Practice Tips and Tactics Involving Additional Providers in New York

On January 1, 2020, additional medical providers have been authorized to treat claimants under the New York State workers’ compensation system. Physicians, chiropractors, podiatrists, and psychologists are joined by physical therapists, occupational therapists, physician’s assistants, nurse practitioners, licensed clinical social workers, and acupuncturists as Board-authorized providers. Not all approved providers have blanket approval from the Board, though. The differences in approval of the expanded providers give the carriers and self-insured employer the upper hand in some situations under New York State workers’ compensation.

Of note, …

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Obtaining and Maintaining Proper Working Papers – It’s No Minor Task

Prior to hiring a minor (an employee who is under the age of 18), an employer has an obligation to obtain the minor’s employment certificate or permit issued in accordance with the education law (commonly referred to as “working papers”). Prior to the minor starting work, the employer must file this certificate at the place of the minor’s employment so that it may be readily accessible to any person authorized by law to examine such a document.

If a minor is injured while on the …

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Treatment Authorization Requests: Ensuring Proper Compliance with 12 NYCRR 325-1.4

Workers’ Compensation Law Section 13 establishes the obligation of the employer to “promptly provide for an injured employee such medical surgical, optometric or other attendance or treatment… for such period as the nature of the injury or the process of recovery may require.”

When requesting authorization for treatment, the provider submits a Board form titled, “Attending Doctor’s Request for Authorization and Insurer’s Response.”  The Board code for the form is shortened to C-4AUTH. Unlike a variance request, a request for authorization in a C-4AUTH is …

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Concurrent Employment – Limiting and Litigating Average Weekly Wage

Claimants may have more than one job at the time of their work incident. Pursuant to New York Workers’ Compensation Law Section 14(6), the average weekly wage can be increased if the claimant has two or more jobs at the time of the work injury. Therefore, this issue of concurrent employment is raised by a claimant, and not a carrier, because it can mean more indemnity benefits to the claimant. When concurrent employment is raised, the claimant should provide written documentary proof of concurrent employment, …

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American Patriotism Honored: 9/11 First Responders Receive the Health Benefits They Deserve

On September 11, 2019, some of New York’s greatest heroes were honored as Gov. Cuomo signed legislation to aid first responders who developed a qualifying health condition due to harmful exposure after those dreadful attacks 18 years earlier. This legislation reminds all New Yorkers that while the effects of this horrific day continue to live physically and emotionally within first responders, New York City will continue to connect them to health benefits.

First responders who helped in providing service on September 11 suffered drastic health …

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Special Funds Liability Under the Board’s Special Funds Group

It has become apparent over the recent years that the New York Workers’ Compensation Board, along with the Special Funds Group, will go to great lengths to resolve themselves of liability for outstanding claims under NY WCL Section 25(a), as well as 15(8), particularly in consequential death claims.

Under the 2007 reforms, the then-Second Injury Fund was closed to new claims with dates of injury on or after July 1, 2007. Then, on March 29, 2013, Section 25(a) was amended to close the Fund for …

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Expanded Provider Legislation; Implications for Insurance Carriers

As part of Gov. Cuomo’s 2019-20 executive budget, a new law was passed expanding the types of medical providers that can apply to be authorized to treat injured workers under the New York State Workers’ Compensation System. The law will be effective January 1, 2020.

Prior to the legislation taking effect, only physicians, chiropractors, podiatrists, and psychologists could apply to be board-authorized to treat injured workers while nurse practitioners (NPs), physician assistants (PAs), occupational therapists, physical therapists and licensed clinical social workers (LCSWs) could only …

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Schedule Loss of Use Award or Classification? Litigation Trends Following Taher

On June 14, 2018, the Third Department of the New York State Appellate Division issued the decision Matter of Taher v. Yiota Taxi. In Taher, the Third Department addressed the question of whether a claimant may receive both a schedule loss of use (SLU) award and classification arising out of the same work-related injury at the time of permanency. Ultimately, the Third Department held that a claimant cannot receive both a SLU award and be classified with a loss of wage earning capacity at …

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The Effect of Immigration on New York Workers’ Compensation

New York state has one of the largest undocumented immigrant populations in the nation, coming in fourth behind Texas, California, and Florida. According to the most recent study taken by Pew Research Center in 2016, 725,000 unauthorized immigrants lived in New York state. Although it is illegal for employers to hire immigrant workers who are not documented and authorized to work in the United States, whether it is intentional or not, employers continue to hire undocumented immigrant workers every day.

When undocumented workers are injured …

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What to Expect with Wage Expectancy: A Primer

When dealing with claims of injured workers under the age of 25, the wage expectancy statute of New York’s workers’ compensation law looms overhead that first time you calculate the claimant’s wage at the time of injury. While it does not apply in every instance, there are some ways to effectively avoid pitfalls. One major key to your defense is setting up a game plan as early as possible.

The wage expectancy provision of the workers’ compensation law was enacted in recognition of the fact …

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