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Workers' Compensation Board

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Volunteer Firefighters
Workers' Compensation Benefits


Overview

The Volunteer Firefighters' Benefits Law provides for cash benefits and/or medical care to volunteer firefighters who are injured or become ill in the line of duty.

The local political subdivision pays for this insurance, and cannot require the volunteer firefighter to contribute to the cost of coverage. Weekly cash benefits and medical care are paid by the subdivision's insurance carrier, in accordance with the law. The Workers' Compensation Board is a New York State agency that administers the laws and resolves disputes

A volunteer firefighter loses his/her right to benefits if the injury results solely from his/her intoxication from alcohol or drugs, or from the intent to injure him/herself or someone else.


Eligibility

Workers' compensation insurance provides medical care and/or cash benefits if:

  • You are a New York State volunteer firefighter and are an active volunteer member of a fire company of a county, city, town, village or fire district and are injured
    in the line of duty
    .
  • You volunteered to participate in the rescue, recovery and cleanup of the
    World Trade Center (WTC)
    , between 9/11/2001 and 9/12/2002 and incurred lost wages and/or health related problems due your volunteer work at the following locations: Ground Zero; Fresh Kills Landfill; the barges; the piers; and the morgues.
  • You are a spouse or
    dependent
    of a volunteer firefighter who passed away in the line of duty or due to an existing compensable injury or illness.

Dependent children under age 18, or under age 25 if enrolled in an accredited educational institution (or other dependents as defined by law)


How to File a Claim

File a Claim with the Workers' Compensation Board

Mail your completed form to the Board at: PO Box 5205, Binghamton, NY, 13902-5205

If you have questions about filing a Volunteer Firefighter's Claim for Benefits (Form VF-3), please call (877) 632-4996 and a Board representative will assist you.

You must notify one of the following within 90 days of the injury

  • Clerk of the board of supervisors of the county
  • Town or village clerk
  • Secretary of the fire district or company
  • Comptroller or chief financial officer of the city

Whenever a volunteer member offers individual service to another company in New York State, but outside the area regularly served by the member's company or district, and after such services are accepted by the officer in command at the scene, the responsibility for benefits resulting from an injury in the line of duty will be that of the fire or ambulance company (and its political subdivision) which has accepted such voluntary service.

You may use Notice to Liable Political Subdivision of Volunteer Firefighter's Injury or Death (Form VF-1) adobe pdf for the notification:

A complete list of forms for Volunteer Firefighters are available on the Workers' Compensation Forms for Volunteer Firefighters and Volunteer Ambulance Workers page.

Deadline for filing

Claims must be filed within two years of an accident or two years from the date a death occurs.


Benefits

Cash Benefits

You are eligible for benefits when your volunteer company responds as a unit, whether the injury occurred while serving the home or providing aid to another area.

  • Total disability, schedule loss of use and death benefits are fixed.
  • Weekly benefits for other types of injuries are determined based on your wage earning capacity.
    • Every volunteer member is considered to have an earning capacity. The Board considers the work that you could reasonably be expected to obtain based on your age, education, training and experience to determine a reasonable wage earning capacity.

Benefits are payable from the first day of disability, with no waiting period. Necessary medical care is provided without regard to length of the disability.

The amount of the weekly cash benefit will depend on whether the disability is temporary or permanent, and the loss of the volunteer's earning capacity, which is his or her disability.

Disability Classifications

Your health care provider will give you an opinion on the extent of your disability. Cash benefits are directly related to these disability classifications:

Permanent Total Disability: Your earning capacity is permanently and totally lost.

The weekly cash benefits for all volunteer firefighters with a permanent total disability, regardless of the date of accident, is $600 for benefit payment periods beginning on January 1, 2017. For benefit periods between January 1, 1999, and December 31, 2016, the weekly benefit is $400.

Temporary Total Disability: Your earning capacity is totally lost but only on a temporary basis.

The weekly cash benefit for volunteers with a temporary total disability, who were injured or became ill on or after July 1, 1992, is $400.

Temporary Partial Disability: Your earning capacity is partially lost, but only on a temporary basis.

Permanent Partial Disability: Part of your earning capacity has been permanently lost.

The weekly cash benefits for all volunteer firefighters found to have a temporary or permanent partial disability, who are injured or became ill on or after July 1, 1992 are set forth in the table below.

