Claimant Information Packet
You were injured while volunteering. What now?
If you’ve suffered a workplace injury or illness, you may be eligible for volunteer firefighter or ambulance worker benefits. You may have already received medical treatment. If you haven’t, you should seek the medical care that is necessary.
A Volunteer Members’ Responsibilities
- You must tell your department or squad supervisor, in writing, when, where and how you were injured. Report injuries as soon as possible but always within 30 days of the injury.
- Medical reports are necessary for your case. Advise your doctors that you have a work-related injury, and give the name of your volunteer fire department / ambulance squad. Do not pay for your care yourself or use other health insurance. Tell your doctor to file reports with the NYS Workers’ Compensation Board and with Warren County Self-Insurance, your employers insurance carrier. Ask that your doctor complete the “Encounter Form” and fax it back to Warren County Self-Insurance. This may help expedite your claim. If your case is disputed, the Workers’ Compensation Board needs a medical report on your injury to begin resolving your claim.
Starting a Case
Once your department / squad knows of your injury, they must notify the Warren County Self-Insurance Department by filing a C-2F form. You should file a Volunteer claim (VF-3 or VAW-3) form reporting your injury as soon as possible. If you injured the same body part before, or had a similar illness, you must also file a Form C-3.3. You should complete the “Authorization to Obtain Information” and give it to your department / squad supervisor immediately.
If you haven’t already filed a VF-3, VAW-3 or C-3.3 (if necessary), there are three ways to do it.
- Complete the paper forms that your department / squad provided to you and give them to the employer. Additionally, you can also mail this form to the Workers’ Compensation Board.
- Visit the Workers' Compensation Board to complete the form online.
- Call 1-866-396-8314. A Workers’ Compensation Board employee will complete the form with you.
Health Care Benefits
Do not pay your doctor or hospital. Those bills are paid by the insurer unless the Workers’ Compensation Board disallows your case. If your case is disputed, the providers are paid when the Workers’ Compensation Board decides your case. If the Workers’ Compensation Board decides against you, or if you don’t pursue a case, you will have to pay the doctor or hospital.
Warren County Self-Insurance covers medically necessary drugs and equipment that your doctor prescribes. You’re also entitled to carfare or necessary expenses incurred when traveling for treatment. (Get receipts for those expenses.)
Generally, you can choose any doctor authorized by the Workers’ Compensation Board. You can also use occupational health clinics. Warren County participates in the ONECALL MEDICAL diagnostic radiology network, therefore if you require diagnostic radiology services (MRI, EMG, NCS, CT, Ultrasound, Bone Scan or Arthrograms) you or your physician must contact us before performing these tests. Additionally, Warren County participates in the AWPRx pharmacy benefits network. Therefore, pharmacy benefits must be obtained from a AWPRx network pharmacy.
Benefits for Lost Wages
You are entitled to a portion of your lost wages if your injury affects you in one or more ways:
- It keeps you from work;
- Part of your body is permanently disabled;
- Your pay is reduced because you now work fewer hours or do other work.
An employer or insurer can accept your claim and begin paying your lost wage benefit promptly. Sometimes, employers and carriers dispute a claim. When that occurs, the Workers’ Compensation Board strives to resolve most cases within 90 days.
You may hire an attorney or licensed representative, who can be helpful with complex or disputed claims, but it isn’t required. The Workers’ Compensation Board sets their fees and they will be deducted from your lost wages award. You should not pay anything directly to your attorney or licensed representative.
If your case is disputed, you may be eligible to receive short term disability benefits while the case is heard. Check with your employer about disability benefits and ask for a DB-450 claim form. If your case is accepted, you will pay back the disability benefits out of your lost wages award.
Help is Available
People sometimes need help getting back to work. An injury can also cause family or financial problems. The Workers’ Compensation Board has rehabilitation counselors and social workers to help. Call (877) 632-4996 for assistance. More information is also available on the NYS Workers’ Compensation Board website.
Warren County Self-Insurance will send you information and documentation if your claim is accepted or denied. When the claim is accepted, your treatment will be paid and lost wages benefits begin. If your case is challenged, the Workers’ Compensation Board will notify you about resolving the case. If more information is necessary, the Workers’ Compensation Board will contact you and tell you how to file it.
Important Contact Information
Workers’ Compensation Board: 877-632-4996
Warren County Self-Insurance: 518-761-6528