What Happens To My Privacy In A Workers Compensation Case?

By | Uncategorized

4 things to know about your privacy rights 

Before working with us on your workers comp case, it is important to know exactly what you are getting into. Workers Compensation Cases are stressful enough so to add an element of surprise isn’t the ideal scenario. Let’s make sure that you understand your privacy rights during a workers compensation case 

Your records are private & should remain that way

In NY, your records are private documents. Only the parties to a claim, the employer, employer’s attorney and the employer’s workers compensation insurer and its attorney may receive information from that claim’s case file. 

Your social media could be used against you

A big red flag to be aware of is that in some cases, investigators’ will request passwords to your private social media accounts. If you refuse, they may be able to subpoena your passwords. Be conscious of what you are posting on Facebook and other platforms after you are injured at work. It may be used against you to make it look like the injury was pre-existing or that the injury was extremely minor. 

Signing a confidentiality agreement may not be the best choice

There are times that the employer may want the injured worker to keep the amount and terms confidential. Initially, this may not seem like a big deal to you. Yet depending on how you receive the money, signing an agreement could cause your settlement to be taxed. This could make your settlement significantly smaller than originally intended. 

The Privacy Rule isn’t Perfect

“The Privacy Rule recognizes the legitimate need of insurers and other entities involved in the workers’ compensation systems to have access to individuals’ health information as authorized by State or other law.” This rule holds violators accountable, with civil and criminal penalties and ultimately limits the release of information to the minimum needed for the purpose of the disclosure. While this may sound great, keep in mind that “minimum needed” leaves room for discussion. Since this is a very subjective term, the “minimum” could end up being more information than you had originally intended.

No Worker’s Compensation Case is the same. You may experience one or all of these during your case so it is important to have a basic understanding of the issues at hand.

In order to make sure you know how to protect your privacy, give us a call at 716-854-1446.

Article adapted from:

New York State Workers’ Compensation Board & U.S Department of Health and Human Services

Workers’ Comp Denied? Here is What You Can Do About It

By | Workers Compensation

If you were injured on the job or developed a medical condition because of your work (cumulative trauma like a repetitive strain injury (RSI) you are probably hoping to receive workers’ compensation benefits.  Workplace injuries are generally covered by your employer’s workers’ compensation insurance.  Many states require employers to be covered in accordance with the average level of risk for that particular industry.  What can you do if your claim has been denied?  You may be able to appeal your denial through your state’s board of workers’ compensation. 

Employers or their insurance companies sometimes look for any possible reason to deny workers’ comp claims.  The first thing you need to do is determine the reason why your claim was denied.  The details should be explained in your denial letter.  In New York State that form is called a SRO 1-04.  If you believe your denial was done in error you can appeal. 

Common Reasons for Denial of Workers’ Comp Claims

Your employer may say that you weren’t working when you were injured, or that you were involved in some sort of horseplay or misconduct, or that your current medical condition is not a direct result of an accident at the workplace.  Whatever your reason for filing the workplace injury claim, you will need to gather sufficient evidence to support the claim.  Some examples include, witness testimonials, or medical evidence and records.  If the doctor that is treating you has already stated that your current condition was due to an injury at work, but your insurance company disagrees, you may need to get schedule another medical evaluation to get an additional doctor’s opinion.

The law in your state may have special restrictions on workers’ comp claims for increasing trauma or psychological conditions.  Some states rule out workers’ comp benefits for illnesses caused by long-term stress at work.

In most cases, you must receive medical treatment in order to receive workers’ comp benefits.  If you deny or do not seek out medical treatment your claim may be denied.  When you discuss the extent of your injury with your employer, they should pull out the employee handbook to review their policies and procedures.  Employees that initially report the injury but refuse treatment may see that their workers’ compensation benefits are suspended.  Your employer may not allow you back at work until you pass a medical clearance test to determine if you can perform your everyday duties. 

Timing is everything when it comes to filing a workers’ comp claim.  You should immediately report your injury with human resources and make it clear that you were hurt on the job.  Check with state laws to see what your timeframe is to file your workers’ comp claim. If you did not adhere to the state laws, your claim could be denied.  This goes for both reporting your injury and filing your claim in time.  Many states include limited exceptions for when the injured employee couldn’t file a claim right away because they were in a coma, severe injuries that required immediate and prolonged treatment or surgery (burns) or the employee had to remain quarantined.  Don’t hesitate to file a claim even if your injury seems minor.  It could get worse as time goes on especially if you have neck or back injuries.  If you happen to file a claim and the injury gets better on its own, the claim will be closed but if you wait to file you could lose the chance to get benefits or risk the claim being denied. 

