About one-in-five of the new cases filed in the New Jersey Division of Workers’ Compensation this year will be a “re-opener” claim. Formally called an “Application to Review or Modify a Formal Award” or “Application for Modification of Agreement” as per N.J.S.A. 34:15-27, these claims are brought by petitioners who allege that they have a need for treatment, have new lost time, or have an increase in the amount of permanent partial disability.
What types of cases are eligible for “Re-Opener?”
Compensable workers’ compensation claims are often resolved by way of an “Order Approving Settlement.” Such a settlement requires the employer/respondent to continue providing medical treatment for the injuries described on the Order Approving Settlement. In addition, a claimant has the right to “re-open” her claim for a period of two years from last compensation paid. Additionally, claims resolved by way of Judgment (award following litigation) are subject to re-opening by the petitioner.
As per the statute:
A formal award, determination and rule for judgment or order approving settlement may be reviewed within 2 years from the date when the injured person last received a payment upon the application of either party on the ground that the incapacity of the injured employee has subsequently increased. Continue reading “Re-Opener” Awards in New Jersey
Awards for wage replacement are equal to 66.6% of the employee’s average weekly wage, subject to maximums (currently $ 870.61) and minimums (currently $150 per week). Workers’ Compensation Law § 2(9) defines wages as “the money rate at which the service rendered is recompensed under the contract of hiring in force at the time of the accident, including the reasonable value of board, rent, housing, lodging or similar advantage received from the employer.” In addition to monetary wages, some employee are paid other consideration for performing work, such as tips, bonuses, and housing allowances or “room and board.”
In these cases, the reasonable monetary value of the room and board is to be established an included in the employee’s wages. Smith v. St. Mary’s Hospital, 259 N.Y.S.2d 373 (3d Dept. 1965). While the employee may seek to inflate the value of this consideration, and the employer may seek to deflate the value, the ultimate determination of the valuation of room and board is up to the Board. The Board does not have to accept the figures offered by either the claimant or the defense, but can set its own value for the room and board. O’Neil v. William Randolph Dairy Farm, 410 N.Y.S.2d 695 (3d Dept. 1978).
Practically speaking, where an employer is offering to include room and board in the wage calculation, the employer should use a best estimation where no fixed price is available. The claimant is free to argue that the room and board is undervalued, and ultimately a Law judge will make the determination.
New York’s maximum compensation rate – for temporary total disability and permanent total disability – will go up effective July 1st to $870.61. The new, higher rate will be in effect until June 30, 2018.
How is the New York Maximum benefit Rate Calculated?
The maximum weekly benefit rate for workers’ compensation claimants is two-thirds of the New York State average weekly wage for the previous calendar year, as determined by the New York State Department of Labor (Workers’ Compensation Law §§ 2(16);15(6)).
The Department of Labor reported to the Superintendent of the Department of Financial Services that the New York State average weekly wage for 2016 was $1,305.92. Accordingly, the maximum weekly benefit rate is $870.61 for compensable lost time for workers’ compensation claims with dates of accident during the period from July 1, 2017 through June 30, 2018. Continue reading Don’t Forget! July 1st maximum rate change in New York.
In a Board Panel Decision dated May 24, 2017, the Board found that the Medical Treatment Guidelines apply to the out of state treatment of a claimant residing outside of New York State. The decision in In Re Hospice is important because it reverses the Board’s previous statements that out-of-state treatment was immune from the application of the restrictive Medical Treatment Guidelines (“MTG”). This meant that New York claimants merely had to “cross the river” into New Jersey or any other state and obtain medical treatment and medications which far exceeded the treatment or medications allowed under the Medical Treatment Guidelines, needlessly increasing the costs in their cases. Now employers and carriers have a Board Panel decision supporting the argument that law judges should apply the MTG’s to out of state cases. Continue reading Medical Treatment Guidelines Apply to Out of State Claimants
We can stop paying temporary disability benefits in New York when:
- The claimant has reached “maximum medical improvement” and is discharged from further care.
- The claimant has voluntarily withdrawn from the labor market.
- The claimant has refused a light duty offer that complies with the treating doctor’s work restrictions.
Why seek a return to work in a light duty capacity?
Employees who do not return to work (transitional or otherwise) within 6 months of the date of loss have a less than 50% chance of returning to gainful employment. Injured workers who remain out of work for more than one year but less than two years have a 25% chance of returning to employment. Workers who have lost two or more years to injury have less than a 1% chance of returning to any type of employment. This drives up claims costs and is bad for the injured worker.
The Workers’ Compensation Board envisions a process in which an employer “creates” a light duty job tailored to each injured worker. In reality, most employers have a limited amount of potential light duty employment. In those cases, the goal of the claims professional is to get a clear statement of the claimant’s work ability from the treating physician and then to issue an appropriate offer letter to the claimant. Continue reading How to: Reducing Exposure by Offering Accommodated Positions in New York
The New York Workers’ Compensation Law allows for four types of benefits to be provided to injured workers: medical treatment, lost time wage replacement, death benefits, and permanent disability benefits. This article discusses the three types of permanent disability benefit available to the injured worker:
- Scheduled loss of use.
- Permanent Total Disability.
The employer is exposed for permanent disabilities which the claimant may prove. These three types of disability are compensated at different rates.
Scheduled Loss of Use.
Values come from tables which establish the compensation for loss of limbs, vision, and hearing in terms of ‘weeks of compensation.’ Scheduled loss is the percent of those weeks equal to the percentage loss of function of the member (for example a 10% schedule use loss of the arm equates to 31.2 weeks of compensation. The award is the number of weeks of compensation according to the schedule multiplied buy the workers’ maximum rate (2/3rd of Average Weekly Wages subject to the maximum and minimum rates in place according to the year of the accident). Prior payments of compensation and wages (all wages, not just those paid at the compensation rate) are deducted from the award. Continue reading Explainer: Permanency Benefits in New York