In claims that involve both injuries to the spine and extremities, at the time of permanency, a claimant may obtain evidence of a classification and a schedule loss of use. In the past, in order to collect a schedule loss of use, there had to be a finding of no permanency to [...]
PRACTICE TIP: When negotiating a schedule loss of use award involving multiple extremities, first determine whether periods of temporary total disability can be assigned to individual extremities in order to avoid additional weeks of indemnity benefits due to protracted healing. In the case of Department of Correction, WCB G127 [...]
Practice Tip: At present the New York State WCB is not requiring the submission of an explicit opinion from a qualified expert causally relating a worker’s development of COVID to an exposure on the job. Decision-making with regard to individual claims should anticipate Appellate Decision and/or Court of Appeals rulings in [...]
PRACTICE TIP: Do not assume that a physician practicing at an Occupational Health Clinic Network (OHCN) is exempt from the requirements of Section 137 if the physician is evaluating the claimant for purposes of a permanency or other opinion outside of a continuing doctor/patient relationship. New York State Workers’ Compensation Law [...]
From the Desk of Attorney Jason M. Carlton PRACTICE TIP: After a finding of Prima Facie Medical Evidence (PFME) is made, careful cross-examination of an attending physician should be undertaken to probe the certainty with which a causal relationship opinion has been provided. In the New York workers’ compensation case of [...]
Practice tip: Beware of the L Code. Consider the timeline you have to file your first FROI form and always err on using the W code or the without liability code to allow ample time to properly investigate the claim. If you are unsure of the extent of liability [...]
PRACTICE TIP: Upon receipt of an appeal from an adverse party, make sure that your counsel carefully scrutinizes the RB-89 (Application for Board Review) form looking for defects in completion of the form which might render the appeal non-reviewable on procedural grounds. In the case of Perry v. All American School [...]
Practice Tip: Medicare Set Asides are a crucial step in settling a New York Workers’ Compensation Claim. Obtaining formal approval from the Centers for Medicare and Medicaid Services (CMS) of a set aside is never required. However, obtaining approval is obviously the best case since it allows for confirmation directly from [...]
Many carriers automatically reimburse private health insurance providers in full for medical treatment and prescriptions that were initially billed to the private health insurance provider rather than a workers' compensation carrier. In many cases, full reimbursement is not appropriate. There are many valid defenses to paying some or all of these [...]
CONVERTING NEW YORK STATE WCL § 15-8 REIMBURSEMENT CLAIMS INTO A LUMP SUM ON BEHALF OF THE EMPLOYER: THE WHOLESALE WAIVER AGREEMENT PRACTICE TIP: Converting future Section 15-8 reimbursement claims into a lump sum may be a viable option resulting in immediate financial resources and elimination of the need to routinely [...]
