Do You Know the Rule? N.Y. Scheduled Loss

New York, NY (WorkersCompensation.com) -- In New York, as in other states, there is a special category of permanent partial disability that counts as a scheduled loss. In the Empire State, a scheduled loss involves loss of eyesight or hearing or loss of a part of the body or its use. Compensation is limited to a certain number of weeks, according to a schedule set by law.

The following gives an overview of what New York law details about scheduled losses.

What is a schedule loss of use award?

A cash benefit that pays for the loss of wage-earning capacity resulting from a permanent functional impairment of a body part as a result of an on-the-job injury.

An SLU award may be made for injuries to any of the following:

• Arm (shoulder and elbow)
• Hand (wrist and forearm)
• Fingers and/or thumb
• Leg (hip and knees)
• Foot (ankle)
• Toes and/or great toe
• Eyesight (loss of vision)
• Hearing (loss of hearing)
• Disfigurement (face/scar, neck, scalp)

Who is eligible for an SLU award?

A worker may be eligible if she:

• Has recovered to the greatest extent possible from her injury.
• Her health care provider has submitted a medical report that: 1) follows the current Permanent Impairment Guidelines; and 2) states that she has reached maximum medical improvement.
• She has a permanent loss of function in the injured body part as a result of an on-the-job injury.

Permanent loss of function may result from damage to bone, muscles, cartilage, tendons, nerves, blood vessels and other tissues.

How is MMI determined?

When a health care provider says a worker has reached MMI, the health care provider must submit a medical report to the Board that states this. The report must include an examination of the injured body part and state the percentage of functional use the worker has permanently lost in the body part she injured.

For example, the report may state that the employee has 25 percent less function than she had before her injury. This is also called a schedule loss of use, or SLU.

What happens after a health care provider's medical report is submitted?

• If the insurer agrees with the health care provider's SLU percentage, that percentage will be used to calculate the number of weeks of benefits and the payment the worker will receive.
• If the insurer does not agree with the health care provider's percentage, the insurer may obtain an opinion from its consultant or independent medical examiner.
  • The Board will consider the medical reports on permanency and SLU percentage from the health care provider and the IME, and will issue a decision about the SLU percentage.
  • This percentage will then be used to determine the number of weeks of benefits and the payment the worker will receive.
• After the decision is filed, the insurer has 10 days to pay. If there is a dispute, either party can appeal within 30 days of the decision.

What is the amount of an SLU award?

SLU award amounts are determined by the Workers' Compensation Law (statute), which contains a schedule (list) of the maximum number of weeks of benefits you can receive based on the body part you have permanently injured. The schedule is below:

Scheduled Injuries Chart

Using this schedule, the award is calculated based on the following:

1. The body part injured
2. The percentage of loss of function (or SLU percentage) as decided by the judge
3. The worker's average weekly wage

The worker's average weekly wage is based on the worker's total gross earnings (not take-home pay) for the 52 weeks before the date of injury or illness, including overtime and other compensation. The worker's AWW is calculated by dividing your total gross earnings by 52. For example, if the worker's gross earnings are $“x”, she would divide “x” by 52 to obtain her AWW.

The following is an example of an SLU award calculation: Due to a work-related arm injury a worker loses 25 percent of the use of that arm and the worker's AWW is $900.

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