INJURED IN THE LINE OF DUTY? - New York State Workers' Compensation Board www.WCB.NY.Gov 1-877-632-4996
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INJURED
IN THE
LINE OF DUTY?
A Volunteer Firefighter’s and Ambulance
Worker’s Guide to New York State Benefits
New York State Workers’ Compensation Board
www.WCB.NY.Gov
1-877-632-4996i NYS Workers’ Compensation Board
Privacy Statement
All documents the Workers’ Compensation Board has about your case are private. Under workers’
compensation law, only the parties to your claim may receive information from your case file.
Beyond you and your attorney or representative, the parties who may see information include
• your employer and your employer’s attorney
• your employer’s workers’ compensation insurance carrier and its attorney
That insurance carrier may share information with health care providers it hires to examine you.
Your health care providers will have to share your health information with that insurer when they
bill for their services.
Anyone who obtains a court order authorizing access to your claim information is also included.
Your information may also be shared with government entities if they are processing a claim
for benefits or investigating fraud. No one may disclose your information to anyone who is not
authorized to see it.
You may give written permission to anyone you choose to access your claim information, in two
ways.
1. File an original Form OC-110A, Claimant’s Authorization to Disclose Workers’ Compensation
Records. This is available from www.wcb.ny.gov under Forms, or by calling 1.866.750.5157.
2. File an original notarized letter or form where you authorize a particular person or entity to see
your claim information.
You may submit an authorization at any time. It’s always helpful to share a copy of that document
with the person you authorize to see your records. Some people authorize their spouse or child to
access their records when they initially file for benefits.
Prospective employers may not ask you for
information about your workers’ compensation
claims before hiring you, or in connection with
assessing fitness or capability of employment.ii NYS Workers’ Compensation Board
Table of Contents
Privacy Statement........................................................... i
What Benefits are Available to
Volunteer Firefighters or Ambulance Workers?....... 1
How to File a Claim....................................................... 1
Who is Covered?............................................................ 2
What is In the Line of Duty............................................. 2
What is Not In the Line of Duty..................................... 3
Cash Benefits................................................................... 4
Death Benefits................................................................. 5
Waiver Agreements....................................................... 5
Disability Classifications............................................... 6
Rehabilitation and Social Work................................... 6
Medical Care................................................................... 7
Hearings and Appeals................................................... 8
Common Questions....................................................... 8
District Offices and Phone Numbers......................... 10
The VAW-3, VF-3, and OC-110a3 forms follow the text of this document.
This pamphlet is a general and simplified presentation of
Workers’ Compensation provisions and procedures. It is
not a substitute for the law or legal advice.
The Workers’ Compensation Board does not discriminate on the basis
of race, color, national origin, sex, religion, age, disability or sexual
preference in employment or the provision of service.
Workers’ compensation fraud is a Class E felony,
punishable with up to four years imprisonment, $5,000
individual/$10,000 corporate fine, and five years probation.
Subsequent conviction is a Class D felony.1 NYS Workers’ Compensation Board
What Benefits are Available How To File A Claim
to Volunteer Firefighters or Obtain form VAW-3 (ambulance workers) or
Ambulance Workers? VF-3 (firefighters), the Claim for Benefits, from
the nearest Board office, the Board’s website,
The Volunteer Firefighters’ and Volunteer or from the fire or ambulance district or
Ambulance Workers’ Benefits Laws provide company.
cash benefits and/or medical care for
volunteer members who are injured or Notify one of the following individuals
become ill in the line of duty. Recognizing the within 90 days of the injury. This may be
unselfish service of volunteer firefighters and in the form of a signed copy of a VAW-1 or
volunteer ambulance workers, laws designed VF-1:
to protect volunteers who are injured, or who
become ill, in the line of duty were enacted in • Clerk of the board of supervisors of the
1957 and 1989, respectively. county;
• Town or village clerk;
The local political subdivision pays for this • Secretary of the fire or ambulance district
insurance, and cannot require the volunteer or company; or
member to contribute to the cost of coverage. • Comptroller or chief financial officer of
Weekly cash benefits and medical care the city.
are paid by the subdivision’s insurer, in
accordance with the applicable law. The Mail a completed VAW-3 or VF-3 to the
Workers’ Compensation Board is a state Board District Office nearest you. Claims
agency that administers these laws, and if must be filed within two years of an accident
disputes arise, adjudicates them through a or two years from the date a death occurs.
quasi-judicial proceeding.
