You are entitled to a portion of your lost wages, which must be paid promptly, if your injury or illness affects you in one or more of the following ways:
- It keeps you from work for more than seven days.
- Your pay is reduced because you now work fewer hours or do other work.
When are Lost Wage Benefits Paid?
If you are totally or partially disabled and unable to work for more than seven days, you may receive lost wage benefits. Necessary medical care is provided no matter how short or long the length of the disability.
- Lost wage benefits are not paid for the first seven days of the disability, unless it extends beyond fourteen days.
- After 14 days, you may receive lost wage benefits from the first work day you were unable to work.
- If your claim is accepted by the insurer, payments should begin within 18 days of the day that you were injured, or within 10 days after your employer became aware that you were injured, whichever is later.
- If your claim is disputed by the insurer, you must wait until a judge considers the case and directs the insurer to pay. You may receive disability benefits until the case is heard. If the case is resolved in your favor, the disability benefits would be deducted from your lost wages award.
If Your Employer Continues to Pay Your Wages
In some cases, an employer might decide to continue paying you while you are out of work due to the injury.
- If your employer continues to pay your wages, you may not receive money from the insurer. Your employer can be reimbursed by the insurer for these wages.
If you are working for more than one employer at the time of injury, depending upon the circumstances, you may be entitled to include both salaries when determining your average weekly wage (AWW). This is called concurrent or dual employment.
If you can return to work but your injury prevents you from earning the same wages you once did, you may be entitled to a benefit that will make up two-thirds of the difference between your current earnings and your pre-injury average weekly wage.
Degree of Disability
The rate at which benefits are paid is based upon the level (or "degree") of disability on your medical reports.
- The medical opinion might come from your doctor, or it might come from an independent medical examiner who has examined you at the request of the insurer.
- If your doctor and the independent medical examiner disagree about your degree of disability, you may choose to a compromise with the insurer or request a hearing to decide which opinion is more correct.
Generally, the degrees of disability range from total (100%), marked (75%), moderate (50%), or mild (25%) and various levels in between. Anything less than a total disability is called a partial disability.
Amount of Weekly Benefit
The amount you receive is determined by multiple factors and is based on your average weekly wage for the previous year and the degree of your temporary disability.
Sample Calculation of Weekly Benefit
2/3 × (average weekly wage) × (% of disability based on medical evidence) = weekly benefit
Therefore, an injured worker who was earning $500 per week and is totally (100%) disabled would receive $333.33 per week. A partially disabled injured worker (50%) would receive $166.67 per week.
Minimum Weekly Benefit
The weekly benefit cannot be less than the minimum benefit amount. The minimum benefit amount is $150.00 per week for accidents occurring after 5/1/13.
Maximum Weekly Benefit
The weekly benefit cannot exceed the maximum benefit amount. The maximum benefit amount adjusts every July 1.
It is based on the New York State Average Weekly Wage for the previous calendar year, as reported by the Commissioner of Labor to the Superintendent of Insurance on March 31 of each year.
The benefit rate an injured worker receives is determined by the date of injury and does not increase if new maximum benefits are adopted into law.
Social Security Disability Benefits
If you become seriously disabled and can't work as a result of a medical condition that's expected to last at least one year, or result in death, you may be entitled to Social Security benefits. For additional information about these federal disability insurance benefits, write or call the nearest Field Office of the Social Security Administration.