Meggesto, Crossett & Valerino, LLP


The Average Weekly Wage (AWW) is one of the most important issues in your case. The AWW determines how much you will be paid in the event that you are out of work for a work-related injury. The higher the AWW, the higher your rate of pay. At MCV Law, one of the first things we look at is whether the AWW has been calculated correctly.

The Average Weekly Wage is just that – an average. It is calculated by taking your total earnings for the 52 weeks prior to your injury and dividing that by the number of days worked, giving you the average daily wage. The average daily wage is then subjected to a multiplier depending on the number of days worked, as provided for by Section 14 of the New York Workers’ Compensation Law. For example, Section 14 provides that a seasonal worker’s AWW should be calculated by multiplying the average daily wage by 200, whereas the AWW of an employee who works 6 days per week is calculated using a 300 multiple. However, the vast majority of employees work 5 days per week, and, thus a 260 multiple is generally used. There are various other arguments that can be made to increase an AWW. At Meggesto, Crossett & Valerino, LLP (MCV Law), we work to support the argument that is likely to produce the highest AWW.
The law also accommodates injured workers who had a second job at the time of their accident. This is referred to as “concurrent employment.” The assumption is that, if your injury prevents you from earning wages at another job, those wages should also be replaced. The concurrent employment must be “covered employment,” meaning that the concurrent employer must carry Workers’ Compensation insurance. Your total earnings from your concurrent job are added to your earnings at your primary employment. Just like the primary AWW, arguments can be made to maximize the concurrent AWW.

Section 14 of the law also accommodates minors. Under the Workers’ Compensation Law, the age of majority is 25. If you are injured at work before reaching the age of 25, a “Minor’s Wage Expectancy” calculation is assessed to determine what you would have been making at the age of 25. A Minor’s Wage Expectancy determination applies at the time of permanency. The determination is made by analyzing the injured worker’s performance reviews and potential for promotion, as well as looking at what other employees in the same field are earning. For many, this will substantially increase their AWW.

Lastly, the law sets forth maximum and minimum rates depending on the date of accident. Below is a chart demonstrating the maximum rates since 2009. The current minimum rate is $150.000.

Date of AccidentMaximum Rate
July 1, 2009 – June 30, 2010$600.00
July 1, 2010 – June 30, 2011$739.83
July 1, 2011 – June 30, 2012$772.96
July 1, 2012 – June 30, 2013$792.07
July 1, 2013 – June 30, 2014$803.21
July 1, 2014 – June 30, 2015$808.65
July 1, 2015 – June 30, 2016$844.29

H00C8974   Some typical questions include:

   Should I stay inside?  

    Can I go to the grocery store?

    Can I drive?         

    Can I watch my grandchildren?

    Can I mow my lawn?  

    Should I cancel my vacation?

 

At Meggesto, Crossett & Valerino, LLP, we advise injured workers to pursue their normal activities as much as their condition allows, and to use common sense when doing so.

Injured Workers’ activities should be consistent with their doctor’s restrictions and degree of disability. Doctors and other medical providers, will usually make recommendations of which activities to avoid or suggest limitations, not only regarding work, but also regarding activities of daily living. If the medical provider does not make such recommendations, be sure to ask for them and obtain them in writing whenever possible.

Most often after a traumatic injury or a surgical procedure, medical providers will opine that an injured worker has a temporary total disability. In these instances, it would be inconsistent to undertake activities such as lawn mowing, snow shoveling or physical, recreational activities. For example, we would not recommend that a claimant go bowling, skiing or dancing. We would also recommend refraining from strenuous hobbies, such as homecare and car repair. However, if you recently underwent surgery, it would not necessarily be inconsistent to take a planned vacation south to recover.

The question of “What can I do when I am on Workers’ Comp?” becomes particularly troublesome when your doctor suggests a partial degree of disability. Many times when this happens, the employer will not allow an injured workers to return to work, with restrictions.  Nevertheless, Workers’ Compensation benefits may be reduced as a result of the partial disability and many wonder if looking for work elsewhere will jeopardize their Workers’ Compensation benefits.

When your doctor suggests a partial degree of disability, it becomes particularly important to understand exactly what restrictions your doctor recommends. At MCV law we recommend that our clients discuss their abilities, including their activities of daily living, with their doctor. We recommend that the injured worker obtain written restrictions so as to avoid any misunderstanding. Some medical providers use a functional capacity evaluation to assist in setting restrictions and limitations.

Additionally, we encourage injured workers not to exaggerate their injury or disability and to be candid with their doctors and Independent Medical Examiners about their activities of daily living, including any hobbies and volunteer activities. Importantly, we encourage injured workers to use common sense to avoid an allegation that the injured worker has committed fraud under Section 114 of the Workers’ Compensation Law.