You will be notified by mail if a hearing on
In a volunteer firefighter’s or ambulance your case is necessary.
worker’s benefits case, no one party is
determined to be at fault. The amount that
a claimant receives is not decreased by her
carelessness, nor increased by the company’s
fault. A volunteer member loses his right to
benefits if the injury results solely from his
intoxication from alcohol or drugs, or from
the intent to injure himself or someone else.2 NYS Workers’ Compensation Board
Who is Covered? What is In the Line of Duty for
All New York State volunteer firefighters are Volunteer Firefighters?
entitled to benefits under the law if they are
Any of the following activities, pursuant to
active volunteer members of a fire company of
orders or authorization:
a county, city, town, village or fire district and
are injured in the line of duty. • Participation at a fire, alarm of fire,
hazardous material incident, or other
Most New York state volunteer ambulance emergency situation that triggers response
workers are entitled to benefits under the law by the fire company or its units;
if they are active volunteer members of an • Travel to, from and during fires or other
ambulance company and are injured in the calls to which the company responds;
line of duty. Volunteer ambulance companies travel in connection with other authorized
that are not under contract with a county, city, activities;
town, village or other political subdivision, • Some duties in the firehouse, such as
or that do not wish to become special construction, repair, maintenance and
improvement districts of towns, may provide inspection;
optional coverage to their workers. • Inspection of property for fire hazards or
other dangerous conditions;
• Fire prevention activities;
• Attendance at fire instructions or fire
school; instruction at training;
• Participation in authorized drills,
parades, funerals, inspections/reviews,
tournaments, contests or public exhibitions
conducted for firefighters;
• Attendance at a convention or conference
as an authorized delegate;
• Work on or testing of fire apparatus/
equipment, fire alarm systems and fire
cisterns;
• Meetings of the fire company;
• Pumping water or other substances from a
basement or building;
• Inspection of fire apparatus prior to
delivery;
• Response to a call for general ambulance
service by a member of an authorized
emergency rescue and first aid squad;
• Participation in a supervised physical
fitness class; or
• Fund-raising activities (noncompetitive
events).3 NYS Workers’ Compensation Board
What is In the Line of Duty for Volunteer Ambulance Workers?
(continued)
• Travel to, work at, and travel from an • Work in connection with the construction,
accident, alarm of accident or other duty testing, inspection, repair or maintenance
to which the ambulance company has of the ambulance facility and the fixtures,
responded; travel in connection with furnishings and equipment thereof,
other authorized activities; and the ambulance vehicles, ambulance
• Personal assistance rendered to another apparatus and equipment used by the
ambulance company; ambulance department, ambulance
• Performance of duties at the ambulance company, or other unit;
facility or elsewhere, directly related to • Practice for, or participation as
the prevention of accidents or disasters or a contestant or an official in any
the delivery of emergency health care; competitive tournament, contest or public
• Instruction or being instructed in exhibition conducted for ambulance
ambulance duties; attendance at a workers intended to promote the
training school or course of instruction for efficiency of the ambulance department,
ambulance workers; ambulance company or any unit;
• Attendance at, or participation in, any • Inspection of ambulance vehicles and
noncompetitive training program; ambulance apparatus prior to delivery
• Attendance at, or participation in, under a contract or purchase, or
authorized drills, parades, funerals, performing duties related to the delivery;
inspections or reviews; • Attendance at a convention or conference
• Attendance or work at meetings of the of ambulance workers or officers as the
ambulance department or company, authorized delegate or representative of
or any organized unit thereof, at the the ambulance department, ambulance
ambulance facility or other regular or company or any unit; or
special headquarters of the department, • Work in connection with a fund-raising
company or unit; activity of the ambulance company, not
including competitive events where
volunteer ambulance workers are
competitors.
