Author: Erin Warr

Could you have a CONSEQUENTIAL injury?

What happens if another body site starts hurting after your initial injury? For example, let’s say you injured your right knee. You had surgery a few months later, and recovery is not going well. You spend months in physical therapy and develop a limp. Because you have been favoring your right leg, your left knee or left hip starts hurting. For workers’ compensation purposes, this is called a consequential injury. The courts have long recognized that a consequential injury is compensable, provided there is “a sufficient causal nexus between the initial work-related injury for which a claim is established and the subsequent injury” (see e.g. Matter of Barre v Roofing & Flooring, 83 AD2d 681 [1981]; Matter of Pellerin v N.Y.S. Dept. of Corrections, 215 AD2d 943 [1995], lv den 87 NY2d 806 [1996], Matter of Scofield v City of Beacon Police Dept., 290 AD2d 845 [2002]).

 

What should you do? First, report the symptoms to your doctor as soon as possible. The doctor will need to be sure his or her medical notes include an opinion on whether the new condition developed as a consequence of the initial work related injury.  If he or she feels that is the case, they should include in their report a diagnosis, a medical opinion on the underlying cause of the condition, and how he or she feels the condition is related to the work related compensable injury, i.e., is it an expected consequence of the injury you have. Second, this note needs to be sent to the workers’ compensation board, insurance carrier, and attorney so a hearing can be requested to address this additional body site. The carrier has the right to send you for an independent medical exam for that doctor to evaluate whether they believe you have a consequential injury. Finally, once this is done, and the site has been accepted by the carrier and added to the claim, you will have full medical coverage, and potentially an additional award, for this injury as well.

 

If you think you may have developed a new condition as a result of your work related injury, or if you have questions about this process, contact the Zea Proukou team today.

WORK-RELATED CONDITION THAT IS NOT A RESULT OF AN “ACCIDENT”

It is easy for workers, employers, and insurance companies to clearly define an injury that resulted from a specific accident at work.  Slip and fall, machine accident, lifting a heavy object, to name a few.

 

What is harder to grasp are the conditions that develop over time as a result of work activity or exposure.  These conditions are known as “occupational diseases.”  To be considered an occupational disease (OD), there must be some recognizable link between the disease or condition and some distinctive feature of the worker’s job.  Occupational disease claims include, but are not limited to, asbestosis, exposure to chemicals on the job, back injuries that develop over time, hand and wrist conditions as a result of repetitive work or frequent typing (carpal tunnel syndrome), and hearing loss due to noise exposure.  Often times because an injured worker cannot report a particular date or incident that caused their injury, employers and insurance companies have a harder time accepting these types of claims.

 

Injured workers with OD claims receive the same types of benefits as those in traditional accident claims.  However, timely reporting of the condition and establishing the “date of disablement” is a very different process with different rules and timelines.  If you feel, or a medical professional tells you, that your condition is likely related to your work activity or environment, your employer should be immediately notified and a claim should be filed.

 

Contact Zea Proukou for more specific details about these types of claims and what to do if you have an occupational disease.

Estate Planning is for EVERYONE

Sometimes when people hear the words “asset protection” or “estate planning” they think those terms do not apply to them.  They may think estates are only for the wealthy, or that only the rich have assets.  But everyone has an estate.  Your estate is made up of everything you own – home, vehicles, any investment accounts, insurance policies, furniture, jewelry, and all personal possessions.

 

Studies show more than half of Americans die without a will or having an estate plan in place. People often think they aren’t old enough to consider having a will.  Unfortunately, the unexpected does happen – illnesses and accidents do occur.  It is not enough to let your loved ones know what your wishes are.  A well-thought and careful process will ensure your wishes are carried out how, when, and by whom you choose.  If you die without an intentional estate plan, any assets you may have will be distributed according to probate law.  If you have children and both parents die (for example, in a car accident), the courts will appoint a guardian they deem appropriate.

 

Estate Planning also takes into account other important documents such as Power of Attorney and Health Care Proxies.  The Power of Attorney is a legal document delegating financial authority from the person who signs (“principal”) to another person(s) of their choosing (“agent”).  The Power of Attorney will grant rights of your choosing to your agent(s), such as, real estate purchases, banking transactions, investment decisions, etc.  This document, however, will be inoperable when the principal passes away.  This is why a will and Health Care Proxy are also important.  The Health Care Proxy allows you to appoint another person (“proxy”) to make health care decisions on your behalf if you cannot make them or cannot speak for yourself.  These decisions can include the use of feeding tubes, breathing machines, medications, or termination of life support.

 

The team at Zea Proukou wants to help you create the best plan to ensure your family is protected. Call us today.

