WORK RELATED AUTO ACCIDENTS

Auto accident claims are heavily advertised by some attorneys.  If you are injured in an auto accident, as a driver, passenger, or pedestrian, in most instances you have will file a motor vehicle accident claim.

However, if your auto accident happens while you are at work, you also have a Workers’ Compensation claim and this needs to be filed separately.  There are many jobs and industries where the employees are on the go during the day.  A work related motor vehicle accident can happen to:

  • A delivery driver (package deliveries, food and beverage deliveries, etc.)
  • A home health aide or home care nurse who visits patients in their homes
  • A landscaper who drives to different properties to mow lawns, etc.
  • An insurance representative who visits clients for meetings or claims
  • A bus driver
  • A utility service worker who installs services in different homes and businesses
  • A construction worker who drives to different work sites

A work related auto accident does not have to happen in a company vehicle.  It does not have to happen on your employer’s property.  You do not have to be doing your “usual” work duties at the time of the accident.

If you are injured in a motor vehicle accident while you are at work, contact Zea Proukou to discuss whether a Workers’ Compensation claim is necessary!

 

DON’T LOSE OUT ON YOUR LUMP SUM AWARD!

Under the new budget passed by the New York State Legislature, the Workers’ Compensation Permanency Guidelines for schedule loss of use awards will be getting an overhaul by the end of 2017. This means that for injured workers with injuries to their fingers, hands/wrists, elbows, shoulders, hips, knees, ankles/feet, and toes, the schedule loss of use award as we know it could be eliminated or largely reduced.

The insurance companies and their lobbyists have pushed the idea that because of “advances in medical science” people recover better after treatment and surgery, and therefore percentages for schedule losses of use should be lowered. The lump sum award that many people see approximately a year after their injury or surgery is dependent upon the percentage loss of use. Lower percentage = lower monetary award.

Often times, when an injured worker is out of work recovering from their injury or surgery, they incur debt because the Workers’ Compensation benefits do not equal their normal wages. It is hard to get back on your feet, even if you get back to your normal job and pay. The schedule loss of use award is necessary for so many people to regain some normalcy in their lives after suffering a workplace injury.

Your voices have to be heard on this issue. If you are an injured worker that anticipates a schedule loss of use award, or if you have received one in the past, tell the New York Workers’ Comp Alliance that your benefits cannot be reduced or eliminated! Take the simple 8 question survey at this link as soon as possible!

http://tiny.cc/NYWAC

Claim Denied

WHY WAS MY WORKERS’ COMP CLAIM DENIED?

You suffered an injury on the job.  Maybe you strained your back while lifting something heavy.  Maybe you felt a pop in your knee when climbing down a ladder.  Perhaps you have developed wrist pain and weakness after years at the computer.  However the injury occurred, it happened at work and you feel you have a valid Workers’ Comp claim.

But one way or another, you find out your claim has been denied.  Why would this happen?  Let’s discuss some of the reasons why a Workers’ Compensation claim may be denied.

Notice to your employer

As soon as you are aware that you have an injury that happened on the job or as a result of your work activity, you need to immediately notify your employer – your supervisor or Human Resources representative.  They should have an  accident report or form to complete to take down information regarding your injury. You have thirty (30) days from the date of injury to provide proper notice to your employer.

Notice to the Workers’ Compensation Board

In addition to notifying your employer, a claim needs to be filed with the Workers’ Compensation Board.  This is not your employer’s responsibility.  A C-3, Employee Claim Form, (which can be found on the Workers’ Compensation Board website) needs to be filled out and submitted within two (2) years of your work related injury.

Medical Evidence

A Workers’ Compensation claim has strict requirements when it comes to medical evidence to prove your case.  Your medical provider must provide a report which specifically identifies 1) a history of your work activity, 2) a diagnosis of the injury, and 3) a statement that the injury is causally related to your work activity.  This is the basis of your claim and all Workers’ Compensation cases rely heavily on medical evidence.  Without these key pieces of information, a Workers’ Compensation Law Judge does not have a basis to establish a Workers’ Compensation claim.

Pre-Existing Condition

Having a pre-existing condition is a hurdle that can ultimately be overcome in a Workers’ Compensation claim; however, it is also a reason why an insurance company will initially deny a claim.   For example, perhaps you have had back pain and problems for many years for which you have seen your primary care doctor occasionally.  You experience a back injury while at work which causes you to lose time – maybe even require surgery.  An insurance company may try to allege that you had a preexisting back injury and use that as reason to deny your Workers’ Compensation claim.