Temporary or Permanent Partial Disability
Loss of Earning Capacity Weekly Benefit
75 percent or Greater $400
Between 50 and 75 percent $268
Between 25 and 50 percent $30
Less than 25 percent No cash benefit

Schedule Loss: This is a special category of Permanent Partial Disability, and involves loss of eyesight or hearing, loss of a part of the body or its use. Compensation is limited to a certain number of weeks, according to a schedule set by law. For instance, 25 percent loss of use of an arm is equal to 78 weeks (1/4 of 312 weeks). Understanding your Schedule Loss of Use adobe pdf

Disfigurement: Serious and permanent disfigurement to the face, head or neck may entitle you to compensation up to a maximum of $20,000.

Death Benefits

If a volunteer firefighter dies from a compensable injury, the surviving spouse is entitled to continuing weekly cash benefits. Dependent children under age 18, or under age 25 if enrolled in an accredited educational institution (or other dependents as defined by law), are also entitled to weekly cash benefits. In no instance may the weekly benefit amount exceed the legal maximum, regardless of the number of dependents.

Surviving Spouse and Dependent Children Cash Benefits

Surviving Spouse and Dependent Children Cash Benefits
Marital Status / Dependent Status Cash Benefits
Not remarried - no dependent children $887 weekly cash benefit
Not remarried - with dependent children Smaller weekly cash benefit. Children also entitled to weekly cash benefits.
Remarried - no dependent children $92,219 Lump Sum Benefit
Remarried - with dependent children. Surviving spouse receives a smaller lump sum benefit. Children continue to receive weekly cash benefits.

Funeral Expenses

Funeral expenses for volunteer members are payable up to a maximum amount of $6,700. However, if a volunteer firefighter dies from injuries received in the line of duty as the direct result of firefighting, the $6,700 maximum is not applicable.

Lump Sum Benefit

A lump sum benefit of $56,000 is paid to the surviving spouse, or to the estate if there is no surviving spouse. The funeral expense and lump sum benefits are in addition to all other benefits provided.

If a beneficiary claiming death benefits as a dependent or spouse of a volunteer member dies before a determination in the beneficiary's favor is made on the claim, all weekly benefits due from the date of death of the volunteer member up to the date of death of the eligible beneficiary will be paid to the executor or administrator of the beneficiary's estate.

In the event of death or disability due to disease or malfunction of the heart or coronary arteries, the claim must be decided within 90 days from the time the Board receives the claim.


Medical Care

All medical care for your injury or illness is paid for by your political subdivision's insurer. This care is covered whether or not you lose time from work. It is also paid in addition to any benefits for missed wages.

Health care providers must be authorized by the Board. You can find a doctor on the Board's website, or by calling (800) 781-2362. You may receive care from any of these providers or from your own doctor if he or she is authorized.

The provider will send the bills directly to the insurer and the Board. You are not to pay any bills unless the Board disallows your claim. If specific medical services are disputed, the insurer must pay any undisputed portion. It must also explain in writing why the services were not paid, and request any information needed to pay them.

Your doctors may ask you to sign a Notice that You May Be Responsible for Medical Costs in the Event of Failure to Prosecute, or if Compensation Claim is Disallowed, or if Agreement Pursuant to WCL 32 is Approved (Form A-9) adobe pdf. This states that you will pay the bills if the Board disallows the claim, or if you drop the claim before it is accepted.

Medical Treatment Guidelines

The Workers' Compensation Board has Medical Treatment Guidelines that health care providers are required to use when treating certain injuries.

These guidelines allow the health care provider to perform much of your treatment without needing to ask the insurer for authorization. However, your health care provider may still need to ask for authorization before performing certain tests or procedures.

If you or your health care provider receives a notice that a treatment authorization has been denied, you should read the notice carefully. You or your health care provider may be able to request a review of the denial, giving you the opportunity to present evidence to the Board. The Board will then determine whether the treatment should be authorized.

Preferred Provider Organizations

The workers' compensation insurance carrier or local political subdivision may use a network of providers, known as a Preferred Provider Organization (PPO), to care for its members. You can choose to opt-out of the PPO provider network by notifying the workers' compensation insurance carrier or your local political subdivision in writing (simple letter specifying your intent to opt-out of the PPO network). You will need to wait 30 days after the initial visit to the PPO provider to seek treatment from your desired provider. The workers' compensation insurance carrier or local political subdivision has the right to require that you seek a second opinion from another PPO provider.

Diagnostic Tests

The workers' compensation insurance carrier or local political subdivision will send you a Notice That Claimant Must Arrange for Diagnostic Tests & Examinations through a Network Provider (Form DT-1) if you are required to use a specific network provider for diagnostic tests. You should inform your health care provider(s) that the insurer has this requirement.