What is Not In the Line of Duty?
• Participation, including practice, in any • Competitive events where volunteer
recreational or social activity, other than members are competitors, such as base-
noncompetitive fund-raising activities; ball, basketball, football, bowling, tugs
• Work rendered in service of a private of war, donkey baseball, donkey basket-
employer, public corporation or special ball, boxing, wrestling, contests between
district; bands or drum corps, or other competi-
• Work rendered while on leave of absence tive events where volunteer members
or suspended from duty, or work that the compete, that involve physical exertion
volunteer was ordered not to perform; or on the part of the competitors.4 NYS Workers’ Compensation Board
Cash Benefits
Benefits are payable when the volunteer company responds as a unit, regardless of whether the injury
occurred in the service of the home area or an aided area. Total disability, schedule loss or death benefits
are fixed according to the statute. In determining weekly benefits for other types of injuries, the loss
of earning capacity is based on the ability of the person to perform the work usually and ordinarily
performed in his/her regular employment.
Earning capacity is the capability of a volunteer member to perform on a 5-day or 6-day basis the work
normally done in regular employment at the time of injury, or other work that could be considered
a reasonable substitute if there is no employment. Every volunteer member is considered to have an
earning capacity. The Board determines the reasonable earning capacity, considering the work that he/
she could reasonably be expected to obtain and for which he/she would be qualified by age, education,
training and experience.
Benefits are payable from the first day of disability, with no waiting period. Necessary medical care is
provided without regard to the length of the disability.
Schedule of Benefits for Volunteer Firefighters and Ambulance Workers
Date of Accident Weekly Maximum
Total / Partial Disability
July 1, 1992 and after $400 / $400
July 1, 1991 - June 30, 1992 $400 / $350
July 1, 1990 - June 30, 1991 $400 / $280
Note: The maximum benefit for volunteer firefighters and volunteer ambulance workers classified as
totally and permanently disabled is $400 per week, regardless of the date that the injury occurred.
In the event of death or disability due to disease
or malfunction of the heart or coronary arteries,
the claim must be decided within 90 days from
the time the claim is received by the Board.5 NYS Workers’ Compensation Board
Death Benefits Weekly benefits for surviving spouses who
If a volunteer firefighter or ambulance remarry and have dependent children are
worker dies from a compensable injury, the replaced by smaller lump sum benefits.
surviving spouse and/or minor children Children continue to receive weekly benefits.
(or other dependents as defined by law if
there are none), are entitled to continuing Funeral expenses are payable up to a
weekly cash benefits, depending on the maximum of $6,700, if the death occurs
date of death. A minor child is under age on or after January 1, 2006. If a volunteer
18, or under 25 if enrolled in an accredited firefighter dies from injuries received
educational institution. In no instance may in the line of duty as the direct result of
the weekly benefit amount exceed the legal firefighting, the $6,700 maximum is not
maximum, regardless of the number of applicable. A lump sum benefit of $56,000 is
dependents. paid to the surviving spouse, or to the estate
if there is no surviving spouse, after Jan.
Surviving spouses who have not remarried 1, 2006. These are in addition to all other
and have no dependent children are entitled benefits provided.
to the following weekly benefits:
If a beneficiary claiming death benefits
Firefighters, for benefits paid after Jan. 1, as a dependent or spouse of a volunteer
2006 member dies before a determination in his/
$887 per week if death occurred on or after her favor is made on the claim, all weekly
July 1, 1992. benefits due from the date of death of the
volunteer member up to the date of death
Ambulance Workers, for benefits paid after of the eligible beneficiary will be paid to the
Jan. 1, 2006 executor or administrator of his/her estate.
$887 per week if death occurred on or after
July 1, 1992.
Surviving spouses with dependent children
are entitled to smaller weekly cash benefits.
Children are also entitled to weekly cash
benefits. Waiver Agreements
Claimants can reach a settlement agreement
Weekly benefits for surviving spouses who with the insurer for the benefits the claimant
remarry after January 1, 2006, and have no will receive. In exchange, the claimant will
dependent children are replaced by the fol- waive his right to future benefits. Waiver
lowing lump sum benefit: agreements are entirely voluntary and are
not effective until approved by the Board.
