Category Archives: Benefits

New York State Workers’ Compensation Heart Attack Claims

Joseph Melchionne
Joseph Melchionne, Esq.

Pursuant to Workers’ Compensation Law (WCL) § 21,  injuries that occur at a claimant’s place of employment are presumed to be compensable work-related injuries for the purposes of awarding indemnity and medical benefits unless substantial evidence to the contrary is produced.  In essence what this means is that if an employee suffers an injury during work hours and/or on the premises of his or her place of employment, the claimant will be entitled to indemnity benefits for any causally related lost time from their employment as long as they are able to produce medical reports evidencing a disability resulting from the injury.

However, according to WCL § 10,  New York law dictates that for a workers’ compensation claim to be compensable the associated accident must have arose out of and in the course of employment, meaning there must be a causal nexus between the injury and the claimant’s employment. Idiopathic injuries, or personal injuries, may create a defense to a Workers’ Compensation claim if the employer can rebut the presumption that accidents arising in the course of employment arise out of the employment with “substantial evidence to the contrary.” See WCL §21.

Continue reading New York State Workers’ Compensation Heart Attack Claims

The Limit To “Stacking” Injuries To Multiple Body Parts in New Jersey

Michael Tomasino
Michael Tomasino, Esq.

In New Jersey, petitioners’ attorneys will often attempt to improperly “stack” injuries to multiple body parts in order to obtain greater settlements for their clients. However, “stacking” is subject to numerous longstanding limitations. One of such limitations is that in order to “stack” injuries to multiple body parts, said injuries must have resulted from a single underlying accident.

The concept of “stacking” injuries has long-existed in New Jersey workers’ compensation law. Stacking’s inception dates to the 1984 case of Poswiatowski v. Standard Chlorine Chemical Co., 96 N.J. 32,1475 A.2d 1257 (1984). In that case, the Supreme Court of New Jersey indicated that in instances where a worker has suffered injuries to multiple body parts, Judges of Compensation must “treat the individual as a whole.” This means that the Supreme Court of New Jersey determined that when affixing the extent of disability suffered by a given worker, workers’ compensation courts must determine the cumulative impact that each of the injuries had upon said worker. Continue reading The Limit To “Stacking” Injuries To Multiple Body Parts in New Jersey

How an Award of Workers’ Compensation Benefits Impacts Other Disability Benefits

In New York, when an individual suffers an accident or illness arising out of and in the course of employment, workers’ compensation becomes the primary source of wage replacement and medical benefits. It is important to understand how workers’ compensation benefits affect or are affected by other available benefit programs. Some of these additional benefit programs duplicate workers’ compensation benefits, some supplement workers’ compensation benefits, and others are paid instead of workers’ compensation benefits.

Private Long Term Disability Benefits: Some employers voluntarily provide employees with long term disability benefits. Individuals can also obtain these policies on their own. Long term disability benefits are typically available for periods of disability which extend beyond an ‘elimination period.’ These policies issue indemnity benefits to policyholders who are disabled and unable to work beyond a set period of time, i.e. six months, 26 weeks, or another set period of time specified in the long term disability policy.

The Workers’ Compensation Board does not have jurisdiction over private long term disability benefit plans. As there is no jurisdiction, the Board has no legal authority to direct reimbursement for a duplication of benefits. Therefore, a claimant can receive both workers’ compensation indemnity benefits and benefits from their long term disability policy at the same time and even receive more from the two than their normal weekly wage while working. However, most long term disability policies contain provisions that require reimbursement to the long term disability carrier or take an offset for any workers’ compensation benefits. These reimbursements and offsets are to be determined in accordance with the terms of the long term disability policy. Continue reading How an Award of Workers’ Compensation Benefits Impacts Other Disability Benefits

Using Voluntary Tenders (Advance Payments) To Reduce Exposure in New Jersey.