The insurer cannot demand that you use a network provider for a diagnostic test in a medical emergency. It cannot demand that you use a network that does not have a provider or facility within a reasonable distance from your home or employment.

Pharmacy Charges

You can use any pharmacy, unless the workers' compensation insurance carrier or local political subdivision uses an independent pharmacy, pharmacy network or Pharmacy Benefit Manager (PBM).

You should let the pharmacist know that you have a workers' compensation case. Many pharmacists will bill the insurer directly; however, the pharmacy can ask for payment of the prescription up front. If you pay for the prescription, the pharmacy can only charge the amount specified by law. You are not responsible for a co-payment (co-pay).

If a workers' compensation insurance carrier or local political subdivision uses an independent pharmacy, pharmacy network or PBM, the pharmacy should be within a reasonable distance from your home or employment, or offer mail order service. The workers' compensation insurance carrier or local political subdivision must notify you, in writing, which local pharmacies you can use along with their locations and addresses. It must also tell you how to fill and refill prescriptions through the mail, internet, telephone or other means.

When there is a medical emergency and it is not reasonably possible to obtain the medicine you need immediately from the pharmacies in the chosen network, you can purchase the drugs elsewhere.

Network pharmacies are paid directly. You are not responsible for any charges.

Opioid Pain Medications

If you are prescribed opioid pain medications such as OxyContin, Percocet and Vicodin, among others, you should know that these medications have serious side effects, can reduce your ability to function and are highly addictive.

Continued use of opioid pain medication causes changes in the brain and results in the need for higher dosages to obtain the same level of pain relief (called tolerance). Additionally, continued use of opioids can cause increased sensitivity to pain, and may even make the pain worse.

Some common side effects of opioid use include: drowsiness, severe sedation, dizziness, nausea, vomiting, constipation, confusion and memory loss. Severe side effects can include difficulty breathing, overdose and death. Uncomfortable withdrawal symptoms may occur when opioids are reduced or stopped suddenly (called dependence). Normal day-to-day functioning may become difficult. Cravings for opioids may be uncontrollable, which can lead to use of other drugs and behaviors harmful to oneself or others (called addiction). If there are concerns that opioids are harming you or your loved one, don't hesitate to get help.

Where to get help

  • Primary care physician: Patients (and/or family members) should first discuss concerns with their physician. He or she can recommend the right specialist.
  • For more information, visit the OASAS website.

Workers' compensation insurance will pay for treatment if it is recommended by a judge or approved by your workers' compensation insurance carrier.


Rehabilitation and Social Services

Rehabilitation is a program offering special services designed to: eliminate the disability, if that is possible, or to reduce or alleviate the disability to the greatest degree possible; help an injured worker to return to work when possible; or to aid the person with a residual disability to live and work at his/her maximum capability. The Board's Rehabilitation staff includes Vocational Rehabilitation Counselors, social workers, and claims examiners to coordinate and follow-up on medical and vocational rehabilitation services. Rehabilitation is voluntary except in limited circumstances, it is mandatory under WCL §15.3(v), i.e., 50% or greater scheduled loss of use. Injured workers should contact the Rehabilitation Unit at the Board if they have any questions about rehabilitation

There are four general types of services offered:

  • Vocational Rehabilitation programs for those who, because of their disability, cannot return to their former jobs. These services may provide guidance to help the claimant determine the best way to return to work.
  • Selective Placement programs for those claimants who are left with a permanent disability, and who need a job that will fit their abilities.
  • Medical Rehabilitation programs include exercise and muscle conditioning, under the supervision of a physician, to restore a person to maximum usefulness. Only a physician may recommend a medical rehabilitation program.
  • Social Services provide a staff of social workers to assist an injured worker with a family or financial problem that is interfering with the rehabilitation.

Claimants who are participating in one of the rehabilitation programs continue to receive cash benefits based on the extent of the disability. Claimants who return to work but cannot earn the same wages because of an injury may be entitled to compensation benefits at a reduced rate.


What Is and IS NOT "in the line of duty"?

What is "in the line of duty"?

