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

                                                                                  
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.

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.

If you are planning to take Social Security Retirement Benefits before full retirement age, are you doing this because you want to stop working or because you have an illness or injury that is forcing you to stop working?

If you are taking early retirement due to an illness or injury, you should consider filing a claim for Social Security Disability Benefits. You can do both, meaning you can collect your Reduced Retirement Benefit while you are waiting for a decision on your Social Security Disability Claim. If Social Security approves your disability claim, Social Security will pay you the difference between your Disability Benefit and your Reduced Retirement Benefit for the months that you are eligible for both. Thereafter, you will continue to receive your Disability Benefits.

-Kimberly Slimbaugh

Email: kslimbaugh@mcvlaw.com

Kimberly Slimbaugh