Category Archives: Insurance

New York Workers’ Compensation Reform Impact on Gaming, Thoroughbred, and Breeding Industries

Joseph MelchionneAs has been widely publicized, in April the New York State Senate passed a $153 billion state budget for 2017-2018 which included numerous reforms and changes to the state’s Workers’ Compensation laws.

The most publicized changes to the existing law have been new reforms that ensure that significantly injured workers have the right to be considered for lifetime benefits, new prescription drug formularies, and the overhaul of the New York State Medical Treatment Guidelines. The aforementioned changes have obscured less obvious or publicized provisions such as changes to the gaming, thoroughbred, and breeding industries in the state. Continue reading New York Workers’ Compensation Reform Impact on Gaming, Thoroughbred, and Breeding Industries

Is this Workers’ Compensation Claim Fraud in New York?

  1. Claimant denies having gainful employment while collecting temporary disability benefits. He actually started up a small business, but the business lost money.
  2. Claimant says he applied for jobs at 34 different businesses while seeking benefits. The employer performed its own follow-up search and learned he applied for only two (2) jobs.New York Workers' Compensation law 2017
  3. Claimant lying about his physical restrictions to our IME doctor
  4. Concealing volunteer work while “too disabled” to do your regular job?
  5. Caught selling street drugs while collecting workers’ compensation benefits?
  6. Claimant first admits to working, but her attorneys later state she isn’t. Claimant later found working seasonally while collecting benefits.
    Continue reading Is this Workers’ Compensation Claim Fraud in New York?

Practical Advice on Injury Reporting in New York

When Injury Reporting is Required.

Greg LoisNew York Workers’ Compensation Law §110 states that an accident must be reported when it:

“will cause a loss of time from regular duties of one day beyond the working day or shift on which the accident occurred, or which has required or will require medical treatment beyond ordinary first aid or more than two treatments by a person rendering first aid.”

In order to be reportable, the injury must:

  • Cause the worker to lose one day of work in addition to the date of loss; OR
  • Require more than ordinary first aid; OR
  • Require at least three “first aid” visits.

The Workers’ Compensation Board has an official form for reporting injuries (Form C-2F “Employer’s Report of Work-Related Injury/Illness“). The form must be provided to the injured worker upon request and has to be maintained (held) by the employer for at least 18 years.

The C-2F report must be filed with the Workers’ Compensation Board within 10 days after the occurrence of the accident.

Penalties

Failure to file the report subjects the employer to potential misdemeanor criminal liability, punishable by a fine of not more than $1000. A second penalty – not to exceed $2500 – can be imposed by the Board. Continue reading Practical Advice on Injury Reporting in New York

Penalties Under New York Workers’ Compensation Law Section 52

In New York, all employers are required to carry Workers’ Compensation insurance. This includes employers with less than five employees. Workers’ Compensation Law imposes heavy penalties against the employer for failure to obtain insurance as well as for defrauding the insurance carrier. [See WCL Section 52]

The Law.

Penalties are assessed against the employer for misclassifying and concealing employees. The law specifically includes employer’s actions of intentionally and materially understating or concealing payroll, concealing duties to avoid proper classification or

Tatyana Redko
Tatyana Redko, Esq.

concealing any other information pertinent to the calculation of premiums. Section 52 covers misrepresentations such as paying workers “off the books,” not reporting wages paid to illegal aliens and misclassifying employees as “independent contractors” in an attempt to pay a lower premium. Continue reading Penalties Under New York Workers’ Compensation Law Section 52

Limits to Recovery in a New York Loss Transfer Claim.

In a previous post, we discussed the process of Loss Transfer and specifically why it matters to Workers’ Compensation carriers.  In connection with the Workers’ Compensation aspect, a workers’ compensation carrier can recover up to $50,000.00 by way of arbitration in a Loss Transfer claim through the Arbitration Forums.  However, this does not mean that you can simply assert a right to $50,000.00 against another insurance company and think this is enough. Indeed, when arbitrated, liability still has to be proven as well as damages. Continue reading Limits to Recovery in a New York Loss Transfer Claim.

New York Electronic Data Interchange (“eClaims”) and “Monitoring and Compliance” Initiatives

The Board’s new 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?).

Timeline 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.
  4. File update EDI documents as the case progresses.

The process in detail.

Investigation and Communication.

All accidents should be investigated fully. The employer should contact the insurance carrier and maintain those communications throughout the claim. The investigation’s results should be copied to your defense attorney in the case of a controverted claim.

Continue reading New York Electronic Data Interchange (“eClaims”) and “Monitoring and Compliance” Initiatives