Meggesto, Crossett & Valerino, LLP


New York’s Workers Compensation Law is an employee’s only remedy for injuries arising “out of or in the course of employment”. This means that if you are injured or hurt while at work or develop a sickness or disease that is caused by your employment, you are entitled to Workers Compensation benefits. In most cases, the Worker’s Compensation law prevents you from suing your employer, with the exception being an intentional act by the employer, such as an assault.

If your injury, sickness, or disease is a result of the negligence of a third party who is not a co-employee, you may have the right to bring an action in addition to your Workers Compensation case. This is commonly referred to as a third party action.

Some examples of third-party actions are:

  • An action against a property owner who has a statutory duty to provide a safe place to work. This usually occurs on construction sites, particularly regarding falls from elevated heights.
  • An action against an owner of an automobile or truck that caused a serious injury to an employee driving in the course of employment.
  • An action against the manufacturer of a machine or device that caused injury due to a defect or lack of warning.

If a recovery is made in the third-party action, the Worker’s Compensation carrier is entitled to be reimbursed for what was paid in the Workers Compensation case.

In New York, Workers’ Compensation benefits include lost wage benefits and medical care that is causally related to the injury, sickness, or disease.

For a more in depth look at workers compensation, click here.


Disclaimer: Quick Answers by MCV Law is provided by the attorneys and Meggesto, Crossett and Valerino, LLP. The content contained in this post, as well as on the website as a whole, is provided for informational purposes only and should not be construed as legal advice on any matter.

                                                                                  
INJURED WORKERS DESERVE RESPECT

Recently, a significant part of the national conversation has been about respect. Respect for Black and Hispanic lives, respect for those accused of crimes, and respect for police and law enforcement officials. Certainly, this conversation is important and overdue.

Also overdue, in my opinion, is the conversation about respecting the men and women who are injured every day at work. Injuries occur in every line of work without discrimination. Certain injures, however, seem to garner more respect. Is that because certain lives are more important than others or because certain injures are undoubtedly going to result in a permanent disability?

I think not. Rather, I suspect that we perceive certain circumstances as repugnant. No one asserts that an on-the-job injury is desirable. However, an acute injury is more likely to be accepted than an injury that is not readily apparent.

Time and time again an injured worker tells us that they thought their back pain would go away in a couple of days or over the weekend, or that they did not want to report their injury due to fear of being labeled a complainer, a bad employee, or a person on compensation. Injured workers commonly tell us that they need to work, that they like their job, or are unsure of what was wrong and just wanted to see their doctor first.

Why don’t employers value the word of their employees? Have they hired cheaters? I doubt it. Rather, I believe that there is a stigma attached to both the injured worker and employers – a stigma that both want to avoid.

No one seeking to get ahead wants to be an injured employee collecting compensation to support their family instead of working and earning real wages. The lifestyle of spending days and nights in pain, trekking from medical appointments, to therapy, to court, just to stay above water is far from appealing.

No employer wants to have to report that something went wrong and an employee was injured, specifically if the injury resulted from one of the employer’s own processes. Nor do employers want to incur additional costs and expenses associated with an injury.

Despite this, it eludes me as why conversations about this topic rarely take place – a conversation in which both parties respect each other’s perspective and a realistic plan is formulated.

Instead, the process often starts with no respect. For example, employers often challenge that an injury even occurred, especially if it was not immediately reported or witnessed. Typically following this is litigation, where the employer challenges both the underlying circumstances and the medical treatment needed thereafter.

While I do believe the recent procedural, regulatory, and legislative changes were well-intended, they have had unforeseen consequences that have made medical treatment harder to find and understand. These consequences have resulted in even more litigation, and delays in the injured worker’s recovery, which adds costs to both sides. This results in a further lack of respect for the injured worker.

At MCV Law we strive to understand the issue posed above, and to ensure that our clients are respected not only by us, but by their employers, insurance carriers, and the Workers’ Compensation system.

William Crossett

The law says that an injured worker is entitled to causally-related medical treatment. This simply means medical treatment related to an injury or illness that occurred at work. In the real world, this means that you can see a doctor or medical provider, such as a chiropractor or a physical therapist, who accepts New York State Workers’ Compensation insurance, has been approved by the Workers’ Compensation Board to treat injured workers, and completes the required forms.

It is often difficult to find medical providers to treat injured workers. In fact, many family doctors and internists have elected not to treat injured workers even if they generally provide them with routine medical care. Thus, conservative care for a back or extremity injury that was once offered by a family doctor is now referred to the big orthopedic practices, which are set up to handle Workers’ Compensation. In other specialties such as lung, heart or hearing loss cases, familiarity with the forms and procedures is limited, because these injuries are rarer. A list of board authorized medical providers can be found here: http://www.wcb.ny.gov/hps/HPSearch.jsp.

The medical providers are paid according to a fee schedule prescribed by the Board and are required to complete special forms. The forms are referred to as the “C-4 family” and can be found here: http://www.wcb.ny.gov/content/main/forms/Forms_HEALTH_PROVIDER.jsp.

Many medical providers have opted out of the Workers’ Compensation system because they believe that the fee schedule is inadequate, especially given the time and effort that is required to complete the forms. While a new fee schedule was proposed, it was withdrawn and is now being reworked to encourage more universal acceptance.

Consequently, injured workers with injuries to their back, neck, upper, or lower extremities, will most likely find themselves at an orthopedic practice shortly after their injury. Treatment for these sites is now subject to the Medical Treatment Guidelines. The Guidelines lay out acceptable treatments, as well as the sequence and duration for such treatment. If your doctor or medical provider wants to vary from the Guidelines, a variance must be filed and authorization must be obtained. A link to the Guidelines can be found here: http://www.wcb.ny.gov/content/main/hcpp/MedicalTreatmentGuidelines.

The Guidelines also require pre-authorization for more complicated treatments, such as fusion of the vertebrae of the low back. This process brings further requirements for doctors to follow. Specifically, doctors must complete and properly file a C-4AUTH form and wait 30 days for the Carrier to respond. The Carrier may approve or deny the request. To properly deny, the Carrier must provide evidence to support their denial, such as an opinion from an Independent Medical Examiner. Although a denial can be challenged in court, the process is still complicated and lengthy.

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.