Meggesto, Crossett & Valerino, LLP


The law providers for Workers’ Compensation benefits for all injuries or illness that arise from or occur during the course of employment. This does not mean that the accident or illness has to occur at any particular place. Many people don’t work in a factory or an office every day. Some work from their vehicles or at different sites each day, such as a home health aide, a construction worker, or a salesperson.

Portal to Portal
Certain employees are entitled to “Portal to Portal Coverage,” which is essentially door-to-door coverage. An example of this might be an exterminator who uses a company vehicle to pick up supplies once per week and then travels to customers from home during the remainder of the week. Under Portal to Portal Coverage, he would be entitled to Workers’ Compensation benefits if he was involved in an automobile accident on the way to a job.

Another example is a home health aide who travels from patient to patient and falls and breaks a hand in between visits on a snowy day. This person may be entitled to Workers’ Compensation benefits, as an argument can be made that the injury arose out of or in the course of employment.

Your employer or Insurance Company, however, is likely to argue that Portal to Portal Coverage does not apply. The Carrier may argue that there was a deviation for a personal reason that was outside the duties of the job. For example, if the home health aide on that same snowy day decided to check on a child and slips and falls on the sidewalk going into the school, the Carrier could argue that the injury did not arise out of or occur in the course of employment. Rather, the Carrier will argue the injury was the result of a personal act. Even for people who work in an office or factory, Workers’ Compensation benefits may extend to injuries that occur outside of the physical office. Often, this occurs in the context of parking. If your employer provides parking, and you are injured while you’re in the parking lot, this is generally covered under the Workers’ Compensation law. A similar situation arises if you work in a high-rise building and are injured in the lobby or elevator.

Cases of this type are very fact dependent. When considering to bring a Workers’ Compensation case arising out of an accident that occurs away from the workplace, it is best to seek immediate legal help. There may be other legal remedies, such as New York State No-Fault Benefits or a civil action against the owner or operator of the property where the injury occurred that must also be considered. See the Chapter on Third Party Actions.

William W. Crossett, IV
Partner

Email: crossett@mcvlaw.com

Phone: 315-471-1664

Mr. Crossett concentrates his practice in the representation of Injured Workers. Since 1982, he has regularly appeared before the Workers’ Compensation Board and the Courts of New York. As an advocate for the Injured Worker, he has testified before the New York State Senate and has presented many Continuing Legal Education programs. Presently, Mr. Crossett serves as President of the Injured Workers Bar Association of New York and is an active member of Workers Compensation Law Division of the New York State Bar Association. In 2012, he was inducted as a fellow in the College of Workers Compensation Lawyers. Mr. Crossett practices throughout Central New York with an office in Syracuse.


The New York State Workers’ Compensation Law is the exclusive remedy of an employee who is injured or made sick while at work in New York State.
“Exclusive remedy” means that, by law, you cannot sue your employer for an injury or illness that arises from your work. There are some very limited exceptions to this rule, such as where your employer has no Workers’ Compensation insurance. However, you can sue a third party whose negligence caused your injury.
Under New York State Workers’ Compensation Law, you are entitled to:
• Lost wage benefits, and
• Medical care.

The New York State Workers’ Compensation Law requires there be a direct connection or nexus between employment and injury or illness.
The law provides for two types of claims:
• Accidents and
• Occupational Diseases.

Accident
Accident claims generally arise from a sudden, unexpected event. Examples include a slip and fall, auto accident, or a fall from a ladder or other heights. Accidents also include injuries that arise from lifting, pushing, or pulling. Sometimes nurses and other health care professionals are injured while helping those they are caring for.

Occupational Disease
Occupational disease cases traditionally refer to injuries or illnesses that result over time. For example, occupational disease cases can include a secretary or clerk who develops carpal tunnel syndrome from typing or a baker who develops asthma from exposure to flour. Exposure to asbestos or other harmful substances and chemicals are included in this type of case.
Often, there is a thin line between what the law designates as an accident and an occupational disease. There are, however, some important differences regarding statute of limitations, burden of proof, and permanency that must be carefully considered.

William W. Crossett, IV
Partner

Email: crossett@mcvlaw.com

Phone: 315-471-1664

Mr. Crossett concentrates his practice in the representation of Injured Workers. Since 1982, he has regularly appeared before the Workers’ Compensation Board and the Courts of New York. As an advocate for the Injured Worker, he has testified before the New York State Senate and has presented many Continuing Legal Education programs. Presently, Mr. Crossett serves as President of the Injured Workers Bar Association of New York and is an active member of Workers Compensation Law Division of the New York State Bar Association. In 2012, he was inducted as a fellow in the College of Workers Compensation Lawyers. Mr. Crossett practices throughout Central New York with an office in Syracuse.


