If you’re out of work after an injury, your workers’ compensation check can become the money you’re counting on to pay the bills. So when the first check takes longer than expected, the amount changes, or a payment doesn’t show up at all, you need to know why.
In New York, several things affect when you get paid and how much you receive, including your wages before the injury, your medical reports, and whether a judge has ordered your benefits. Let’s walk through how those pieces fit together, what can cause a delay or change in your checks, and what happens to payments if your injury becomes permanent.
If the insurer accepts your claim, your first check may come quickly. In New York, lost-wage benefits generally kick in after you’ve missed more than seven days of work. If you’re out for more than 14 days, you may get paid for those first seven days, too. Once the insurer accepts the claim, payments should start within 18 days of your injury or 10 days after your employer finds out, whichever is later.
A months-long wait often means something is missing: notice of the injury, a claim filed with the Workers’ Compensation Board, or a medical report showing why you can’t work. Tell your employer, file your own claim even if they say they’ve reported the injury, and make sure your doctor sends in the report.
The insurer may also be fighting the claim. If it disputes whether the injury is covered, you may have to go through a hearing before checks start. That can take months.
Your checks are based on what you earned before you got hurt. New York calculates an average weekly wage using your gross pay. If you can’t work at all, your benefit is generally two-thirds of that amount, up to the state’s maximum. If your average weekly wage was $900, that works out to $600 a week. The minimum and maximum depend on your injury date, so your benefit won’t automatically go up when the state raises those limits.
That’s a weekly rate, though checks usually come every two weeks. At $600 a week, you’d typically get $1,200 for two full weeks. Save your payment stubs so you can check both the rate and the dates you were paid for.
Your check may shrink if a new medical report says you can do some work, even if an earlier report said you couldn’t work at all. The insurer’s doctor may also give a different opinion. And if you go back to work, your earnings matter: you may still get benefits if your injury leaves you earning less, but lost-wage checks may stop if you’re back to your old pay.
One last thing to check: is the insurer paying you on its own, or did a judge order the payments? If a judge ordered them, the insurer generally can’t change your rate based only on a new medical opinion without going back to the Workers’ Compensation Board.
First, find out who decided you should be paid. If a judge ordered your checks, the insurer generally can’t stop them just because its doctor says you’re doing better. It usually has to go back to the Workers’ Compensation Board. Going back to work is a key exception.
If the insurer started paying you on its own, it has more room to lower or stop your checks based on a new medical report. That’s why the difference between voluntary payments and a judge’s order matters.
A missing check doesn’t always mean you’ve been cut off. A hearing can throw off your payment schedule while the amount gets sorted out. Check the dates on your last payment stub, then ask your attorney or the insurer what’s going on.
Your checks can also be at risk if you miss an insurance medical exam, don’t have an updated medical report, or don’t meet a work-search requirement that applies to you. If payments stop, ask for the exact reason so you know what to address.
At some point, your doctor may say you’ve reached maximum medical improvement, or MMI. That just means they don’t expect you to get much better. Your checks don’t stop the day you reach MMI; they generally keep coming while the Workers’ Compensation Board figures out your permanent benefits.
From there, it depends on what you hurt. Certain injuries to an arm, leg, hand, foot, vision, or hearing can lead to a schedule loss of use award. The amount depends on the body part, how much use you’ve lost, and your benefit rate. Checks you got while temporarily disabled are usually taken out of that award. You may still get the award even if you’re back at work.
Back and neck injuries usually work differently. In these non-schedule cases, the Board looks at how much the injury affects your ability to earn a living. If you’re still out of work or earning less because of it, checks may continue for a set number of weeks. If you’re permanently and totally disabled, you may qualify for payments for life.
If your checks are late, the amount changed, or you’re not sure what happens next, give me, Rex Zachofsky, a call. We can look at what’s going on with your case and help you figure out your next step.
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