We’re going to break down what you can expect when your case wraps up, the possible outcomes, and the steps you might need to take afterward. Let's get started on making this transition as smooth and stress-free as possible.
When a workers' compensation case reaches its conclusion, there are a few different ways it can go. Each outcome has its own set of implications and steps you might need to follow. Here’s a rundown of what might happen:
Case Goes Idle and Closes: Sometimes, a case might just quietly close. This happens when you’ve received all the benefits you were entitled to, such as payment for lost time and necessary medical treatment, and you don't have any permanent disabilities. Essentially, you’ve recovered fully, and there's no more action needed. However, it's important to note that in places like New York, the Workers' Compensation Board may push for a final determination to ensure there's no permanent disability before truly closing the case.
Schedule Loss of Use (SLU) Awards: If you've sustained a permanent disability to an extremity—think arms, legs, hands, feet, fingers, or toes—you might qualify for what's called a Schedule Loss of Use (SLU) award. This is a lump sum payment calculated based on the percentage of loss of use for that body part. For example, if you have a 10% disability in your arm, you’ll receive 10% of the total weeks of compensation assigned to a full arm disability.
Non-Schedule Loss of Use Awards: When the injury affects core parts of your body like your head, neck, or back, things are a bit different. These are considered Non-Schedule Loss of Use cases. Instead of a lump sum, you receive bi-weekly payments based on your loss of wage-earning capacity (LWEC), which is essentially how much your injury affects your ability to work. The greater your LWEC, the more weeks of benefits you receive. For example, if you're found to have a 45% LWEC, you might receive benefits for 300 weeks at 45% of your previous wage rate. This system helps provide a steady income while you adjust to your new circumstances.
When your workers' compensation case is winding down, you might hear about different ways to settle. Here are the main options:
Section 32 Settlements: One of the most common types of settlements is the Section 32 agreement. This type of settlement is a full and final closure of your case in exchange for a lump sum payment. Once you and the insurance company agree on the amount, and the paperwork is signed, your case is closed completely. This means you won't be able to reopen it later, but you get the benefit of a lump sum payment that you can use as you see fit.
Indemnity-Only Section 32 Settlements: Sometimes, you might not want to close out the medical part of your case. In these situations, you can negotiate an indemnity-only Section 32 settlement. This means that while the financial side of your case is settled with a lump sum payment, your right to medical treatment remains open. This can be helpful if you still need ongoing medical care but want to resolve the financial aspects of your case.
Stipulation Agreements: Another settlement option is a stipulation agreement. Unlike Section 32 settlements, stipulation agreements do not close your case completely. Instead, they allow you to reach a partial settlement with the insurance company regarding certain aspects of your claim, such as the degree of disability or the amount of weekly benefits. This type of agreement provides flexibility as it allows you to address specific issues without giving up your rights to future benefits or medical treatment related to your injury. Stipulation agreements can be beneficial if you and the insurance company agree on certain aspects of your case but still want to keep the door open for future claims.
One of the biggest questions after a workers' compensation case is whether you'll be able to return to work and what that might look like. Here are some scenarios you might face:
Full Recovery and Return to Previous Job: In the best-case scenario, you've made a full recovery and can return to your old job at the same pay rate. Your employer has held your position open for you, and you can jump back into your work routine as if nothing happened. This is ideal because it allows you to move on from the injury and continue with your career uninterrupted.
Returning with Restrictions (Light Duty Work): If you’ve suffered a permanent disability and have restrictions on the type of work you can do, your employer might offer you a different job that accommodates these limitations. This is often referred to as "light duty" work. It’s important to note that if your new position pays less than your previous one, you might be eligible for reduced earnings benefits. These benefits are generally calculated as two-thirds of the difference between your pre-accident salary and your current salary. For example, if you used to earn $1,000 per week but now only earn $600 due to your restrictions, you might receive an additional $266 per week in reduced earnings benefits.
No Job Available with Previous Employer: Sometimes, your employer may not have a position available that fits your new restrictions, or they may have already filled your old position while you were recovering. In such cases, you might need to find a new job. If your new job pays less than what you earned before your injury, you could still be eligible for reduced earnings benefits, as discussed earlier. If you find a new job that pays the same or more, you wouldn’t receive these benefits, but you might still be eligible for an award for any permanent loss of use if your injury involved extremities.
If your injury prevents you from returning to your previous job, there are resources and strategies to help you transition to new employment.
Vocational Rehabilitation Services: Vocational rehabilitation services are designed to help you get back into the workforce, even if you can’t return to your old job. These services might include job retraining, resume assistance, and help with job placement. In New York, the Workers' Compensation Board offers vocational rehab services in certain cases. Judges can refer you to these programs, but there are also numerous state and local agencies that provide similar support. They can assist with everything from learning new skills to improving your English, helping you become more competitive in the job market.
Job Search and Employment Transition: If returning to your old employer isn't an option, you may need to start looking for a new job. This process can be daunting, but there are ways to make it more manageable:
Maintaining Labor Market Attachment: If you’re receiving workers' compensation benefits for a partial disability, you need to show that you’re actively seeking work. This concept, known as labor market attachment, requires you to demonstrate a good faith, continuous effort to find employment within your physical restrictions. Document your job search activities and keep records of the jobs you apply for and any interviews you attend.
Unemployment Benefits: In some cases, if you’re ready, willing, and able to work but can’t find a job, you might be eligible for unemployment benefits. However, be cautious with this option. Receiving unemployment benefits can affect your workers' compensation benefits, and you must be honest and upfront about your employment status to avoid complications.
It’s possible that after your workers' compensation case is closed, you might need to revisit it if your condition worsens. Here’s what you need to know about reopening your case:
Conditions for Reopening a Case: If you experience complications or a worsening of your original injury after your case has closed, you might be able to reopen it to get additional medical treatment. To do this, you’ll need to provide medical evidence showing that your condition has deteriorated. This is why it’s crucial to stay in touch with your healthcare providers even after your case is resolved.
Time Limitations for Reopening: In New York, there are specific time frames within which you can reopen a workers' compensation case:
Section 32 Settlements and Reopening: If your case was closed with a full and final Section 32 settlement, reopening it is nearly impossible. A full and final Section 32 settlement is designed to close your case permanently. The only way to reopen it is with the consent of all parties involved, which is highly unlikely since the insurance company agreed to the settlement to avoid future liability. If you do have a worsening condition after a Section 32 settlement, you will likely be responsible for any related medical expenses.
Filing a New Claim: In some cases, filing a new claim might be an option. If your injury is due to a new accident, even if it affects the same body part, it could warrant a new claim. For example, if you previously injured your back at work and then hurt it again in a different incident, this new injury might be considered separately from the original claim. This distinction is important for ensuring you receive appropriate benefits for each injury.
Clear Communication with Healthcare Providers: To navigate these complexities, it’s important to give a clear and accurate history to your doctors. They need to understand whether your current issues stem from an old injury or a new one to provide proper treatment and documentation. This clarity will help determine the right path for reopening your case or filing a new claim.
Whether you're looking to understand your settlement options, returning to work, or need guidance on legal protections, feel free to reach out.
Give me, Rex Zachofsky, a call at 212-406-8989. Let's chat about your situation and find the best path forward for you. I'm always here to help and make this process as smooth as possible for you.
.jpg)
.jpeg)
