Goldberg Segalla, Author at Workers' Compensation Defense

December 14, 2017 General

Luck Favors the Prepared: Reducing Exposure and Expense with a Thorough Initial Claims Investigation

The importance of thoroughly investigating a claim at its inception cannot be overly stressed. Whether a case is accepted or controverted, a thorough investigation is necessary to be prepared to raise all defenses at the first hearing to set the case on a course to the least exposure and the most cost-effective management of liability.

In the event a case is accepted, a thorough investigation entails getting a detailed reporting from the insured such that the FROI-00 and FROI-02 outlines the mechanism and sites of …

December 1, 2017 Uncategorized

Admissibility and Disclosure of Social Media Information

Facebook. Twitter. Instagram. Social media platforms have become useful sources for carrier investigation and surveillance of injured workers. Claimants utilize these social media platforms on a daily basis, posting a variety of photographs and videos. Often these photographs and videos contradict claimants’ allegations that they are “totally disabled” from performing any type of activity, allowing carriers and employers to raise fraud under Workers’ Compensation Law Section 114(a).

Generally, in order to raise fraud under WCL Section 114(a), the carrier and employer must disclose covertly obtained …

November 17, 2017 North Carolina

North Carolina Court of Appeals Affirms Full Commission Decision: Injury does not Fall under Pre-Amendment N.C. Gen. Stat. § 97-29

The North Carolina Court of Appeals has recently decided a case where the 2011 amendment of N.C. Gen. Stat. § 97-29 was in dispute.

In Brown v. N.C. Dept. of Public Instruction, the plaintiff suffered three injuries in 2002, 2011, and 2012, respectively all to her right shoulder. Here, the plaintiff alleged that her 2012 injury was related to her 2011 injury, which occurred days before § 97-29 was amended to establish the 500-week cap on compensability benefits. Prior the amendment, there was no …

October 30, 2017 Average Weekly Wages

The Department of Labor Announces Increased National Average Weekly Wage Now in Effect

The time has come for the annual adjustment in Longshore and Harbor Workers’ Compensation Act (LHWCA) rates. The Department of Labor, which administers the Longshore Act, has announced the new National Average Weekly Wage (NAWW) of $735.89; an increase of 2.46 percent over the previous NAWW. This NAWW will be in effect from October 1, 2017 through September 30, 2018, and will affect ongoing permanent total disability benefits and death benefits.

The increase in the NAWW will also lead to a slight increase in the …

October 30, 2017 Maryland

The Aftermath of Zakwieia and Reger — The Court of Special Appeals Finds LE §9-610 Offset Does Not Apply to Ordinary Disability Benefits for a Different Injury

In the past year there has been a flurry of litigation in Maryland regarding what exactly a “similar benefit” is, and when an offset is warranted under Labor and Employment § 9-610. We first had Zakwieia in early 2017, holding that a similar benefit is “whether the benefits provide a similar wage loss benefit to a workers’ compensation award, not whether the benefits accrue from a similar injury.” Zakwieia v. Baltimore Co. Bd. Of Educ., 231 Md. App. 644, 654 (2017). Just six months later …

October 16, 2017 New York

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 is only available when payments for lost wages or payments for prescribed medicine (prescribed medication …

October 6, 2017 Uncategorized

Fruit of the Poisonous IME: Avoiding IME Preclusion

Independent medical examinations are often the only evidence a carrier can rely on when litigating medical issues. As much as avoiding a situation where an IME is precluded for not complying with the strict requirements of Section 137 is ideal, from time to time it happens, and it is best to have a plan for moving forward. If the medical issue is ongoing, such as degree of disability or need for further treatment, the best thing to do is to schedule another IME as soon …

October 6, 2017 Disability Benefits / Maryland

The Law Is Fickle – Maryland Court of Appeals Clarifies Zakwieia, the Phrase “Similar Benefits,” and its Effect on Disability Offsets

Recently, the Court of Special Appeals of Maryland (CSA) held that the phrase “similar benefits,” found within LE §9-610, examined whether an employee’s ordinary disability benefits provided a similar wage loss benefit to the employee’s workers’ compensation benefits. Zakwieia v. Baltimore County, Board of Education, 231 Md. App. 644 (2017). The practice of law is fast-paced and waits for no one. In Reger v. Washington County Board of Education, et al., 2017 WL 3317892 (publication pending), the Maryland Court of Appeals (COA) has …

September 22, 2017 Maryland

Get Ready: New Maryland Workers’ Compensation Laws Set to Take Effect on October 1, 2017

The date for your new workers’ compensation laws to take effect is now upon us. The Maryland legislature passed several workers’ compensation bills in early 2017 that will be taking effect on October 1, 2017.

The law that will likely have the greatest effect on claims handling in Maryland is the requirement that medical providers submit their bills for payment within one year from the later date of: (1) the date of service; (2) the date the claim was accepted as compensable by the employer/insurer; …

September 22, 2017 Illinois / Temporary Total Disability (TTD)

Holocker Widens the Interstate: A New Workers’ Compensation Decision Sets Forth Employer Defenses to Terminate Temporary Total Disability Benefits

A recent Workers’ Compensation decision has outlined employer defenses to terminate temporary total disability (TTD) benefits prior to a maximum medical improvement (MMI) finding.

In Holocker v. Ill. Workers’ Comp. Comm’n, 2017 IL App (3d) 160363WC (June 16, 2017), the Appellate Court affirmed that termination of temporary total disability benefits was proper despite the petitioner’s ongoing causally related treatment. The court also affirmed that termination of benefits due to the petitioner’s discharge for cause was proper because the petitioner’s restrictions had no effect on …