Friday F.A.Q. “Why are so many C-8.1s being resolved in favor of the providers even when there is a legitimate reason to deny the treatment or bill?”

Tashia Rasul, Esq.
Tashia Rasul, Esq.
Many C-8.1s are resolved in favor of the providers because they are defective, meaning the C-8.1s are not properly completed or timely filed.

Part A Defenses.

The C-8.1 form is divided into two Parts: A and B. Part A requires the carrier to specify the legal reason for its objection to treatment, and to provide information on its conflicting medical evidence, that is, an IME or Peer Review Report. If treatment is being objected to, the carrier must notify the claimant, provider and Board within five days of the objection (e.g. denial of a C-4AUTH request). If the carrier is asserting that the basis for the objection is conflicting medical evidence, such evidence must be supplied with the C-8.1, or if already in the Board file, identified using the Board document identification number. Further, the carrier must provide proof of mailing of notice to the claimant, his attorney and his doctor. See NYCRR 300.23(d). Continue reading Friday F.A.Q. “Why are so many C-8.1s being resolved in favor of the providers even when there is a legitimate reason to deny the treatment or bill?”

Defending Specific Accident Claims: Third Fridays Podcast


In this podcast, two attorneys discuss defending specific, traumatic loss claims in New York Workers’ Compensation court. Who was the claimant working with? Who was the claimant’s supervisor? What accident reporting or investigation is available? Investigating accidents, working with risk professionals, and preparing the defense. Host Christian Sison is joined by Tashia Rasul, partner at LOIS LLC, to discuss defending specific accident claims in New York workers’ compensation claims.
Continue reading Defending Specific Accident Claims: Third Fridays Podcast

Friday F.A.Q. “What can be done to address opioid overuse or abuse by claimants?”

Tashia Rasul, Esq.
Tashia Rasul, Esq.
While the Medical Treatment Guidelines (MTG) governing the treatment of non-acute pain allows for the use of opioids only in certain circumstances, we are still seeing an abundance of claims where the prescribing doctor fails to comply with the stringent requirements of the MTG. In October, 2016, the Board announced a new procedure that allows employers to have the issue addressed by the Board in an effective manner. Continue reading Friday F.A.Q. “What can be done to address opioid overuse or abuse by claimants?”

Friday F.A.Q. “What does the ‘Extreme Hardship Redetermination’ of an LWEC classification mean for an employer’s exposure?”

Tashia Rasul, Esq.
Tashia Rasul, Esq.

The 2007 New York Workers’ Compensation Law reforms capped the number of weeks of compensation a claimant can receive for a permanent partial disability (PPD). However, the 2017 reforms now allows claimants who are classified with higher than a 75% LWEC the opportunity to seek redetermination due to “extreme hardship”. This means that a claimant with a 76% or higher LWEC can request that the Board reclassify him and allow more benefits – potentially benefits for life – thereby creating more exposure for the employer. What qualifies as an “extreme hardship”? Continue reading Friday F.A.Q. “What does the ‘Extreme Hardship Redetermination’ of an LWEC classification mean for an employer’s exposure?”

Appellate Division Issues Decision Clarifying How To Calculate Schedule Loss of Use For Shoulder Injuries

Case: Matter of Maloney v Wende Correctional Facility

Issue
In determining the Schedule Loss of Use (SLU) percentage applicable to a shoulder injury, whether it is appropriate to assign separate loss of use values for deficits in anterior flexion and abduction or if this is duplicative and results in an inflated SLU percentage.

Facts of Case
Claimant was a Correctional Officer who injured himself while working in July 2013. The claim was established for a right shoulder injury. At permanency, the claimant’s treating physician opined claimant had 90% SLU of the right arm while an IME opined the claimant had 50% SLU of the right arm. Following litigation of the issue, the law judge credited the IME opinion over that of the treating physician and found claimant to have 50% SLU of the right arm. The Workers’ Compensation Board affirmed the Law Judge’s finding and the claimant appealed to the Third Department.

Decision
Board decision is affirmed, finding claimant to have 50% SLU of the right arm. The Court noted “the Board is vested with the authority to resolve conflicting medical opinions concerning the SLU percentage to be assigned to aspecific injury.” Additionally, the Court noted “judicial review is limited, and the Board’s determination will not be disturbed as long as it is supported by substantial evidence.” Continue reading Appellate Division Issues Decision Clarifying How To Calculate Schedule Loss of Use For Shoulder Injuries

New Jersey: No Modification to Award 18 Years After Loss

Joe Jones, Esq.
Joe Jones, Esq.
The New Jersey Appellate Division just handed down a decision in Larry D. Batts v. Flag House, a case that although not precedent for other courts to follow (the decision was an unpublished decision under Docket No. A-5616-15T4, January 16, 2018), discusses two important things:

  • A decision by a workers’ compensation Judge supported by substantial credible evidence will be generally upheld as substantial deference is given to their decisions as the trier of fact. This is a common theme in many Appellate decisions but an important one to note when you are making a record in a trial.
  • When an original case settles under an Order Approving Settlement involving more than one body part (arm and back, neck and psych, etc.) and the first re-opener is filed and settled with an increase to one of the original body parts but remains silent as to the other body parts, the second re-opener may include an increase in disability to the other body part that was not increased in the prior re-opener OAS (of course the petitioner still has to prove an increase in permanency!).

In Larry D. Batts v. Flag Ship, petitioner claimed injury to his right foot as well as psychiatric disability for chronic depression and anxiety disorder as a result of an accident that occurred on April 2, 1998 while at work when a forklift ran over his right ankle. The original case settled under an Order Approving Settlement awarding the petitioner 50% of the right foot for orthopedic disability and 10% of partial total for psychiatric disability. Continue reading New Jersey: No Modification to Award 18 Years After Loss

Defending Employers