New York Workers’ Compensation Law (WCL) dictates that an injured worker is entitled to reimbursement for certain expenses relating to an established compensable claim. WCL Section 13(a) provides that an employer is obligated to provide an injured employee with such medical, surgical, or other attendance or treatment as the nature of the injury or the process for recovery may require. In kind, courts have ruled that transportation costs incurred in connection with medical treatment are compensable if reasonable, and that the statute should be interpreted …Continue Reading
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 …Continue Reading
In order for an Independent Medical Examination (IME) report to be compliant with Section 137 of the Workers’ Compensation Law, a copy of each report must be submitted by the practitioner on the same day and to the Board, the insurance carrier, the claimant’s attending physician or practitioner, the claimant’s representatives, and the claimant themselves in the same manner (WCL Section 137(1)(a)). “If a practitioner who has performed or will be performing an independent medical examination of a claimant receives a request for …Continue Reading
There are two types of permanency evaluations:
- Schedule awards for the impairment of extremities, vision loss, hearing loss, or facial disfigurement
- Non-schedule classification as a permanent partial or total disability.
On October 4, 2019, in subject number 046-1211, the Board issued specific circumstances where a new attachment must be used when stipulating to schedule loss of use and non-schedule sites are also involved.
The new stipulation must be used in three situations:
- When there is no medical report from either party regarding the established non-schedule
Occasionally, when a workers’ compensation claim is initiated, medical bills are paid by the claimant’s private health insurance. If this happens, you may receive correspondence from the health insurer asking for reimbursement. What should you do in that situation?
The short answer is that you have no obligation to respond to a direct demand for reimbursement. However, there is a process for reimbursement. This is where the Health Insurer Match Program (HIMP) comes into play.
Per the Board, “health insurers may submit information regarding payments …Continue Reading
When settling a workers’ compensation claim in any state, carriers and self-insured employers often make one of two crucial errors based on two commonly accepted compliance myths. Most focus solely on $25,000 and $250,000, the two threshold markers for determining if the Centers for Medicare and Medicaid Services (CMS) approval is required (the former if the claimant is Medicare enrolled, the latter if the claimant is expected to be enrolled within 30 months of settlement). However, the real issue that both parties in a workers’ …Continue Reading
Clients frequently seek advice on how to resolve workers’ compensation claims. Often, as attorneys, we are in the best position to negotiate a settlement when we have some leverage on issues impacting a claimant’s entitlement to benefits, such as cases where labor market attachment has been raised or a client’s consultant is of the impression that a claimant has no further causally related disability. In short, timing is everything in negotiations.
Timing is also important when attempting to resolve a workers’ compensation claim where the …Continue Reading
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 …Continue Reading
The North Carolina Court of Appeals recently affirmed the Industrial Commission’s denial of claims, collectively known as the bellwether cases, that constituted a small portion of 144 consolidated workers’ compensation claims.
Specifically, Walter Hinson, decedent-employee, worked for Continental Tire the Americas at its factory in Charlotte, North Carolina. The decedent’s estate alleged that his employment exposed him to levels of harmful airborne asbestos sufficient to cause asbestos-related disease. In addition to the decedent’s estate, approximately 143 other employees and/or estates similarly alleged occupational exposure to …Continue Reading
Upon the filing of a New Jersey workers’ compensation claim petition, it is extremely important to thoroughly investigate the history of the alleged injured worker to ensure you attain the best possible outcome and to prevent unnecessary expenses. This is a relatively well-known strategy. However, in a rush to close or settle a matter, this strategy can sometimes be overlooked, which can result in significant costs to an employer.
In a recent unpublished opinion by the New Jersey Appellate Division, the appellate court affirmed the …Continue Reading