What Did You Know and When Did You Know It? The Meaning and Impact of Knowledge in Occupational Disease Claims

There are statutes of limitation relating to occupational diseases which reference the claimant’s knowledge of their condition and other factors. Generally, I find that people tend to misinterpret the meaning of knowledge in these contexts; as such, I will endeavor to provide you with a general idea of what this means in a workers’ compensation context in New York claims. The first reference I’ll discuss comes from New York Workers’
Continue reading...

Defending Against Darcon: The Policy Language is Controlling

In 2011, the Board Panel issued a decision in Employer: Darcon Construction (2011 NY Wrk comp G0223167), which contained one throwaway line that has been causing confusion at the hearing level ever since. In this case, a specific work site was covered by a wrap up policy. The Board Panel found that no discrete accident occurred at the work site, therefore, the proper carrier was the carrier of the general
Continue reading...

New York Sets Boundaries: How to Calculate Schedule Loss of Use of the Shoulder in 2018

The New York Appellate Division has provided direction on what constitutes an improper calculation of the schedule loss of use of a shoulder. In Matter of Maloney v. Wende Correctional Facility, 2018 WL 456207 (January 18, 2013), the claimant injured his right shoulder as a result of a work related accident on July 30, 2013. The claimant’s treating physician rendered a permanency finding of 90 percent schedule loss of use
Continue reading...

Pre-Hearing Conference Statement Crackdowns Throughout New York

Throughout New York State, we are starting to notice the Law Judges becoming extremely strict on the content placed on the carrier’s Pre-Hearing Conference Statements which accompany claim denials.  Where Law Judges used to be lenient, they are now requiring more detailed information regarding the denial and the employer witnesses who will be called to testify — and in some cases precluding witnesses due to lack of necessity or vagueness
Continue reading...

The How-To’s of Virtual Hearings

New York State has recently revealed that it will be implementing a virtual hearing procedure for all workers’ compensation hearings. The roll-out of the virtual hearing process began in November and is already in place in select downstate hearing points and is making its way to Binghamton and other upstate hearing locations in the very near future. The virtual hearing process allows (read: strongly encourages) claimants, attorneys, licensed representatives, and
Continue reading...

It’s Possible to Avoid Total Industrial Findings When Claimants Have a High Impairment Rating

Recent Board Panel decisions are providing guidance for employers to successfully avoid a total industrial finding when addressing Loss of Wage Earning Capacity. Indeed, there does not appear to be any basis under the law for an administrative law judge to find a total industrial disability. In Town of Fenton, Case Nos. G0501597, 90502069, G0087246, 2015 WL 7067972, at *6 (N.Y. Work. Comp. Bd. Nov. 5, 2015), the Board Panel
Continue reading...

To Pay or Not to Pay While Investigating a Claim

New York State Workers’ Compensation law §21-a allows an employer/carrier to pay lost wage benefits or prescribed medicine for up to one year without admitting liability and without prejudice to the right to controvert the claim. The purpose of this section of the law is to provide workers lost wage benefits and payment of prescription medicine while the employer/carrier continues to investigate the compensability of the claim. However, § 21-a
Continue reading...

Live Outside of New York? The Medical Treatment Guidelines Still Apply

In a recent Board Panel Decision, In the Matter of Hospice Inc., 2017 NY Wrk Comp 59513410, the Board found that the Medical Treatment Guidelines apply to any treatment provided to any claimant, regardless of where the claimant lives or where the treatment is provided, for treatment to the neck, mid and low back, shoulder, knee, carpal tunnel, and non-acute pain. Notably, the Board held that the applicability of the
Continue reading...

The Essentials: Proposed New York 2018 Schedule Loss Guidelines

On September 1, 2017, the New York Workers’ Compensation Board issued draft guidelines and regulatory changes for 2018. The guidelines are intended to revamp the schedule process to align with modern medical practices. The drafts of both the guidelines and regulations appear to include possible errors, omissions, and ambiguities. Click here for a brief overview of the new proposed SLU process and for an idea of what to expect if
Continue reading...

Denied Again! Bronx Civil Court Rejects Request of Out-of-State Providers to Re-Litigate Denied Medical Billing

One of the most basic and well-settled tenets of New York law is that the Workers’ Compensation Board maintains exclusive subject matter jurisdiction over all work-related claims and collection disputes. However, in 2015, a small law firm based out of Westbury, New York sought to disrupt the system by commencing several hundred lawsuits in Civil Court, Bronx County on behalf of out-of-state pharmaceutical and durable medical equipment providers arising out
Continue reading...