Firefighters The Board will approve an agreement unless
$92,219 if death occurred on or after July 1, it is unconscionable, unfair or improper as a
1992. matter of law, is the result of an intentional
misrepresentation of material fact, or within
Ambulance Workers 10 days of submitting the agreement one
$92.219 if death occurred on or after July 1, of the interested parties asks the Board to
1992. disapprove the agreement.6 NYS Workers’ Compensation Board
Disability Classifications Rehabilitation and Social Work
An injured volunteer member’s health care Rehabilitation programs offer special services
provider will give an opinion on the extent of designed to eliminate the disability if possible,
the disability. Cash benefits are directly related or to reduce or alleviate the disability to the
to the following disability classifications: greatest degree possible; help an injured
worker return to work when possible; or aid
Permanent Total Disability: The volunteer a person with a residual disability to live and
member’s earning capacity is permanently and work at her maximum capability. The Board’s
totally lost. Rehabilitation staff includes counselors, social
workers, a consultant physiatrist, and claims
Temporary Total Disability: The injured examiners to coordinate and follow-up on
volunteer member’s earning capacity is lost medical and vocational rehabilitation services.
totally, but only on a temporary basis. Rehabilitation is voluntary except in limited
circumstances. Injured workers should
Temporary Partial Disability: The earning contact the rehabilitation unit at the Board to
capacity is lost only partially, temporarily. If the determine if they are required to participate.
loss of earning capacity is 75 percent or greater,
the volunteer member receives the maximum There are four general types of services.
amount, determined by the date of accident. If Vocational Rehabilitation programs help
the loss of earning capacity is between 50 and people whose disability keeps them from
75 percent, the benefit rate is $186.76 per week. returning to their former jobs. These services
may provide guidance to help the claimant
If the earning capacity loss is between 25 and 50 determine the best way to return to work.
percent, the benefit rate is $30 per week. If the
earning capacity loss is less than 25 percent, no Selective Placement programs help claimants
cash benefits are paid. who are left with a permanent disability, and
who need a job that will fit their abilities.
Permanent Partial Disability: Part of the
volunteer member’s earning capacity has been Medical Rehabilitation programs include
permanently lost. Benefits are payable at the exercise and muscle conditioning, under the
same rates as Temporary Partial Disability, supervision of a physician, to restore a person
except for Schedule Loss. to maximum usefulness. Only physicians may
recommend a medical rehabilitation program.
Schedule Loss: This is a special category of Social Services, which are provided by a
Permanent Partial Disability, and involves loss of staff of social workers, are designed to assist
eyesight or hearing, or loss of a part of the body an injured volunteer member with family
or its use. Compensation is limited to a certain or financial problems that interfere with
number of weeks, according to a schedule set rehabilitation.
by law. For instance, 25 percent loss of use of
an arm is equal to 78 weeks (1/4 of 312 weeks). Claimants who participate in one of the
rehabilitation programs continue receiving
Disfigurement: Serious and permanent cash benefits, based on the extent of the
disfigurement to the face, head or neck may disability. Claimants who return to work
entitle the volunteer member to compensation but cannot earn the same wages because of
up to a maximum of $20,000, depending upon an injury may be entitled to compensation
the date of the accident. benefits at a reduced rate.7 NYS Workers’ Compensation Board
Medical Care
An injured or ill volunteer member will have his
health care for that condition paid. This care is
Types of
covered whether or not you lose time from work. It Services Covered
is also paid in addition to any benefits you get for
missed wages. Medical
Health care providers must be authorized by the Osteopathic
Board. The Board has lists of providers who are au- Dental
thorized to treat you. You can find a doctor on the
Board’s web site, or by calling 1-800-781-2362. You Podiatric
can receive care from any of these providers, or Psychological
from your own doctor, if he or she is registered. (by referral)
The providers will send the bills directly to the
Chiropractic Treatment
insurer and the Board. Do not pay any bills un- Surgery
less the Board disallows your case. You may also Hospital Care
receive reimbursement for travel to and from a
health care provider’s office.
