Workers' Compensation Defense

January 19, 2018 New York

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 on the PH-16.2 forms.

The procedure for denying claims has not changed. The carrier is …

January 4, 2018 General

Tips for a Safe and Successful Year

The start of a new year is the perfect time to review your list of panel providers. Make certain that your list meets the requirements of at least six designated health care providers. At least three of the providers must be physicians and no more than four can be a coordinated care organization. At least one provider on the list must be a chiropractor. The list must include the names, addresses, phone numbers, and areas of medical specialties of all health care providers and be …

January 4, 2018 Medical Marijuana

Leafing Through Medicinal Marijuana Updates

Since the spring of 2017, there has been an addition to the list of qualifying conditions eligible for medical marijuana. There has also been an increase in the number of patients and providers eligible and registered under the program. This post will serve as an update on the issue and how to “weed” through the options for denials in New York State workers’ compensation claims.

The most recent list of medical providers for medicinal marijuana can be found here.

Currently, there are 35 …

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 14, 2017 New York / Virtual Hearings

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 witnesses to appear at all workers’ compensation hearings via their computer, tablet or mobile device. …

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 …

December 1, 2017 Illinois

Is Your Valid FCE Really Valid?

It may not be. There is a tendency to accept a Functional Capacity Evaluation (FCE) as an objective measurement of everything a claimant can and cannot do. However, it may pay to delve deeper as not all FCEs are created equal. Understanding what to look for and when to challenge a valid FCE can be the difference between a simple loss of use becoming a job change or even a wage differential award.

FCE Method

There is no standard method of performing an FCE so …

November 17, 2017 Uncategorized

Chemical Exposure Case!? Fear Not! You Are Not at the Mercy of the Claimant’s Physician

Imagine receiving a medical report from an oncologist that notes “myelodysplastic changes to chromosome 3 and chromosome 7.” Imagine further that you see such language as “cytogenetics” that reports “abnormal results,” or that both “monosomy 7 and fusion RPM 1/MECOM typically correlate with myelodysplastic syndrome and acute myeloid leukemia.”

Imagine further that this medical report is attached to a C-3 opening a claim for a causally-related occupationally acquired cancerous condition. Certainly, the highly technical language of cancer diagnoses (in this case acute myeloid leukemia) is …

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 Trucking

Hey! What about Workers’ Compensation? Evidence Preservation and Investigation for Trucking Workers’ Compensation Claims

Evidence preservation seems to be the number one discussed topic in terms of defending trucking companies for liability claims. For serious accidents, it is common to dispatch defense attorneys and experts to the scene of the accident to preserve evidence necessary to contest liability when appropriate. What is less discussed is that the same data can be invaluable for investigating and defending workers’ compensation claims.

A rapidly increasing number of fleets are utilizing onboard event recorders with both outward and inward facing cameras. Electronic driver …