Occupational Disease

We’ve talked about occupationally developed conditions in a prior blog “Work-Related Condition That is Not a Result of an Accident”.  Some work injuries develop over time and are not the result of a particularly identifiable incident.  These types of claims are often the most difficult for insurance companies to recognize and many times they are denied for that reason alone. 

So what do you do when your Workers’ Compensation claim is denied?  It is certainly no reason to give up!  A denied Workers’ Comp claim will likely require litigation and hearings at the Workers’ Compensation Board.  The insurance company will have an attorney representing them.  You should have an attorney to protect and fight for your rights. Contact Zea Proukou to further discuss the steps necessary to properly defend your claim. 

Can I get Workers’ Comp if I’m not at Fault?

You get hurt at work and it is not your fault.  And technically, it’s not the employer’s fault either.  Like with motor vehicle accidents, Workers’ Compensation in New York State is a no fault insurance based system.  So what does this mean for you?

The Workers’ Compensation system is designed to provide coverage for medical and wage replacement benefits for injured workers regardless of fault.  In order to establish a valid Workers’ Comp claim, you must have an accidental or occupationally developed injury that arises out of or in the course of your employment.  After properly notifying your employer, you must also produce medical evidence regarding your injury.  Specifically, your medical provider must put in writing a history of your work activity, a diagnosis, and a statement of causal relationship between your work and the resulting injury or condition.  This must then be filed with the Workers’ Compensation Board along with a C-3, Employee Claim Form. 

Now you are thinking, but my employer really is at fault!  Maybe there was a known issue on a machine and they still continued to run it.  Maybe there was a leak that resulted in an always slippery floor.  Even if the situation that resulted in your injury was clearly the fault of your employer, there is no payment or consideration for pain and suffering in the New York Workers’ Compensation system.  If there is some negligence that can be determined on the part of a third party, other than your employer, this would be handled by way of a separate, third party action claim.

Navigating these laws on your own can be difficult. An experienced workers’ compensation attorney can help you throughout the process and get you the benefits you deserve. If you believe your injury falls within these parameters, please contact us directly to further discuss that possibility. 

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.

Workers’ Compensation Claim Tips

When filing a workers’ compensation claim there are a few things you need to keep in mind.  As with any set of laws, the NYS Workers’ Compensation system can be a difficult one to navigate alone.  If you are injured while working there are things you can do to help secure your claim and protect yourself.

Tell your Employer ASAP

If you get injured on the job, don’t wait, tell an authoritative figure with your employer. Each employer has different policies for reporting on-the-job injuries, so if you were injured on the job, be sure you report it immediately. Don’t wait for the pain to go away. Not reporting can result in a loss of benefits.

Be sure, when reporting the injury you completely and legibly fill out any accident report documents given to you by your employer. This form will likely be the first formal notification you are giving your employer. Be sure to mention exact details of your accident and any affected body sites, even if they are not where your pain is centralized.

As with any set of laws, the NYS Workers’ Compensation system can be intimidating and difficult to navigate alone.  Hiring a good attorney should be at the top of your list if you are hurt as it allows you to relax and focus on getting better, rather than trying to figure out state laws and paperwork on your own.

Fill Out the C-3, Employee Claim Form

It is also necessary to file an additional form with the Workers’ Compensation Board which will initiate a claim through the State.  There are timely claim filing requirements which if not followed, could result in the denial of your claim.  Do not wait for your employer to file documents for you.  You must be proactive on your own case.

See a Doctor

Up to date medical evidence which gives a history of your accident and symptoms, a diagnosis, and a statement of causal relationship are all necessary in successfully getting your Workers’ Comp claim established. Most family and primary care doctors do not accept work injuries anymore.  We can help you find a doctor that will see you for your injury.

Keep Records of All Expenses Related to Your Treatment

Keep track of your out-of-pocket expenses as these are generally reimbursable. Keep receipts for parking lot fees, bandages and over the counter medicines. You could even keep track of your mileage traveled to your physician or independent medical examiner.

Filing a workers’ compensation claim can be a daunting task. However, if you don’t wait to report the injury, hire an experienced attorney and see an authorized physician, you will be making this process much easier on yourself.

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.