If you have been involved in a car accident with property damage there is a chance that you have heard the term subrogation. You may not know what that means, or why someone is contacting you about the claim, but don’t be worried you are not alone. Subrogation is nothing more than an avenue to get a just resolution to a claim. It allows an insurance company to “step in the shoes” of their insured and recover payments they have made because of an accident.

Why am I Involved in a Subrogation Claim?
What does that mean to you? For many people, if they are ever involved in a subrogation claim it is related to an automobile accident. When you are involved in a motor vehicle accident and there is a question about who is at fault, your insurance company may choose to pay you under YOUR policy. However, if at a later point, your insurance company believes another person responsible for your damages, they can try to recover from them. No one wants to pay for something they are not responsible for, not even insurance companies.

Are There Benefits for Me if my Insurance Company Starts a Claim?
How does this help you? If you paid your deductible and your insurance company wins you may receive money back. You were able to get money back, and your insurance company did all the work, that’s a win for everyone.

Do I Have to Cooperate With My Insurance Company?
It is important to note that most insurance policies require you to cooperate with their subrogation claims. Check your individual policy for specific requirements.

Richard Derrick

Email: rderrick@mcvlaw.com

Phone: 315-471-1664

Richard Derrick graduated from Roger Williams School of Law in 2009 where he received the Public Service Award for his commitment to providing legal assistance to the community during his studies. He was admitted to the New York Bar in 2010 and Massachusetts Bar in 2009. He has been a member of Meggesto, Crossett & Valerino, LLP since August 2015.


Yes! Everyone who rents an apartment or a house should have renter’s insurance. And yet, if you are like most people, you probably do not have renter’s insurance. Most people are under the illusion that any damages will be covered by their landlord’s insurance, however this is not true. A landlord’s insurance will only cover what a landlord owns, and will be limited to the land and the physical structures on the land. Any of your personal property, will not be covered by your landlord’s insurance company.

A little known secret of renter’s insurance is that it does not cost that much. An average policy cost $15 per month or $180 per year. If you go with a cash-value plan, which reimburses you for the current market value of any given item, you will pay a little less. If you have a replacement plan, which covers the entire cost of purchasing a new item, you will pay a little more.

Therefore, if you have a break-in or a fire, and you have renter’s insurance, you will be able to replace your belongings. In addition, if someone hurts themselves inside your home and claims you are responsible, renter’s insurance will cover your liability.

As you can see, renter’s insurance is well worth the cost.

Heather La Dieu

Email: hladieu@mcvlaw.com

Phone: 315-471-1664

Heather R. La Dieu has been an associate in Meggesto, Crossett & Valerino, LLP’s Litigation Department since 2001.  Ms. La Dieu focuses her practice primarily in personal injury cases involving motor vehicle accidents, premises liability, construction accidents, municipal liability, wrongful death and products liability.  Ms. La Dieu also practices in the area of insurance law, contract law and criminal defense.

Ms. La Dieu is a graduate of Syracuse University where she earned her B.S. in Chemical Engineering and received her J.D. at Syracuse University College of Law.

Ms. La Dieu is admitted to the New York State Bar, the U.S. District Court for the Northern District and the Supreme Court of the United States of America.  Ms. La Dieu is a member of the Onondaga County Bar Association, New York Bar Association and Central New York State Women’s Bar Association.  Ms. La Dieu also has arbitrated for the Syracuse City Court Arbitration Program.


I recently discussed in the past on my blog that everyone who rents an apartment or a house should have renter’s insurance. A landlord’s insurance will only cover what a landlord owns, and will be limited to the land and the physical structures on the land. Any of your personal property, will not be covered by your landlord’s insurance company.

I would note that damage from an earthquake or flood will likely not be covered. In fact, any hazard that is not specifically mentioned, like water damage from faulty plumbing, if it is not specifically stated in your policy, will not be covered. In addition, if you own something valuable, like jewelry, artwork or antiques, you will need additional insurance specifically covering the special item.

People often ask how much renter’s insurance should they purchase. The answer depends on how valuable are your personal belongings. $2,000 would be sufficient for some people, while $100,000 would not be enough for others. You might want to do some research into how much your possessions are worth before you determine how much renter’s insurance you need. Some possessions, like antiques, may require an appraisal.

In addition, you may want to inventory your most valuable possessions. It would be helpful if you took photos and kept purchase receipts. The inventory should be kept outside your home so they are not destroyed by whatever happened to the rest of your belongings.

Renter’s insurance is well worth the cost should something happen to your home.

Heather La Dieu

Email: hladieu@mcvlaw.com

Phone: 315-471-1664

Heather R. La Dieu has been an associate in Meggesto, Crossett & Valerino, LLP’s Litigation Department since 2001.  Ms. La Dieu focuses her practice primarily in personal injury cases involving motor vehicle accidents, premises liability, construction accidents, municipal liability, wrongful death and products liability.  Ms. La Dieu also practices in the area of insurance law, contract law and criminal defense.

