Workers Compensation Law
The law allows insurance carriers or in this case is the company and self-insured workers to contract with New York State Health Department certified Preferred Provider Organizations (PPOs). They will provide the services, to diagnose rehabilitate, and to treat the injured or ill workers that need the medical treatment. PPOs are needed to make the available two providers in every medical specialty. They also have to choose two hospitals. The workers are required to seek initial treatment with a provider affiliated with the PPO. In this case, after the initial treatment, they can select any authorized provider outside of the PPO 30 days after their initial treatment. A thing you have to know about the Worker’s Compensation Law is the negotiated labor agreement. By it, a co-worker’s competition Board adjudication claim process called the ADR or Alternative Dispute Resolution. It is used for employers and employees in the unionized construction industry. The workers that get injured will be covered by the ADR program. They will get the medical treatment from medical providers that participate in the ADR program.
It began on July 11, 2007, a claimant or pharmacy submits a claimant to the insurer carrier for payment or reimbursement of the cost of prescribed medicine for the workers. However, the insurer carrier should pay the amount of setting forth in the Pharmacy Fee Schedule within 45 days of receipt of the claim. Except, the claim has not been established, or the prescribed medicine is not for a casually related condition. If the claim is not established or the prescribed medicine is not for an injury or illness related to the work accident any disease, it means that the insurer carrier should pay any undisputed portion. It also notifies the injured or ill workers or any pharmacy in writing within 45 days of receipt of the claim.
The insurance carrier may have any contract to the pharmacy or pharmacy network. It means to ask them to provide prescribed medicines to injured or ill workers. They also may require the workers to obtain their prescribed medicines from such as pharmacy or any pharmacy network. When a medical emergency occurs, and it is not possible to obtain immediately required prescribed medicines. When the illness workers want to get any services from the pharmacy or pharmacy network, they have to give the contract information and the instructions on how to obtain the prescribed medicines. The cost of necessary medical services is paid by the insurance carrier, and the health care provider may not collect a fee from the patient. That is the rule. In addition, when appropriate, the claimants will be awarded reimbursement for automobile mileage to and from a healthcare provider’s office.
The form A-9 should be provided to notice the injured worker that he or she may be responsible for paying the medical bills if the Workers’ Compensation Board disallows the claim. On the other hand, the injured worker does not pursue the claim. How about the supplemental benefits that got from claimants? This is the most affected one by rising costs. The combination of the weekly benefits, supplemental benefits, and death benefits cannot exceed $215/week. This was the effect of January 1, 1979. There are two categories for the claimants to get the supplemental benefits. They are the claimants that permanently and totally disabled because of the result of the injury or disability because of the job and widows or widowers that receiving death benefits as the result of the death of their spouse. To get the benefits of it, file an SC-4 form, and the administrative determination can be put. In addition, workers also can get the social security benefits. In this case, the workers who become seriously disabled, no matter permanently or to a continuous period of not less than 12 months may be entitled to the payment of monthly Social Security benefits. You can get the additional information about the Federal Disability Insurance Benefits by write or call the nearest Field Office of the Social Security Administration.
Now is about the death compensation. The surviving spouse or minor children, and other dependents as defined by law get the weekly cash benefits if the workers die from compensable injury. The amount of it is equal to two-thirds of the deceased worker’s average weekly wage for the year before the accident. If there are no surviving children, anyone and related family entitled to compensation, the surviving parents or the estate of the deceased worker may be entitled to payment of a sum of $50,000. The funeral expenses may also be paid up to $6,000 in Metropolitan New York counties and up to $5,000 in all others. All of that explanation may make you confuse, but you have to make sure that you understand the rule so that you can have the clear information and understand about the compensation you can get as the workers.