Volunteers and Responders

The Volunteer Ambulance Workers’ Benefits Law provides cash benefits and/or medical care for volunteer ambulance workers who are injured or become ill in the line of duty.

The local political subdivision pays for this insurance, and cannot require the volunteer ambulance worker 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 New York State Workers’ Compensation Board administers the law and resolves disputes.

A volunteer ambulance worker loses the right to benefits if the injury results solely from their intoxication from alcohol or drugs, or from the intent to injure themself or someone else.

Eligibility

• Most New York State volunteer ambulance workers are covered by workers’ compensation benefits if they are active volunteer members of an ambulance company and are injured or become ill in the line of duty.

  What is and is not “in the line of duty?”

• Volunteer ambulance companies that are not under contract with a county, city, town, village or other political subdivision, or that do not wish to become special improvement districts of towns, may provide optional coverage to their workers.

• You are eligible if 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: Ground Zero, Fresh Kills Landfill, the barges, the piers, or the morgues.

  File for World Trade Center (WTC) benefits

• You are eligible if you are a spouse or dependent of a volunteer ambulance worker who passed away in the line of duty or due to an existing compensable injury or illness.
  • Dependent children are eligible is they are under age 18, or if enrolled in an accredited educational institution, under age 25 (or other dependents as defined by law).

Benefits

Cash Benefits

You are eligible for benefits when your volunteer company responds as a unit, whether the injury occurred while serving the home area 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 a wage-earning capacity. Your wage-earning capacity, determined by the Board, is what you could reasonably be expected to earn based on your age, education, training and experience. 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 your wage-earning capacity.

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 wage-earning capacity is permanently and totally lost.
  • The weekly cash benefits for all volunteer ambulance workers with a permanent total disability, regardless of the date of accident, is $600.
• Temporary Total Disability: Your wage-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.
  • The weekly cash benefit for volunteers with a temporary total disability, who were injured or became ill on or after July 1, 2021, is $650.
    • Note: Weekly cash benefits at the rate of $650 began on July 1, 2022.
• Temporary Partial Disability: Your wage-earning capacity is partially lost, but only on a temporary basis.
• Permanent Partial Disability: Part of your wage-earning capacity has been permanently lost.
  • The weekly cash benefits for all volunteer ambulance workers 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 Wage-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 of Use: This is a special category of Permanent Partial Disability, and involves loss of eyesight or hearing, or the 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 Award

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 ambulance worker dies from a compensable injury, the surviving spouse is entitled to continuing weekly cash benefits. Dependent children under age 18, or if enrolled in an accredited educational institution, under age 25 (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.

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 who treat you must be authorized by the Board. You can find a provider 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 your doctor is Board-authorized.

The health care provider will send the bills directly to the insurer and the Board. You do 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 health care providers 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). 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 receive 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. (A short letter specifying your intent to opt-out is all that’s needed.) 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

If you are required to use a specific network provider for 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). 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.

If a workers' compensation insurance carrier or local political subdivision uses an independent pharmacy, pharmacy network or PBM, the pharmacy should either 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, of 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). 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 (a result of developing a dependence) may occur when opioids are reduced or stopped suddenly. 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

If you think you may need help, you (and/or your family members) should first discuss any opioid pain medication any concerns with your physician. Your physician can recommend the right specialist. Workers' compensation insurance will pay for treatment if it is recommended by a judge or approved by your workers' compensation insurance carrier.

Contact the Board

Customer Service Toll-Free Number: (877) 632-4996
Monday through Friday - 8:30 a.m. to 4:30 p.m.

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