PPD Caps
| % Loss of Wage Earning Capacity | Maximum Weeks of PPD Benefits |
|---|---|
| Greater than 95% | 525 |
| Greater than 90% to 95% | 500 |
| Greater than 85% to 90% | 475 |
| Greater than 80% to 85% | 450 |
| Greater than 75% to 80% | 425 |
| Greater than 70% to 75% | 400 |
| Greater than 60% to 70% | 375 |
| Greater than 50% to 60% | 350 |
| Greater than 40% to 50% | 300 |
| Greater than 30% to 40% | 275 |
| Greater than 15% to 30% | 250 |
| 0% to 15% | 225 |
Understanding the 2017 PPD Benefit Caps in New York Workers’ Compensation
In 2017, significant reforms to New York’s Workers’ Compensation Law introduced duration caps on Permanent Partial Disability (PPD) benefits. These caps apply to injuries occurring on or after April 10, 2017, and are determined based on the claimant’s assessed loss of wage-earning capacity (LWEC).
A key aspect of the reform is the credit mechanism for Temporary Partial Disability (TPD) benefits. Specifically, any TPD benefits paid beyond 130 weeks (2.5 years) from the date of injury are credited against the total duration of PPD benefits. This means that prolonged TPD payments can reduce the overall period during which PPD benefits are payable.
These changes aim to streamline the compensation process and ensure a balanced approach to benefit distribution. For detailed information, refer to the New York Workers’ Compensation Board’s Subject Number 046-936.
Extreme Hardship Redetermination Under WCL § 35(3)
In New York, injured workers classified with a Permanent Partial Disability (PPD) and a loss of wage-earning capacity (LWEC) exceeding 75% may seek an Extreme Hardship Redetermination. This provision allows claimants to request reclassification to Permanent Total Disability (PTD) or Total Industrial Disability (TID) if they face extreme financial hardship as their capped indemnity benefits near exhaustion.
LWEC Threshold: The claimant must have an LWEC greater than 75%.
- Timing:The application must be filed within one year prior to the scheduled end of PPD benefits under WCL § 15(3)(w).
- Demonstrated Hardship:The claimant must provide evidence of extreme financial hardship impacting their ability to meet basic living expenses.
Application Process:
To initiate the redetermination, claimants must complete and submit Form C-35, detailing their financial situation and the basis for the hardship claim. The Workers’ Compensation Board will review the application and determine eligibility for reclassification.
Important Considerations:
- Statutory Amendment:The 2017 amendment to WCL § 35(3) lowered the LWEC threshold from 80% to 75%, expanding eligibility for more claimants.
- Review Process:The Board evaluates each application on a case-by-case basis, considering the claimant’s financial documentation and circumstances.
For more detailed information, refer to the Workers’ Compensation Board’s Subject Number 046-938.
130-Week Credit Toward PPD Benefit Caps in New York Workers’ Compensation
Under the 2017 amendments to New York Workers’ Compensation Law (WCL) § 15(3)(w), a credit mechanism was introduced affecting Permanent Partial Disability (PPD) benefit durations. Specifically, for injuries occurring on or after April 10, 2017, any Temporary Partial Disability (TPD) benefits paid beyond 130 weeks (2.5 years) from the date of injury are credited against the maximum duration of PPD benefits.
Key things to know:
- Applicability:This credit applies to cases where the injury date is on or after April 10, 2017.
- Credit Calculation:Weeks of TPD benefits paid after the initial 130 weeks post-injury reduce the total number of weeks available for PPD benefits.
- Maximum Medical Improvement (MMI):If a claimant has not reached MMI by the time the credit would apply, the credit may not be enforced until MMI is attained. NYS Workers Compensation Board
This provision aims to encourage timely progression towards MMI and ensures that the duration of PPD benefits reflects the period of actual partial disability.
For more detailed information, refer to the Workers’ Compensation Board’s Subject Number 046-936.
Permanency Guidelines and Loss of Wage-Earning Capacity (LWEC) in New York Workers’ Compensation
Determining a claimant’s Loss of Wage-Earning Capacity (LWEC) is a critical component in New York workers’ compensation cases, particularly for non-schedule permanent partial disabilities. The New York State Workers’ Compensation Board has established guidelines to standardize this assessment.
2012 Guidelines for Determining Permanent Impairment and LWEC
Implemented in January 2012, these guidelines provide a structured three-part analysis for evaluating LWEC
- Medical Impairment Evaluation:Assessing the nature and severity of the permanent medical impairment.
- Functional Ability Assessment:Evaluating the claimant’s functional limitations resulting from the impairment.
- Vocational Factors Consideration:Incorporating elements such as age, education, work history, and transferable skills to determine the overall impact on wage-earning capacity.
These guidelines aim to ensure a fair and consistent approach to determining LWEC across cases.
2018 Updates to Permanency Impairment Guidelines
As part of the 2017 executive budget, Workers’ Compensation Law §15(3)(x) mandated the development of new Permanency Impairment Guidelines, which took effect on January 1, 2018. These updated guidelines specifically address Schedule Loss of Use (SLU) evaluations, providing revised criteria for assessing permanent impairments related to extremities and other body parts amenable to SLU awards.
Key Resources:
- 2012 NYS Guidelines for Determining Permanent Impairment and Loss of Wage Earning Capacity (PDF)
- 2018 Impairment Guidelines for Determining Schedule Loss of Use (PDF)
- Impairment Guidelines Overview – NY Workers’ Compensation Board
Understanding these guidelines is essential for accurately assessing claims and ensuring compliance with New York State workers’ compensation regulations.