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
What is “PIP”?
“PIP” is short for “Personal Injury Injury Protection.” Personal Injury Protection is a mandatory coverage in New Jersey automobile insurance policies. that provides medical expense, income continuation, essential services, an funeral expense benefits for persons injured in automobile accidents. The coverage is available to the insured regardless of who was at fault in the accident. Personal Injury Protection is provided for “private passenger automobiles” as that term is defined in N.J.S.A. 39:6A-2. The definition covers both the type of vehicle and the ownership of the vehicle.
Disputes regarding medical care provided under the Personal Injury Protection coverage are resolved by way of Internal Appeal Procedure mandated by law or, where that fails to resolve the issue, by way of appeal to arbitration forum (Forthright, a provide company providing alternative dispute resolution services). This guide provides a background on PIP and a primer on resolving disputes for lawyers handling these cases. Continue reading Practical Guide: Understanding “PIP” and Winning Appeals in New Jersey
The day before Thanksgiving the Board released new proposed Guidelines – and these are not great for employers. But wait, what about the draft Guidelines that were issued in September and we were so excited for? Those Guidelines, widely viewed as favorable to carrier and employers as they appeared designed to curtail the worst abuses of the current impairment determination guidelines, have been scrapped.
The new proposed Guidelines are here. When you check them out it will be clear that the old “range of motion” system that the Board was supposed to scrap and start over from has returned. The whole point of the April 2017 statutory reform was that the Board had to adopt updated Scheduled Loss of Use guidelines that reflected “medical advances” (i.e., better outcomes for basic injuries) and were supposed to address the fact that employees with minor injuries, with little or no impact on their working ability, were collecting giant SLU awards, often with only a few days of lost time (which goes to show that there really wasn’t any impact on their working ability). Instead, the Board has caved into pressure from union and “pro-worker” groups (read: trial attorneys representing workers and collecting fat fees) and issued new Guidelines that are bad for businesses and carriers.
Why is this a big deal?
The Board must adopt new Guidelines for Determining Impairment in Schedule Loss of Use cases (think fingers, hands, wrists, elbows, shoulders, knees, ankles, feet, toes) which will take effect on January 2, 2018. The first proposed impairment guidelines were a departure from the prior practice before the Board – in a good way! The initial draft was favorable to employers in that the most frustrating and unfair cases – where the claimant loses minimal time from work for a Schedule Loss of Use Injury (meaning, a minor injury) would result in giant Scheduled Loss of Use awards based on range of motion testing. In those cases, where there was neglible (if any) impact on the claimant’s working ability, it is patently unfair that the employer must pay large Schedule Loss of Use awards based on turn of the century medical guidelines that don’t reflect anything more than subjective range of motion tests. These latest draft guidelines bring back that old range of motion system.
What can we do about it?
The proposed Guidelines are now in “comment period.” Comments can be made here. The Board was clearly persuaded by the flood of comments from the unions and trial attorneys – we are recommending that our clients review the “new” Guidelines and make comments urging the Board to adopt the first proposed impairment guideline.
Training on the New Guidelines.
We will be running training on the new Guidelines, in whatever form they take, on January 8, 2017 in multiple sessions. Register here:
Register for 12PM EST January 8 – New Guidelines Training
Register for 3PM EST January 8 – New Guidelines Training
Both webinars are LIVE and Questions-and-Answer sessions will be held.
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.