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Q: What is the difference
between Workers’ Compensation Insurance and Disability Insurance?
A: Workers’ Compensation Insurance
entitles a worker to medical care and to weekly benefits for loss
of wages or salary due to an injury sustained on the job or an illness
resulting from work-related activities. In contrast, Disability
Insurance provides limited wage loss replacement for individuals
who have non-work-related disabilities. Medical expenses are not
covered by Disability Insurance.
Q: When must an employer
file a C-2 Form?
A: If the injury or work-related illness
requires the worker to seek medical attention on three or more visits
to a medical provider, or he/she misses two or more days of work
as a result of the incident, then you must file a C-2 Form with
the Workers’ Compensation Board. You should also fax a copy
to us at 212/269-6212. We will then send a copy to the insurance
carrier and facilitate claim processing.
Bear in mind that the C-2 Form must be filed within 10 days of knowledge
of the incident. Failure to do so constitutes a misdemeanor and
can result in a fine and penalty.
Q: If a worker is injured
on the job and received first aid but requires no further medical
care, does a C-2 Form need to be filed?
A: No. If the employer is willing to pay
the medical bill for that one-time visit and no further medical
attention is required or loss of time accumulated beyond two days,
then a C-2 Form does not have to be submitted. However, the employer
is required to prepare a C-2 on the incident and it must be kept
in company files for 18 years. But it need not be filed with the
carrier, the Workers’ Compensation Board or us.
Q: Is it a good idea for an employer
to pay small medical bills?
A: Definitely. If a work-related accident
necessitates a worker’s seeking medical attention on no more
than two visits to a medical provider, we highly recommend that
the employer pay the medical bills. A company’s premium is
based upon several factors including an
experience
rating.
Each time a Workers’ Compensation claim is filed, the employer’s
experience rating is affected. In fact, an employer is penalized
more for the frequency of claims rather than the severity of claims.
So it makes sense to pay small medical bills out of pocket and save
on the company’s premium payments.
Q: How long will it take for a worker
to start receiving Workers’ Compensation benefit checks?
A: If the claim has not been challenged
by the employer or the carrier, and if the worker has been disabled
for more than seven calendar days, then the first benefit check
is payable on or before the 18th day of disability or within 10
days of the employer having knowledge of the injury, whichever period
is greater.
Q: If an employer suspects that an
injury allegedly sustained on the job is not work related, what
should the employer do?
A: If the worker misses two or more days
of work or visits a medical provider on more than two occasions,
then the employer is legally bound to file a C-2 Form. However,
the employer should contact the Lovell Claims Department as soon
as possible and notify us that they believe the case should be investigated
and/or denied. Our staff will advise as to the proper wording on
the C-2 and then investigate the questionable claim, or authorize
the employer’s carrier to do so. We will assist in determining
whether the worker had a pre-existing medical condition and, ultimately,
if the case is adjudicated at a hearing before the Workers’
Compensation Board, Lovell will advise the carrier on litigation
strategies.
Q: How are premiums for Workers’
Compensation determined?
A: Contrary to common belief, the Workers’
Compensation Board has nothing to do with determining premium rates.
Premiums are actually set by the New York Compensation Insurance
Rating Board ("CIRB"), subject to approval by the State
Department of Insurance.
Premiums are based on classifications assigned to each type of business.
Each company within a specific classification is assigned the same
basic premium rate. These rates apply to each $100 of reportable
gross payroll. To calculate the premium rate for each classification,
the actual loss experience of all businesses within that classification
is compared with the total reportable payroll for those businesses.
In addition, each company’s experience
rating has a significant impact on its premium rate.
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