvement (MMI)
In order for maximum medical improvement to be reached, the doctor’s evaluating the person must make the determination that the injury will no longer continue to improve despite future medical care and/or intervention and that permanency regarding the injury has been reached. Doctors should base their Schedule Loss of Use determinations on the information that is contained in the Guidelines For Determining Permanent Impairment. These guidelines are very specific and doctors are required to use them when determining the percentage of loss of use.
Once permanency is reached the degree of the injured person’s Schedule Loss of Use is determined based upon medical evidence and is either agreed upon by the parties to the claim or determined by a workers’ compensation law judge in the form of a Schedule Loss of Use award. Once the degree of disability is determined the percentage of disability is applied to a schedule that was established in New York Workers’ Compensation Law which categorizes and identifies the number of weeks that an injured person is entitled to benefits based upon his or her degree of disability minus the amount of indemnity payments already received on the injury.
For instance, the maximum SLU award for 100% loss of use of a hand equals 244 weeks of benefits at the total disability benefit rate. If it is determined that a worker has suffered a 35% loss of use to her hand as a result of a work related injury she would be entitled to 85.4 weeks of compensation benefits based upon the schedule at the claimant’s total degree of disability benefit, minus any prior indemnity payments already received from the insurance carrier.
- A claimant injures her left hand.
- New York Workers’ Compensation law allows for a maximum of 244 weeks of benefits for a 100% or total loss of use of a hand.
- The claimant is found to have a 35% SLU of her left hand.
- According to the schedule, a 35% SLU of a left hand entitles a claimant to 85.4 weeks of benefits at the total rate.
- The claimant had a pre-injury average weekly wage (AWW) of $800. Two-thirds (2/3rds) of her AWW is her temporary total rate, equaling $533.33.
- Therefore, the claimant would be entitled to 85.4 weeks of benefits at the benefit rate of $533.33 totaling $45,546.38, which would constitute the SLU award paid to the claimant.
- The insurance carrier or self-insured employer may take credit for prior indemnity benefits already paid to the claimant.
Generally, once a SLU award is made the indemnity portion of the case is closed. However, in certain circumstances the case may be re-opened in the future if the injury worsens over time and the claimant can seek an additional indemnity award/increased Schedule Loss of Use award. It is important to note, following a Schedule Loss of Use award the carrier remains liable for all causally related medical treatment.
Join In the Learning!
The New York Handbook
Our webinar series was designed as a complement to our New York Workers’ Compensation Handbook. The Handbook is written in “plain English” and provides a resource for risk managers and claims professionals who need a complete and easy-to-use reference guide for handling New Jersey claims.
Digital editions of our book on New York workers’ compensation defense are available for download (FREE) here:
New York PDF link: bit.ly/nywcpdf
New York ePUB link: bit.ly/nywcepub
New York Kindle link bit.ly/nywckindle