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–2F Form?

A: If the injury or work–related illness requires the worker to miss time from regular duties of one day beyond the working day or shift on which the accident occurred, or which has required or will require medical treatment beyond ordinary first aid or more than two treatments by a person rendering first aid. 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–2F 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–2F 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–2F Form does not have to be submitted. However, the employer is required to prepare a C–2F 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–2F 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–2F 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.

Watch Our Presentation on Workers' Compensation