Laboratory Tests
If specific medical services are disputed, the Prescribed Drugs
insurer must pay any undisputed portion. It must
also explain in writing why the services were not Nursing Services
paid, and request any information needed to pay Surgical Appliances
them. Your doctors may ask you to sign Form A-9. Prosthetic Devices
This states you’ll pay the bills if the Board does not
allow your claim, or if you drop your case before
it’s accepted. Preauthorization is
sometimes required.
Preferred Provider Organizations
If the insurer has a network of providers to care
for injured workers, you must use those providers.
You’re not responsible for a copayment.
This is called a Preferred Provider Organization
(PPO). The insurer must notify you of this. If you If you must use an insurer’s network pharmacy,
aren’t satisfied with the care you receive from the the insurer must tell you how you should use it.
PPO, you may select an authorized provider out- Those pharmacies are paid directly. You will not
side the PPO after 30 days of treatment. be responsible for any charges.
Diagnostic Networks Exceptions
Insurers may also require you to use its network of 1. Testing: The insurer may not demand you use a
facilities for diagnostic tests. Make sure to tell your network provider for a diagnostic test in a medi-
doctors and other providers if the insurance carrier cal emergency. It may not demand you use a
requires you to use its network for diagnostic test. network that does not have a provider or facility
within a reasonable distance, which is one mile from
your home or employment in an urban setting, and ten
Pharmacy Charges miles in a suburban or rural setting.
You can go to any pharmacy, unless the insurer
uses a network. Make sure the pharmacist knows 2. Pharmacy: The insurer may not demand you
you have a workers’ compensation case, because use network pharmacies if it is not reasonably
many will bill the carrier directly, rather than you. possible in a medical emergency. You don’t need to
However, the pharmacy can ask you to pay for use network pharmacies if they don’t offer mail order
the prescription up front. The insurer must reim- or aren’t located a reasonable distance from you, either.
burse you within 45 days. The pharmacy can only
charge you the amount specified by law, so even if
you pay in advance, you will be fully reimbursed.8 NYS Workers’ Compensation Board
Hearings and Appeals Common Questions
The Board may hold hearings before a Q. If an activity is authorized by the proper
workers’ compensation law judge. The judge authority, is it covered?
may take testimony, review medical and other A. Not necessarily. The ambulance or fire
evidence, and will decide if the claimant is officer may authorize an activity, but if it is
entitled to benefits. If the claim is determined not provided for in the law, it may not be
compensable, the judge determines the amount compensable.
and duration of the compensation award.
Q. Must the claimant lose time in regular
Either side may appeal the decision within employment for the disability to be covered?
30 days of the filing of the judge’s decision, A. Not necessarily. The disability is
by applying in writing for Board review. If compensable if there is loss of earning
the application is granted, a panel of three capacity, or loss of use or partial use of a
Board members will review the case and either bodily member, eye or hearing.
affirm, modify or rescind the judge’s decision,
or restore the case to the judge to further Q. If a volunteer firefighter or ambulance
develop the record. If the panel decision is not worker receives remuneration or a gratuity
unanimous, any interested party may apply in in the performing a duty or activity covered
writing within 30 days for a full Board Review. under the law, can he still sustain a
The full Board must review and either affirm, compensable injury in the line of duty?
modify or rescind that decision. A. No. The following are not remuneration
or a gratuity: Reimbursed expenses for
Appeals of Board Panel decisions may be taken meals, lodging, necessary travel or a mileage
to the Appellate Division, Third Department, allowance; and accepting transportation, food,
Supreme Court of the State of New York, drink, shelter, clothing and similar items while
within 30 days. The decision of the Appellate on duty.
Division may be appealed to the Court of
Appeals. Q. Must a notice of injury be in writing?