Ms. La Dieu is a graduate of Syracuse University where she earned her B.S. in Chemical Engineering and received her J.D. at Syracuse University College of Law.

Ms. La Dieu is admitted to the New York State Bar, the U.S. District Court for the Northern District and the Supreme Court of the United States of America.  Ms. La Dieu is a member of the Onondaga County Bar Association, New York Bar Association and Central New York State Women’s Bar Association.  Ms. La Dieu also has arbitrated for the Syracuse City Court Arbitration Program.


It is a fact of life in the world of New York State Workers’ Compensation that getting medication is not as easy as your everyday trip to the pharmacy to pick up a prescription. One of the main reasons for this is the number of parties involved, and the regulatory structure under which those parties do business.

We tend to think of the medications which we take as a private business between our doctors and ourselves. Although we are aware that our private health insurance has a say in what will and will not be paid for, the Doctor is well aware of those particular restrictions, and will prescribe accordingly, keeping the prescription machine flowing smoothly enough that being able to obtain a prescription is relatively easy.

For compensation claimants, there are not only more parties that stand between you and your medication, there is the additional regulatory filter of the New York State Medical Treatment Guidelines. These are guidelines that all parties involved must adhere to.

For the Workers’ Compensation claimant it may be better to think of a prescription as a request, rather than Doctor’s Orders. It is a request that has to pass through all parties involved in order to be granted.

Here is an overview of the general process:

  1. Claimant sees the doctor and medications are prescribed.
    The claimant has a medical visit with a doctor who prescribes medication that is related to the treatment of his injury. The prescribing of the medication or the continued use of the medication should be clearly spelled out by the treating physician in the medical narrative report. All medications should be written down at every medical visit. Do not hesitate to let your doctor know this.
  2. The prescription is not enough.
    Although your pharmacy will take your prescription and enter it into their system as a request, a prescription is not adequate documentation for the compensation insurance carrier to authorize the release of that medication to you. When you are first injured, you may get a one-time fill of medication which will be paid when the claim is accepted, or will be charged back to private insurance if the claim is not accepted. However, once past that first-time fill your prescriptions will go through the normal channels. From that point forward, the prescription will not be filled without clear medical evidence of the need for the medication. A prescription, therefore, is just a request without evidence or explanation.
  3. The Third Party
    There is a third party pharmacy administrator that stands between the pharmacy and the compensation insurance carrier. The third party administrator basically verifies all your prescription information and passes your prescription request on to the insurance carrier for authorization.
  4. The Insurance Adjuster/Case Manager.
    The insurance adjuster is the one who will receive the request from the third party administrator and authorize your prescription. Ongoing prescriptions that are clearly recommended by the guidelines will be the easiest to pass through the system. Prescriptions that fall outside the guidelines will require a secondary review, and will normally be rejected without a clear medical explanation of their necessity in the doctor’s medical reports. Often a separate Letter of Medical Necessity will be required.
  5. Adjusters take vacations.
    Compensation claimants need to be aware that insurance adjusters go on vacation, and “substitute” case managers are not always readily available, causing a delay in getting prescriptions. Contact your attorney with any issues.
  6. Nurse Case Manager, Utilization Review.
    Any prescription usage under New York Workers’ Compensation is subject to review by a medical professional, usually Nurse Case Managers. This is especially true with “chronic” users of medication who have been taking medications for extended periods (generally anything longer than 6 months). Any ongoing use of opiates and other narcotic medications is closely monitored. Requests falling outside the guidelines that are clearly indicated as necessary may be subject to Utilization Review.
  7. Durable medical equipment requests (braces, canes, wheelchairs).
    Durable medical equipment is treated as just another prescription, and is subject to the same processes and guidelines as any other medication.
  8. Contact your legal representative.
    If you are represented in your worker’s compensation claim, contact your attorney’s office with any prescription medication issues – Do not contact the insurance carrier directly.
  9. John M. Bellinger
    Paralegal

    Email: jbellinger@mcvlaw.com

    This entry was written by John Bellinger, who is part of the Worker’s Compensation team at MCV Law.


Across New York State, the State Police are currently in the midst of their annual “speed week” campaign, which runs through Tuesday, August 11th. According to the State Police, speed is a contributing factor in one out of every three motor vehicle accidents across the state.

“Our goal during this campaign… is to get dangerous drivers off New York roads”, says superintendent Joseph A. D’Amico.

Troopers will be using both marked and unmarked vehicles in their effort to make New York’s roadways safer. In addition to speeding violations, the Troopers will be ramping up their attention to distracted driving, as well as any non-compliance with seat-belt and “Move-Over” laws.

