Any final determination of law can be appealed. The requirements for the appeal process in the New York Workers’ Compensation system are found in N.Y. Work. Comp. Law § 23. A party that disagrees with a law judge’s decision under the law can request a review of the decision, if the appeal is timely filed on the proper form within 30 days of the filing of the decision being appealed. Orders of the Chair are not appealable but if a party believes there is an error, a party may request the Board to rescind the Order of the Chair.
Application for Board Review
The first level of appeal is known as an “Application for Board Review.” This appeal is made when a party disagrees with a decision at the hearing level (Notice of Decision or Reserved Decision).
This is an administrative appeal and the appeal is considered by a three member Panel of the Board. The appeal must be filed with the Board within 30 days of the filing date of the decision. The party defending the appeal (respondent) has 30 days to file a rebuttal. 12 NYCRR 300.13(b).
An appeal from an award to the Board operates as a stay of the obligation to make payment for disputed indemnity benefits or medical bills. N.Y. Work. Comp. Law § 25(c).
Most people are very familiar with traumatic or specific injuries. An employee slips and falls at work while she is engaged in her work duties and breaks her ankle – this is an example of a traumatic or specific injury that was suffered in the course of a workers’ employment. In the aforementioned example, after investigation of the facts it is usually easy to ascertain if the employee’s accident “arose out of and in the course of her employment.” Therefore, this type of injury will likely be covered under New York’s Workers’ Compensation Law.
An occupational disease is slightly more difficult to define, but like traumatic injuries, if it is determined by the Workers’ Compensation Board that an occupational disease was developed in the course of a workers’ employment, the person suffering from the disease will be entitled to medical and indemnity benefits associated with the work related disease under New York’s Workers’ Compensation Law. Occupational diseases are injuries and/or conditions that arise out of a workers’ employment, usually through exposure to specific harmful conditions or through repetitive physical actions. Continue reading Defining Occupational Disease in New York→
The use of opioids is widespread in the treatment of numerous injuries in New York. Although prescribed by a number of doctors, great care must be taken when opioids are found to no longer be necessary. Recently, Judges have ordered both the carrier and the claimant to submit drug weaning programs when an IME doctor finds that the use of opioid drugs is no longer necessary for the claimant’s continued treatment.
What is a Drug Weaning Program and Why is It Necessary?
Use of Opioids: Transitioning/Managing Patients on Existing Opioid Therapy. The claimant’s physician must abide by the MTG recommendations to ensure that the management and treatment of a patient with non-acute pain is performed according to the principles for safe long-term opioid management and guidelines for optimizing opioid care pain (F.2.c [F.2.c.i-F.2.c.ii] and F.3 [F.3.a, F.3.b.i-iv, F.3.b.c.i-ii, F.3.d.i-iv, F.3.e.i-vi]).
Some of the MTG recommendations include: the need to routinely monitor the safety and effectiveness of treatment (improved function and pain control), an informed consent form (F.3.c), opioid understanding form (F.3.c.ii), appropriate monitoring and screening (random urine drug testing (F.3.d.i-iv), unannounced pill count(s), and evaluation and monitoring for adverse effects of and interactions with medications (F.3.b.i-ii and Table 3: Adverse Effects of Opioids). Continue reading Opioid Weaning Programs under the New York Non-Acute Pain Medical Treatment Guidelines→
Here is the post-webinar video from our most recent presentation, “Do I Have to Pay Temporary Disability?” which discusses the lost time benefit under the New Jersey Workers’ Compensation Act and recent case law. To join us for our monthly webinars on New York and New Jersey workers’ compensation law, Click here to register.
As per NY Workers’ Compensation Law § 14(1), a “claimant’s average daily wage is used in determining his or her annual average wage only when such claimant has worked in the same job for substantially all of the year preceding his or her injury.”