Workers’ Comp Offset of Social Security Disability Benefits

If you are a recipient of both Workers’ Compensation (WC) and Social Security Disability (SSD) benefits, you have likely heard the term “offset” when it comes to the two benefit programs.  SSD benefits are offset, or reduced, by the receipt of WC.  This is why it is important to be sure Social Security has all of the Workers’ Comp info at the time benefits are calculated and awarded; otherwise, overpayment issues can arise.

 

Social Security Retirement (SSR) benefits are not offset.  Typically, a claimant’s WC/SSD offset would end once the worker reached age 65 and they could switch to SSR.  However, in order to keep up with the increase in official retirement age, Congress has increased the age at which offset can end, and SSR benefits begin.

 

It is important to remember that only SSD benefits are offset.  Depending on individual circumstances, it may be more beneficial to take decreased, early retirement benefits beginning at age 62.  This reduced retirement benefit may exceed the offset SSD benefit amount.  There are other factors to consider, however, such as Medicare eligibility. Because Social Security is such a large, complex system, it is important to know your options and put yourself in the best position possible to plan for your future.

 

Talk to the knowledgeable team at Zea Proukou about the specifics of your claims.

No More Administrative Decisions from the Board?

The Workers’ Compensation Board has recently adopted a new policy as of 1/22/16 entitled “Reduction of Administrative Determinations for Claims with No Lost Time.”  While it seems relatively harmless because it pertains to injured workers with no lost time from work, it actually speaks to an inaction by the Board which may result in problems down the road for the claimant.

 

Although the paperwork may be burdensome for already bogged-down Workers’ Compensation Board claims examiners, it is important for those injured on the job to have their claim established administratively, even if there is no lost time right away.   Obtaining medical treatment or medications can become more difficult when a case is not formally established by the Board.  It becomes of utmost importance to ensure all possible sites of injury are listed on the initial C-3, Employee Claim Form.  And should the injured worker lose time from work at some point, getting benefits paid can be more of a process for a case that has never been established.

 

We see plenty of instances where paperwork gets lost in the scanning process, errors are made in official documents, and statutes of limitations have been passed due to inaction.  It is important to have your claim closely monitored for potential problems and to protect your rights if the Board is choosing not to issue an Administrative Decision in your case.

 

Call Zea Proukou for a free consultation today.

Can your WC or SSD benefits affect you at tax time?

Now that the year has come to a close, tax season will be upon us soon. There are a few things that you should be reminded of when filing your federal tax return if you are a recipient of Workers’ Compensation or Social Security Disability benefits.

Generally speaking, Workers’ Compensation indemnity benefits are not considered taxable income. You will not receive any sort of year-end statement from the insurance carrier or the Workers’ Compensation Board and you do not need to report the regular benefits you receive on your return (special considerations do apply).

If you are a recipient of Social Security Disability benefits, you will receive an SSA-1099 each year. Most SSD beneficiaries do not end up owing federal income taxes. Those that do usually have a working spouse or have some other passive income (such as income property or investments). As of 2011, recipients of SSD or SSI benefits did not have to pay federal income taxes if their income did not exceed $25,000.00 for a single person or $32,000.00 for a married couple.

You may have to pay taxes on a small portion of your lump sum past due benefits award but federal law allows individuals to apportion their past due benefits to previous years. This should lower or eliminate the taxable amount of the lump sum per year.

If you are or have been a recipient of both Workers’ Compensation and Social Security benefits, chances are an “offset” has been created. In these cases, Workers’ Compensation benefits are taxable in the same amount that the Social Security benefits have been reduced. For example, if your SSD payments are reduced by $250 per month due to your receipt of Workers’ Compensation, then $250 of your Workers’ Compensation benefits are taxable. Even in these instances, most recipients do not reach the threshold for taxable income to owe federal income taxes.

Tax laws and regulations can be very complicated and confusing. We urge you to talk to your tax-preparer regarding your specific circumstances.

THE VERY REAL CONSEQUENCES OF WORKERS’ COMP FRAUD

Workers’ Comp fraud is a very real thing.  And it can result in very serious penalties.  Just take a look at the recent local headlines out of Rochesterhttp://www.whec.com/article/stories/s3953268.shtml and Lockporthttp://www.lockportjournal.com/news/local_news/funeral-home-president-arrested-for-alleged-fraud/article_caab5c7e-c1de-5415-a238-6db2f2df73e4.html.  In addition to losing weekly benefit checks and medical coverage, insurance companies can also seek charges in criminal court.

Continue reading “THE VERY REAL CONSEQUENCES OF WORKERS’ COMP FRAUD”

Unemployment and Workers’ Comp Benefits

Most of our clients are surprised when we tell them there are circumstances when they can receive both workers’ compensation and unemployment benefits at the same time. In fact, the interplay between workers’ compensation and unemployment benefits occurs at a beneficial time for our clients and it is important to understand how this works.

Continue reading “Unemployment and Workers’ Comp Benefits”