New Jersey Workers' Compensation Law 2017When an employer knows (with certainty) that an employee has been injured and will suffer some degree of permanent injury (for example, when there has been loss of a limb), a voluntary tender, made at the appropriate time, may be offered to reduce exposure for attorney’s fees when the underlying claim is disposed of. N.J.S.A. 34:15-64 provides (in part):

When, however, at a reasonable time, prior to any hearing compensation has been offered and the amount then due has been tendered in good faith or paid within 26 weeks from the date of the notification to the employer of an accident or an occupational disease or the employee’s final active medical treatment or within 26 weeks after the employee’s return to work whichever is later or within 26 weeks after employer’s notification of the employee’s death, the reasonable allowance for attorney fee shall be based upon only that part of the judgment or award in excess of the amount of compensation, theretofore offered, tendered in good faith or paid.

Read on to discover how to use this legal tool to reduce exposure on New Jersey Workers’ Compensation claims. Continue reading Using Voluntary Tenders (Advance Payments) To Reduce Exposure in New Jersey.

Timelines in Admitted Traumatic Cases in New York

Greg LoisTimeline of the “Typical” case: Admitted Traumatic Accident with Lost Time.

  1. Initial investigation to confirm loss.
  2. If there is medical and lost time, begin benefits.
  3. File FROI-00 (Electronic Data Interchange, “EDI”).
  4. File update EDI documents as the case progresses.

The Board’s initiative to enforce EDI (“eClaims”).

Beginning in 2013, the Board has begun an increased tempo of “monitoring and compliance” initiatives intended to enforce the eClaims guidelines and generate more penalty income for the State. The Board has now established a “Compliance Unit” intended to do the following:

  • monitor performance standards for timely submission of First Report of Injury,
  • confirm timely first payment of indemnity benefits,
  • check for timely submission of Subsequent Report of Injury showing first payment,
  • monitor timely submission of Controversy; and
  • track the Percentage of Claims Controverted (how many cases is the carrier denying?).

Continue reading Timelines in Admitted Traumatic Cases in New York

“Protracted Healing Period” and Schedule Loss of Use

Under New York Workers’ Compensation law, a Schedule Loss of Use (SLU) award may be made when a claimant has reached maximum medical improvement and the claimant’s body part(s) have a permanent loss of use as a result of their work-related injury.

There are two types of permanent disability benefits (Schedule Loss of Use and Non-Schedule/Classification); the type of benefit a claimant is eligible for depends on the body part injured. The concept of a “protracted healing period” only comes into play for “schedule loss of use” awards and serves to increase the value of the award.

A SLU occurs when an employee has permanently lost use of an upper extremity (shoulder, arm, hand, wrist, finger), lower extremity (hip, leg, knee, ankle, foot, toe), or eyesight or hearing. Compensation is limited to a certain number of weeks based on the body part and severity of the disability, according to a schedule set by law. Temporary benefits that have been paid are deducted from the total SLU award. [Source]

When Does A “Protracted Healing Period” Apply?

New York defines the “normal healing period” for scheduled injuries. In cases where the claimant remained totally disabled for a period of time in excess of the established healing period, additional compensation payments are required.

Declan Gourley
Declan Gourley, Esq.

The Law provides as follows at Section 15(4-a):

In case of temporary total disability and permanent partial disability both resulting from the same injury, if the temporary total disability continues for a longer period than the number of weeks set forth in the following schedule, the period of temporary total disability in excess of such number of weeks shall be added to the compensation period provided in subdivision three of this section: Arm, thirty-two weeks; leg, forty weeks; hand, thirty-two weeks; foot, thirty-two weeks; ear, twenty-five weeks; eye, twenty weeks; thumb, twenty-four weeks; first finger, eighteen weeks; great toe, twelve weeks; second finger, twelve weeks; third finger, eight weeks; fourth finger, eight weeks; toe other than great toe, eight weeks.

So, where the claimant remained totally disabled after the periods of time set forth by the Legislature, the employer/carrier is exposed for additional comepnsation under the Law. Continue reading “Protracted Healing Period” and Schedule Loss of Use