Section 114(a) is essentially a fraud provision that imposes both mandatory and discretionary penalties for claimants who violate this provision. Typically, a Section 114(a) violation will result in a suspension of benefits. False statements made to doctors or Independent Medical Examiners are often the basis for a Section 114(a) violation. Therefore, is very important to be candid with your doctors and Independent Medical Examiners about your condition and daily activities.

In conclusion the answer is, use your common sense. Be candid and open with your Medical Providers, document the restrictions or limitations suggested and do not exaggerate or over play your degree of disability. For more information on workers compensation, click here.

william crossett

Should I file for Disability, NYS Workers Compensation or something else?

Often people call MCV Law requesting help with a “Disability Case. “ They are injured, unable to work and looking for help to pay the day-to-day bills. The first thing the Attorneys and Staff at MCV Law do is listen.

We carefully listen to your story. We’re listening for particular facts and circumstances that will help us determine what remedy or remedies may be available to you. We ask targeted questions, to determine where you may or may not be in the process of making a claim.

Generally we are trying to determine whether or not you have one of the following:

  • A New York State Disability Case.
  • A New York Workers’ Compensation Case.
  • A No Fault Motor Vehicle Accident Case.
  • A Personal Injury Action.
  • A Private Short or Long-Term Disability Case.
  • A Social Security Disability Case.

Sometimes, there is more than one type of case arising from a single event. For instance if you’re involved in a Motor Vehicle Accident, while Working you have both a Workers Compensation claim and a No Fault Motor Vehicle Accident case. If the Accident was caused by a third-party you may also have a Personal Injury Case. If the injury is life changing you may have a Social Security Disability Case as well.

Of course, every type of case has different rules, the most important of which is the Statute of Limitations. That is the time in which the injured person must act to protect their rights. Often, especially in cases dealing with municipalities or other quasi-government entities, the statute limitations is extremely short. Therefore it is important to seek legal advice shortly after your injury or injuries.  MCV Law does not charge you for the initial consultation.

At Meggesto, Crossett & Valerino, LLP, we pride ourselves on being able to assist the injured person with regard to all of the cases listed above. Instead of looking only for one type of case, we look at the injured individual as a whole. We work to craft a legal strategy that is most likely to produce the best result for you, in a timely and cost-effective manner.

Be sure to click here for further information on workers compensation, and here for a more in depth look at social security disability.

 

william crossettPicture21. Do I have to attend? Yes, the insurance carrier is entitled to have you examined by their doctor. If you do not attend it will harm your case. Your benefits may be stopped, and your treatment and prescriptions suspended.

2. What is the purpose of the exam? Generally the carrier is seeking another opinion on the nature and extent of your injuries, your need for treatment, and your level of disability.

3. What can you expect at the exam? An IME is not like a visit to your doctor – the IME is not treating you. The exam is likely to be very quick and focused on your degree of disability or the need for treatment or prescriptions.  You may be asked to complete a questionnaire prior to the exam. Answer the questions carefully, and be sure you tell the doctor about any prior injuries or new injuries. Do not exaggerate or overstate your injury.

4. What is the IME looking for? The IME doctor will look for any inconsistencies in your behavior. This could include simple observations or may involve video surveillance. The carrier often has an investigator record video of you the day before the exam, the day of the exam, and the day after the exam to try to find inconsistencies. Be frank with the IME and your doctors about your activities of daily living. Also let the IME know of any side effects of your medications.

5. What occurs after the exam? The IME exam generates a report that is sent to all parties generally within 10 days. The report may or may not agree with your doctor and often will vary, especially in assessing your degree of disability. When the carrier receives the report, they will typically request a hearing to change the level of benefits paid. If the dispute cannot be resolved, litigation will start.

6. What is the role of your attorney when you have an IME? Your attorney is aware of your IME. It is best to talk to your attorney before you attend. Your attorney will also work with you to obtain evidence to counter the IME’s conclusions before a hearing.

 5 Things Every Newly-Injured Worker Should Know

New York Workers' Compensation

New York Workers’ Compensation

1. The New York Workers’ Compensation System is driven by medical evidence.

2. If you are injured at work, see a doctor right away, and continue to see the doctor while you are out of work.

3. Give a complete, consistent, and accurate history of your injury or illness.

4. The New York State Workers’ Compensation Law has a two-prong Statute of Limitations. You have 30 days to notify your employer that you were injured on the job or have a work-related illness. You then have 2 years to file a claim for Workers’ Compensation benefits.

5. Having a “Carrier Case Number” does not mean that you have a New York State Workers’ Compensation case. The Workers Compensation Board assembles cases when they have both a claim and medical evidence to support a work-related injury or illness.