Recent Developments in Workers Compensation

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Recent Developments in Workers’ Compensation

AN ARM AND A LEG: CALCULATING PROTRACTED HEALING WHEN A SINGLE CLAIM INVOLVES MULTIPLE EXTREMITIES

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 [...]

AN ARM AND A LEG: CALCULATING PROTRACTED HEALING WHEN A SINGLE CLAIM INVOLVES MULTIPLE EXTREMITIES2021-01-28T13:56:45-05:00

Establishing Work-Related Covid Claims: Back to the Future Part 2.1

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 [...]

Establishing Work-Related Covid Claims: Back to the Future Part 2.12021-02-26T12:03:28-05:00

IF IT LOOKS LIKE AN IME, ACTS LIKE AN IME . . . IT IS AN IME

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 [...]

IF IT LOOKS LIKE AN IME, ACTS LIKE AN IME . . . IT IS AN IME2020-10-29T14:52:26-04:00

Words have meaning, except when they don’t…

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 [...]

Words have meaning, except when they don’t…2020-09-23T13:59:55-04:00

The “L” Code Pigeonhole

          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 [...]

The “L” Code Pigeonhole2020-08-27T11:14:59-04:00

WHEN THE NYS WCB PLACES FORM OVER SUBSTANCE

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 [...]

WHEN THE NYS WCB PLACES FORM OVER SUBSTANCE2020-07-17T10:43:31-04:00

Medicare Set Asides: Know the Basics and Settle with Confidence

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 [...]

Medicare Set Asides: Know the Basics and Settle with Confidence2020-06-25T15:04:23-04:00

Do Not Automatically Reimburse Health Providers When You Receive a HIMP-1 Request

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 [...]

Do Not Automatically Reimburse Health Providers When You Receive a HIMP-1 Request2020-05-26T13:30:57-04:00

The Wholesale Waiver Agreement

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 [...]

The Wholesale Waiver Agreement2020-04-27T13:11:05-04:00

EXPOSURE TO GERMS AND ACCIDENTAL INJURIES UNDER THE WORKER’S COMPENSATION LAW – BACK TO THE FUTURE – pre-Covid-19 background

Practice Tip: be aware that claims can be made by employees outside of the healthcare setting for infections if there is proof that the infection was contracted on the job In 1975 the Court of Appeals rendered a decision in the case of Middleton v Coxsackie Correctional Facility, 38 N.Y.2d 130 [...]

EXPOSURE TO GERMS AND ACCIDENTAL INJURIES UNDER THE WORKER’S COMPENSATION LAW – BACK TO THE FUTURE – pre-Covid-19 background2020-12-21T12:11:45-05:00