Here are the current fines for speeding in a 55 or 65 mph zone:

First Conviction
– 10 mph over limit: minimum $45 maximum $150
– 11-30 mph over limit: minimum $90 maximum $300
– 31+ mph over limit: minimum $180 maximum $600
Second Conviction
– 10 mph over limit: minimum $45 maximum $300
– 11-30 mph over limit: minimum $90 maximum $450
– 31+ mph over limit: minimum $180 maximum $750
Third Conviction
– 10 mph over limit: minimum $45 maximum $525
– 11-30 mph over limit: minimum $90 maximum $675
– 31+ mph over limit: minimum $180 maximum $975
Court Surcharges
– Town or Village: $93
– Other Courts (City/Traffic): $88
Violation Points
– 1 to 10 mph over limit: 3 points
– 11 to 20 mph over limit: 6 points
– 30 to 40 mph over limit: 8 points
– 40+ mph over limit: 11 points (this triggers suspension)

Please be careful on the road, this week and every week.

If you have a traffic ticket, call Gary Valerino at MCV Law (315-471-1664) for help.

Gary_8829_270x163

Gary Valerino

Partner

Email: gvalerino@mcvlaw.com

Phone: 315-471-1664

Gary Valerino, Esq. is a 1998 graduate of Syracuse University Law School. Mr. Valerino is admitted to practice in all New York State Courts, the Federal Northern District of New York, and the Supreme Court of the United States. He has been practicing law since 1989 and has been with Meggesto, Crossett & Valerino, LLP his entire career.  He is a member of the Association of Trial Lawyers of America (ATLA) and the National Association of Subrogation Professionals (NASP).  He is also an approved subrogation counsel for many of the major insurance companies.

MCV Law Attorneys

In order to settle the medical portion of a Workers’ Compensation claim, we are sometimes required to take into account Medicare’s interest. This requires us to obtain a Medicare Set-Aside. While this may seem confusing and unfamiliar, there are many advantages to settling your medical with a Medicare Set-Aside.

First, a Medicare Set-Aside is managed by you. This means that you no longer have to get pre-approval for your treatment and no longer have to wait for pre-approval from your adjuster at the pharmacy for your scripts. You can also treat at your leisure and are not required to follow the Medical Treatment Guidelines. Many of our clients find it easier to leave New York and get to warmer weather when they are in charge of their treatment. Often times, claimants find difficulty getting treatment out of New York State, and a Medicare Set-Aside fixes that problem. The money goes with you – and you use it as you see fit.

The second advantage to a Medicare Set-Aside arrangement assures that you have medical coverage for life. When the Centers for Medicare Services approves the amount of your Medicare Set-Aside, they are agreeing to pay your treatment, subject to their rules, once the monies in the set-aside are exhausted. This way, you have coverage for life, whether it comes from your Medicare Set-Aside monies or directly from Medicare.

During early settlement discussions with our clients, many are confused by the Medicare Set-Aside process, but quickly realize that it has many advantages and is actually quite simple. Given the advantages discussed above, many of our clients are happier using a Medicare Set-Aside than relying on the Carrier to manage their treatment.
Bethany Nicoletti

Email: barliss@mcvlaw.com

Phone: 315-471-1664

Bethany Nicoletti is a graduate of Ithaca College where she earned her B.A. in Communication Studies. She graduated cum laude from University at Buffalo Law School in 2013 and was admitted to the New York State Bar in the Fourth Judicial Department in 2014.

Calculating Weekly Benefits

How much will I get? This question is usually one of the first things a client asks us when discussing a Workers Compensation case. Previously, to answer this, we would have to get the necessary information from the client, then calculate the weekly benefits, and then finally contact them again so they could hear the result. Now, we have made it much easier! The only thing you have to do is follow the instructions on the calculator page and it will give you an estimate of the benefits you will receive!




This week the United States Senate will take up legislation to fund the nation’s highway system. Most of us think this is a good thing. However, we have learned that one or more of the amendments to the legislation would cut Social Security Disability Income (SSDI) to help fund the highways. Specifically, the proposal talks about cutting benefits for people who receive SSDI and Unemployment Insurance (UI).

Typically, the UI overlay is because SSDI beneficiaries have attempted to work, as the law encourages, but lost their job to no fault of their own.
The National Association of Disability Representatives (NADR) has encouraged us to write to our New York State Senators Chuck Schumer and Kirsten Gillibrand urging them to oppose this and other amendments to the Highway bill.

Here is a sample letter from the Consortium for Citizens With Disabilities for your consideration. Please share your concern with our State Senators, whose email addresses are shown below.

Senator Chuck Shumer: robert_gardner@schumer.senate.gov
Senator Kirsten Gillibrand: karina_cabrera@gillibrand.senate.gov