You’re (Probably) Calculating Your Workers' Comp Benefits WRONG!

Today, we’re diving into a topic that's crucial for anyone dealing with a workplace injury: calculating your workers' compensation benefits and understanding the value of your settlement. Let's get into it.

Determining the Value of a Workers' Compensation Case

When it comes to figuring out how much your workers' comp case is worth, three main things matter: your average weekly pay, how much work you miss, and how serious your injury is. Understanding these factors can help make sure you get the compensation you deserve.

1. Average Weekly Pay – This is basically what you were making on average in the 52 weeks before your injury. Workers' comp benefits are usually a percentage of this amount, so it’s a big deal when calculating your payout.
2. Time Off Work – If your injury keeps you from working, the amount of time you’re out plays a big role in your benefits. This is especially true for injuries to the head, neck, or back, where recovery can take longer.
3. How Your Injury Affects You – This is about how much your injury impacts your ability to work, both now and down the road. The more it limits what you can do, the higher your compensation could be.

Calculating Average Weekly Wage

Your average weekly pay is one of the biggest factors in figuring out your workers' comp benefits. It’s basically your gross earnings averaged over the 52 weeks before your injury, and it plays a huge role in determining how much you’ll get.

Here’s how it’s calculated:

1. Total Earnings – Add up everything you made in the year leading up to your accident. This includes your regular pay, overtime, bonuses, and any other income from your job.
2. Adjust for Time Off – If you took time off—whether for vacation, sick days, or unpaid leave—you’ll need to factor that in. For example, if you were out for three weeks total, you’d divide your earnings by 49 weeks instead of 52.
3. Keep Good Records – Accurate paperwork is key. Gather tax returns, pay stubs, and any other proof of what you earned. Even personal calendars or work schedules can help show when you worked and when you didn’t.

Lost Time and Its Impact

Lost time is a major factor in workers' comp benefits, especially for head, neck, or back injuries. To qualify, your injury must keep you from working—if you’re still on the job, you might not be eligible. The longer you’re out, the more it impacts your claim, including both time already missed and any future time off your doctor anticipates.

Medical documentation is key. It’s not enough to just be out of work—you need proof from your doctor. In New York, medical reports cover only 90 days of lost time, so you should see your doctor at least every three months, though every six weeks is even better for proper documentation.

Accurate records matter, too. Keep track of all missed workdays with a calendar or notes to back up your claim and ensure you get the right benefits.

Bottom line—if your injury is keeping you from work, stay on top of doctor visits and keep good records to protect your claim.

Degree of Disability

The degree of disability plays a big role in your workers' comp benefits, determining how much your injury affects your ability to work now and in the future. Different injuries lead to different types of disabilities, and knowing the difference can help your case.

Scheduled Loss of Use applies to injuries affecting body parts like hands, arms, legs, feet, fingers, and toes. Workers' comp uses a chart to assign a value based on how much function you’ve lost—for example, a 10% permanent disability in your arm means compensation is based on that percentage.

Non-Scheduled Injuries include head, neck, and back injuries, which don’t have preset values. Instead, compensation depends on your wages, lost work time, and the severity of your disability. These cases require strong medical documentation to prove how your injury limits your ability to work.

The difference between temporary and permanent disability also matters. Temporary disability means you’ll recover and return to work, while permanent disability means lasting limitations. The type you have affects your compensation.

Medical evidence is key. Regular doctor visits and medical assessments help document your injury’s impact. Reports from both your doctor and the insurance company’s doctor will play a major role in determining your benefits.

Importance of Accurate Records

Good documentation is key to ensuring your workers' comp benefits are calculated correctly. Your average weekly wage plays a big role in determining your compensation, so you need solid proof of your earnings. Tax returns show your yearly income, pay stubs provide a week-by-week breakdown, and work schedules or calendars help account for any time off.

Tracking missed workdays is just as important. Personal notes or calendars can back up your claim for lost wages. Medical documentation also strengthens your case—keep all medical reports, follow your doctor’s treatment plan, and track your symptoms and treatments. The more detailed your records, the stronger your claim.

Consistency matters. Any discrepancies in your records can cause delays or challenges from the insurance company. Double-check that your tax returns, pay stubs, and other documents match up.

Concurrent Employment

Concurrent employment means working more than one job at the time of your injury. If both jobs qualify under New York State Workers' Compensation, your earnings from all jobs can be combined to calculate your average weekly wage.

Combining earnings can significantly boost your benefits. If your second job is covered by workers' comp, that income gets added to your primary job’s wages, increasing your compensation. For example, if you worked a full-time job during the day and a higher-paying part-time job at night, factoring both in could raise your benefits.

To get the full amount you deserve, report all jobs to your lawyer or judge. Provide tax returns, W-2s, pay stubs, and work schedules to show how you split your time. Since workers' comp cases involving multiple jobs can get complicated, legal guidance is key. Make sure your lawyer has all your employment details so they can ensure every dollar you earned is counted in your claim.

Pain and Suffering

Pain and suffering are often misunderstood in workers' comp claims. Unlike personal injury cases, workers' comp doesn’t directly compensate for pain and suffering—it only covers medical bills and lost wages from a work-related injury.

What matters most is how your pain affects your ability to work. Pain is only relevant if it leads to a disability that prevents you from doing your job. To include it in your claim, it must be documented as part of your disability. Your medical records should clearly show how pain limits your daily activities and work performance, with your doctor linking it to your condition.

It’s also key to determine if your pain causes temporary or permanent disability. Temporary disability qualifies you for short-term benefits, while permanent disability may entitle you to ongoing compensation.

To strengthen your case, stay on top of medical visits and work with your lawyer. Keeping detailed medical records and legal guidance can help ensure your pain-related disability is properly factored into your claim.

Common Mistakes and Misconceptions

When filing a workers' comp claim, avoiding common mistakes can help ensure you get the compensation you deserve. Here’s what to watch out for:

• Overvaluing Your Claim – Workers' comp doesn’t consider personal financial struggles like rent or debt. Compensation is based only on how your injury affects your ability to work.
• Undervaluing Your Claim – Many people don’t realize they’re owed more. Even if you’re back at work, you might still qualify for benefits like permanent disability payments or compensation for lost time.
• Misunderstanding Pain and Suffering – Workers' comp doesn’t directly cover pain and suffering. Pain is only relevant if it contributes to a disability that affects your ability to work.
• Skipping Legal Help – Handling a claim alone can lead to missing out on benefits. A workers' comp lawyer knows how to navigate the system, negotiate with insurance companies, and make sure you get what you’re owed.
• Ignoring Medical Documentation – Medical records are critical. Keep track of all doctor visits, treatments, and recommendations. Regular medical reports help prove lost work time and the severity of your disability.
• Not Reporting All Jobs – If you had more than one job when you got hurt, your earnings from all jobs could impact your benefits. Make sure to provide tax returns and pay stubs from all employers to ensure your compensation is calculated correctly.

Contact Us For Help With Your Workers' Compensation Case

If you have any questions or need assistance with your workers' compensation case, feel free to reach out. I’m here to help you through every step of the process. Don’t hesitate to give me, Rex Zachofsky, a call at 212-406-8989. Let’s work together to make sure you get the compensation you deserve.