Any of the following activities, pursuant to orders/authorization:

  • Participation at a fire, alarm of fire, hazardous material incident, or other emergency situation that triggers response by the fire company or its units;
  • Travel to, from and during fires or other calls to which the company responds; travel in connection with other authorized activities;
  • Some duties in the firehouse, such as construction, repair, maintenance and inspection;
  • Inspection of property for fire hazards or other dangerous conditions;
  • Fire prevention activities;
  • Attendance at fire instructions or fire school; instruction at training;
  • Participation in authorized drills, parades, funerals, inspections/reviews, tournaments, contests or public exhibitions conducted for firefighters;
  • Attendance at a convention or conference as an authorized delegate;
  • Work on or testing of fire apparatus/equipment, fire alarm systems and fire cisterns;
  • Meetings of the fire company;
  • Pumping water or other substances from a basement or building;
  • Inspection of fire fighting vehicles and apparatus prior to delivery under a contract or purchase, or performing duties related to the delivery;
  • Response to a call for general ambulance service by a member of an authorized emergency rescue and first aid squad;
  • Participation in a supervised physical fitness class; or
  • Fundraising activities (non-competitive events).

What is NOT "in the line of duty?"

  • Participation, including practice, in any recreational or social activity, other than noncompetitive fundraising activities;
  • Work rendered in the service of a private employer; public corporation or special district;
  • Work rendered while on leave of absence or suspended from duty, or work that the volunteer has been ordered not to perform; or
  • Competitive events in which volunteer members are competitors, such as baseball, basketball, football, bowling, tugs of war, donkey baseball, donkey basketball, boxing, wrestling, contests between bands or drum corps, or other competitive events in which volunteer members are competitors and which involve physical exertion on the part of the competitors.

Next Steps

If your case is disputed, the Board will notify you regarding resolving the case and may request additional information if necessary.

Hearings and Appeals

Insurers will often accept a claim and promptly begin paying benefits. However, an insurer can dispute a claim for various reasons. It may not agree that you were injured, it may not believe the injury occurred while it provided insurance, or any number of other situations. Board claims examiners and conciliators first attempt to resolve issues. If they can't, the Board will hold hearings in front of a workers' compensation law judge. The judge takes testimony and reviews your medical records and wages. The judge then decides the issue, and sets the amount of any award.

Either side may appeal the judge's decision. This must be done in writing within 30 days of the decision. Three Board members review appealed cases. They may agree, change part of a decision or reject it. They may also return the case for more hearings. Insurers don't have to pay lost wage benefits while the case is being reviewed by the three Board members. An insurer can accept part of a case and appeal another. In that instance, it must pay the accepted part of the award while the case is reviewed. The insurer must pay your wages and medical bills if your award is upheld by those Board members, even if it appeals the case further.

Either side may appeal that decision to the full Board of workers' compensation members. If the full Board takes the case, it will either agree, change or overturn the decision.

Appeals from Board decisions may be taken within 30 days to the Appellate Division, Third Department, Supreme Court of the State of New York.

You always have the right to an attorney or licensed representative, who may not ask for or accept a fee. The legal fee is determined by the Board and deducted from a compensation award.

Section 32 Waiver Agreements

A Section 32 Waiver Agreement is

  • an agreement between an injured worker and the insurance carrier
  • used to settle indemnity and/or medical benefits on a claim
  • ends the right of an injured worker to receive future benefits in exchange for a final lump-sum settlement
  • is not final and binding unless it is approved by the Workers' Compensation Board

Learn more about Section 32 Waiver Agreements.

Voluntary Binding Review (VBR)

When there is a request for administrative review and the claimant is represented, parties may wish to explore participation in the Voluntary Binding Review program.


Protecting Your Privacy

New York State Workers' Compensation Board case records are private documents. Under workers' compensation law, only the parties to a claim may receive information from that claim's case file. Beyond the claimant and the claimant's attorney or representative, the following parties may see information:

  • employer and employer's attorney.
  • employer's workers' compensation insurer and its attorney.

The insurance carrier may share information with the health care provider hired to do a medical examination. The health care provider will share medical information with the insurer when billing for services.

Claim information may also be shared with anyone who obtains a court order authorizing access. This information may also be shared with government entities if they are processing a claim for benefits or investigating fraud. No one may disclose information to anyone who is not authorized to see it.

Written permission may be provided to allow someone access to your claim information by filing either:

Written permission may be submitted at any time. It is always helpful to share a copy of that document with the person authorized to see your records. Some people authorize their spouse or child to access their records when initially filing for benefits.

Prospective employers may not ask about a prospective employee's workers' compensation claims before hiring him or her, or in connection with assessing fitness or capability of employment.


Injured in the Line of Duty

Contact

Phone: (877)-632-4996  –  Monday-Friday 8:30 a.m. - 4:30 p.m.

email: general_information@wcb.ny.gov