A. Yes. The volunteer member, or a
Note: If a law judge’s decision is appealed, representative, must sign the notice. However,
the insurer does not have to pay wage the Board may excuse the failure to give
benefits while a Board Panel reviews the written notice on any of the following
case. However, compensation payments and grounds: for sufficient reason notice could
medical bills must be made if the Board Panel not have been given; a member of a body in
upholds the claimant’s award, even if an charge of, or any officer of, the ambulance or
appeal is made to the Appellate Division. In fire company/district had knowledge within
addition, the uncontested portion of a judge’s 90 days of the injuries or death; the political
award is paid even if a review application is subdivision, ambulance company or insurance
filed. carrier was not prejudiced by a delay in giving
such notice; the cause of disablement or death
was not known to be the result of service
performed in the line of duty as a volunteer
Claimants always have the right to an attorney member in sufficient time to comply with the
or licensed representative, who may not ask notice requirement.
for or accept a fee from the claimant. The
legal fee is determined by a law judge or Board
Panel, and is deducted from a compensation
award.9 NYS Workers’ Compensation Board
Common Questions (cont’d)
Q. How much medical care is provided for Q. May a closed case be reopened?
a compensable injury? A. Yes. The Board may reopen a closed
A. Necessary medical care is provided as case, subject to time limitations set forth in
long as the injury and recovery process the statute, upon application of any party.
require. The application must set forth the basis for
the requested reopening. However, a claim
Q. Is medical care provided even when
that has been totally settled by a waiver
time is not lost from work?
agreement cannot be reopened by the Board.
A. Yes.
Q. When does medical care require prior Q. May a volunteer firefighter or
authorization? ambulance worker render emergency
A. Prior authorization by the political service with another district or company?
subdivision, fire or ambulance company A. Yes. If a volunteer member offers
liable for the payment of benefits (or its individual service to another company in
insurer) is necessary for certain types of care, New York outside the area regularly served
such as nursing, and for other services that by the member’s company or district, and
significantly increase costs. after such services are accepted by the officer
in command at the scene, the responsibility
Q. Is the volunteer member reimbursed for benefits resulting from an injury in the
for purchasing necessary medicine or line of duty will fall to the fire or ambulance
prescribed drugs? company (and its political subdivision) that
A. Yes. The claimant must obtain receipts accepted the voluntary service.
and submit them to the political subdivision,
company, or insurance carrier involved. Q. What is the penalty for making a false
claim to obtain benefits?
Q. What happens when a claim is contested
A. Such a person is guilty of workers’
by the insurer?
compensation fraud, a class E felony.
A. To contest a claim, an insurer must
file a notice of controversy with the Board
within 18 days after the disability begins or
within 10 days of learning of the accident,
whichever is later. The carrier must give the
reasons why the claim is not being paid. The
issue is resolved by a law judge at a pre-
hearing conference or a hearing.10 NYS Workers’ Compensation Board
Board Services
Customer Service Advocate for Business
1.877.632.4996 1.800.628.3331
Advocate for Injured Fraud Referral Hotline
Workers 1.888.363.6001
1.800.580.6665 Disability Benefits
Health Care Provider 1.800.353.3092
1.800.781.2362
Board Offices
Albany District Office Hempstead District Office
100 Broadway - Menands 175 Fulton Avenue
Albany, NY 12241 Hempstead, NY 11550
1.866.750.5157 1.866.805.3630
Binghamton District Office Manhattan District Office
State Office Bldg., 44 Hawley Street 215 W. 125th Street
Binghamton, NY 13901 New York, NY 10027
1.866.802.3604 1.800.877.1373
Brooklyn District Office Peekskill District Office
111 Livingston Street 41 North Division Street
Brooklyn, NY 11201 Peekskill, NY 10566
1.800.877.1373 1.866.746.0552
Buffalo District Office Queens District Office
Ellicott Square Building 168-46 91st Avenue
295 Main Street - Suite 400 Jamaica, NY 11432
Buffalo, NY 14203 1.800.877.1373
1.866.211.0645
Rochester District Office
130 Main Street West
Hauppauge District Office
Rochester, NY 14614
220 Rabro Drive, Suite 100
1.866.211.0644
Hauppauge, NY 11788-4230
1.866.681.5354 Syracuse District Office
935 James Street
Syracuse, NY 13203
1.866.802.3730
Send claims-related mail to:
NYS Workers’ Compensation Board
PO Box 5205 • Binghamton, NY • 13902-5205
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