NY Workers’ Comp – The Employer & Insurance Carrier

NY Workers’ Comp – The Employer & Insurance Carrier


In the first two videos, we learned that the rules governing the New York Workers’ Compensation system attempt to be fair to injured workers, employers and insurance carriers alike. Now, we’re going to speak a little about the rights and responsibilities of employers and carriers. All employers in New York have to purchase Workers’ Compensation insurance for their employees. There are plenty of companies willing to provide coverage in hopes of making a profit. But when an insurance company agrees to supply compensation insurance, they must abide by the New York Medical Treatment Guidelines. That’s the list of tools available to doctors to diagnose and treat work-related injuries. According to these guidelines, doctors don’t need to ask permission to order an MRI, send an injured worker to physical therapy, or write a prescription for a pain reliever. By law, the insurance carrier has agreed to provide these and many other things. They are not allowed to interfere by requiring special permission. However, there are limits. Doctors can’t order therapy to go on forever, write excessive medications or order unnecessary tests. And there are a few treatments that aren’t allowed, or for which doctors must first ask permission before providing them. But the guidelines make it easier for injured workers to receive the medical care they need without too much hassle, while allowing the insurance carriers some protection from overtreatment. As for employers, it’s important to remember that your employer hired you because they need you to do a particular job. A business can’t be successful if they hire folks for no reason. So if you’re hurt and can’t do your job, your employer is struggling too. They want you back. Some employers can afford to provide restricted duty; sometimes they can only afford a few months, but many employers feel it’s better to have you there doing something, than at home doing nothing. Some employers can’t afford to offer light duty, or perhaps only have a few light duty positions available. Regardless, the law says it’s the employer’s choice to offer restricted duty or not. Remember, the insurance carrier is only responsible for the liability equivalent to your degree of disability. Generally, your employer is responsible for the rest. There is a formula for an injured worker’s wages for which the insurance company is responsible. The weekly New York Workers’ Compensation benefit equals two-thirds the average weekly wage times the percentage of disability. If an employer can’t afford to offer light duty, they are most likely obligated to provide unemployment benefits to supplement what the insurance carrier has to pay for lost wages due to disability. Somehow, the employer must generally offer the rest, either through restricted duty or unemployment benefits. Although imperfect, this means that the insurance carrier, employer and you, the injured worker, are treated as fairly as possible.

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