Reimbursement of Travel and Medical Expense

“I was hurt in an accident on the job last year. Can I get reimbursed for my trips to my doctor’s office?”

Yes, you can be reimbursed for your travel expenses. In order to get reimbursed, you should submit a C-257 form to the compensation carrier and the Compensation Board. (You can download the form directly from the Board’s websit by clicking on this sentence .) If you were our client, we could assist you with this process.

You are entitled to reimbursement for attending your doctor’s appointments and other treatments you receive, such as physical therapy appointments, and traveling for diagnostic testing such as an MRI, but you do not receive reimbursement for traveling to and from your pharmacy or attending hearings at the Workers’ Compensation Board.

If you drive yourself, or a friend or relative drives you to your appointment, your travel expenses are reimbursable at the approved rate per mile.  The Carrier’s will use google maps (or a similar search engine) to determine mileage bewteen your home and your doctor’s office. You can print out the results yourself and submit the mileagle along with the form. The rate you are paid at varies year to year.  This year the rate is 56 cents per mile. By clicking on this sentence you can see the reimbursement rates over several years.

If you travel to a hospital, hospital parking is reimbursed provided you obtain a receipt. If you take public transportation, you can be reimbursed provided you obtain receipts. The MTA now offers digital receipts (even if you are taking access-a-ride) which you can use to get reimbursed.

However, using services such as Uber is not generally allowed as a reimbursable expense. First, you need a doctor’s note stating that your medications prevent you from driving and, medically, public transportation is too far away and would require too many transfers or too much time for your condition. Second, you must prove that you have no access to a motor vehicle.

You can also submit medical expenses (with receipts) that are not paid directly by the carrier. Prescription medications, over the counter medications (which your doctor recommends with a note), and bandages, crutches, canes (which your doctor recommends with a note) should be reimbursed by the carrier.

 

 

Worker’s Compensation Settlements

“How much money should I expect from a Worker’s Compensation settlement?”

The best answer to the question is to explain the factors the Compensation Board uses when it approves settlements.

First, the wage that an injured worker was making at the time of his/her accident is a factor in determining settlement value.  The more money the injured worker was making, the better settlement the injured claimant can expect.

Second, both the treating doctor and the doctor representing the insurance company have to write reports commenting on the disability for the parts of the injured worker’s body.  The more each doctor believes an injured worker has permanent damage, the higher the settlement.

Third, an injured worker has to look at the part or parts of his/her body that are injured. There is actually a formula in the Worker’s Compensation Law that states, given a permanent injury to certain body part or parts, the injured worker would be entitled to a certain number of weeks of compensation benefits. There are other body parts, like the back, that don’t have a formula per se for settlements, but there are different ways to classify a worker’s disability for injuries to those body parts.

Based on these three factors, an injured worker can assess the amount of a settlement in a Compensation case.

Worker’s Compensation and Sick Time

“Should I lose my sick time if I get hurt on the job?”

If you are hurt on the job and you miss more than one week of work, then you are eligible to collect Worker’s Compensation lost wage benefits.

Compensation lost wage benefits pay workers at most two-thirds of the average (average is computed over the year preceding the accident) weekly pay and that two-thirds of the average may not exceed $934.11 (current rate) per week.

So if your employer uses your sick time while you are out out of work because of an on-the-job accident, then you are entitled to be reimbursed for that sick time at the compensation rate. For example, if your average salary was $900 per week, then your compensation rate is $600 per week. Thus, if your employer used up 15 of your sick days while you are out on Worker’s Compensation, then you would only be reimbursed 10 days by Compensation because the Worker’s Compensation carrier would only reimburse your employer for two-thirds of the value of the sick days. Hence, you would get back 10 of the 15 sick days you had with with your employer.

Length of Time for Settlements

“How long does it takes to get an insurance company settlement?”

There is no one answer for every case.  Cases in certain counties tend to move more quickly than cases in other counties. This is true for both New York as well as New Jersey.

The common types of personal injury cases like car accidents and trip and fall accidents tend to move the quickest. The less common cases like contruction accidents or medical malpractice claims usually take longer.

We tell our clients that most car accidents cases and trip and fall claims brought in Supreme Court, Richmond County settle in between two to three years.  Some cases settle more quickly, some take longer. But there are so many different factors that determine how long litigation takes until a trial or settlement, that it is not fair to give a specific length of time for litigation, especially without knowing the particulars of your case.

Worker’s Compensation claimants may receive no settlement at all. Such settlements only occur when the claimant’s medical conditions have stabilized and the doctor submits a report commenting on disability. There is no set time how long a medical condition takes to stabilize. Furthermore, unlike cases brought in Supreme Court, there are formulas that the Componsation Board uses to calculate the amount of a settlement. (The amount of the settlement is computed on a case by case basis.)

Liens on Accident Claims

If my medical bills were paid by insurance, do I have to pay back the insurance company from my personal injury settlement?”

There is no short answer to this question.  When someone is injured in an accident, they need immediate medical trereatment.  There is no time to wait for a personal injury case settlement which coulkd take years. Medical providers like to be paid for their services rendered. So in almost all accident cases, there is some insurance entity paying the bills for medical treatment. The question really is, will that entity that paid for medical treatment have to be repaid for those medical billls it paid?

Generally, for car accident cases, there would be no lien (but there are certain cases where you do have to pay back medical bills paid by insurance).

For many claims involving innuries on the job, the Worker’s Compensation Carrier who paid the bills would have to be repaid. The amount of that lien would be reduced by proportional amount of legal fee and disbursements. (This would mean the reduction of the lien would be at least one-third of the total lien. (But there are certain types of Worker’s Compensation liens could be waived entirely, but that depends on the type of accident.)

For those accidents covered by Medicare, there is a lien and Medicare would have to be repaid for medical bills covered. But, just like Worker’s Compensation Carriers, Medicare will reduce its lien based on the amount of legal fee and disbursments.

For many other cases, there is no lien. It is difficult to understand the lien reductions without specific facts. But the best answer to the original question would be that there could be a medical lien reduction or waiver, but it really depends on the specific facts of your case.