Category Archives: Benefits

“Re-Opener” Awards in New Jersey

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

When “Room and Board” is used to calculate wages in New York

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.

Video: Defending Motions for Med & Temp in New Jersey

This is video from a live presentation from attorney Greg Lois and answers the following questions: “How do I defend a Motion for Med and Temp in New Jersey?” and “What medical treatment is required under the statute?” and “What are the common defenses used by a Respondent when facing a motion?”

At the end of the presentation, attendees will understand what a Motion for Temporary and Medical Benefits is, what exposures are posed by the motion, and how to best defend the motion.

Subject: New Jersey, Workers’ Compensation Law, benefits, Temporary Disability
Date Presented: August 28, 2017
Presenter(s): Greg Lois
Run time: 27:25 Continue reading Video: Defending Motions for Med & Temp in New Jersey

Video: Medical Treatment Guidelines and Opioid Management in New York

Jeremy Janis and Greg LoisAttorneys Jeremy Janis and Greg Lois lead a presentation and answer questions about medical treatment issues in New York workers’ compensation claims. What we will be talking about:

  • What to do about variance requests.
  • How to dispute unnecessary treatment.
  • The recent (May, 2017) Board Panel decision finding MTG’s DO apply to out of state medical providers.
  • Non-Acute Pain Management Guidelines.

Subject: New York, Workers’ Compensation Law, benefits, Medical Treatment Guidelines
Date Presented: August 21, 2017
Presenter(s): Jeremy Janis and Greg Lois
Run time: 24:35
Continue reading Video: Medical Treatment Guidelines and Opioid Management in New York

Video: Practical Application of New Jersey’s Temporary Disability Benefit

This video is presented by attorneys Michael Gervolino and Greg Lois and answers the following questions: “Should I issue temporary disability benefits?” and ”If so, how much?” and “When can I stop Paying?”

At the end of the presentation, the attendees will have a basic understanding of when to issue temporary disability benefits in New Jersey, how the amount issued is calculated, when payments can be terminated, and the risks associated with the benefit.

Subject: New Jersey, Workers’ Compensation Law, benefits, Temporary Disability
Date Presented: July 24, 2017
Presenter(s): Michael Gervolino and Greg Lois
Run time: 21:58 Continue reading Video: Practical Application of New Jersey’s Temporary Disability Benefit

Video: Temporary Disability Benefits in New York

Attorneys Elizabeth Perez and Greg Lois discuss the nuts-and-bolts of issuing temporary disability benefits – when the benefits are due, how much to pay, and when benefits can be stopped. They also discuss the new C-258.1 work search form issued by the Board on July 14, 2017 and the newly-changed rate of temporary disability compensation.

Subject: New York, Workers’ Compensation Law, benefits, Temporary Disability
Date Presented: July 17, 2017
Presenter(s): Elizabeth Perez and Greg Lois
Run time: 3306 Continue reading Video: Temporary Disability Benefits in New York