Have you recently quit, been laid off or fired from the job where you filed your workers’ comp claim?  Insurance agencies usually deny claims that were filed after you left the company.  Did you report the injury while you were still employed there or during the time that you gave your notice?  Some states have special rules for workers’ comp claims that were filed after you left your job.  If you qualify for one of these exceptions you may be able to receive workers comp. 

So Your Claim Was Denied, Whats Next?

Don’t feel like you won’t be receiving workers’ comp benefits just because your claim was initially denied.  Double check and reread the letter that was sent to you saying that your claim was denied.  The reasons should be listed but if you feel that it had to do with paperwork or a similar mistake, you should contact your claims adjuster and employer to explain your situation.  In most cases you will have to consider appealing the denial.  Your letter should give a deadline for filing your appeal, which is determined by state law.  The first level of the appeal will be a hearing where you will have to provide medical and any other type of evidence that supports your claim in front of an administrative law judge.  The hearing can be done through your state labor department or state board of workers’ compensation. 

If you still want to appeal the decision, you should look into getting a workers’ comp lawyer as soon as possible.  A lawyer will help you determine whether or not an appeal would be the best route.  Since the deadlines for workers’ comp are short you don’t want to miss out on receiving your benefits because you we’re late.  You will want to bring any documentation, medical records and reports that state your case to your court date. 

If you have any questions about your workers’ compensation claim or would like more information, call Losi & Gangi at 716-854-1446. 

How Do You Know If Your Personal Injury Is Sufficient For a Lawsuit?

By | Personal Injury

Most people will experience some sort of injury during their lifetime.  Having an injury doesn’t necessarily mean you should seek out legal claim since some injuries are attributed to age, genetics or an unavoidable accident.  When another person is legally at fault for the incident that led to your injury, you may have a valid legal claim and grounds for a lawsuit. 

Do You Have a Legal Claim?

A legal claim can be made through a personal injury lawsuit or insurance action.  You are able to recover compensation for damages when someone else is legally responsible for causing the accident or creating any of the factors that led up to the injury.  The injury claim is made to allow the injured person to recover compensation for the jury.  This includes damages such as lost wages, medical expenses and sometimes emotional distress and pain and suffering. 

General Types of Incidents & Legal Claims

Type of Case

Cause of Action

Liable Party

Source of Compensation

Car Accident

Driver’s Negligence

At-fault driver (unless you are in a no-fault state)

Insurance Claim/Civil Lawsuit

Slip and Fall

Property Owner’s Negligence

Property Owner

Insurance Claim/Civil Lawsuit

Medical Malpractice

Medical Negligence

Doctor/Medical Professional, Hospital or both

Insurance Claim/Civil Lawsuit

Workplace Accident

None

None

Workers Compensation Claim

Defective Product

Strict Liability

Product manufacturer

Civil Lawsuit/Class Action Lawsuit

Assault/Battery

International Tort

Aggressor/perpetrator

Civil Lawsuit

Animal Attack/Dog Bite

Owner’s Negligence

Animal Owner

Civil Lawsuit/Homeowners Insurance Claim

 

What You Need to Make Your Case

If you want to make an injury claim, you need to prove that the person who caused the injury, the one that you are making the claim against was negligent.  Being negligent means they breached a legal duty owed to you and the breach led to the accident and injuries resulted from it.  The person making the claim needs to prove this is true under personal injury law.  If your claim makes to trial, the legal standard which you must prove your case is by a preponderance of the evidence.  Preponderance of the evidence means you must prove to the judge or jury that everything you are alleging is true regarding the cause and extent of your injuries and the liability of the defendant.  Many times a case will not make it to trial, especially the verdict stage. Instead, a settlement may be reached between the two parties.

Not every injury case will come down to the question of whether or not the other party was negligent but most do.  If your injury was caused by a defective product, a workplace accident, or an intentional act, your claim will follow different rules (civil lawsuits).  If you suffered an injury while at work you will need to file a workers’ compensation claim under the procedures that New York State follows.  In almost every workplace accident, the worker who became injured is banned by law from suing their employer.

Necessary Evidence Needed to Prove Your Claim

If the kind of lawsuit you are bringing requires you to establish that the other party was negligent, this is the type of evidence you might need to fight your claim. 

  • Police reports documenting the circumstances and cause of the car accident
  • Incident reports written by the business or place where the injury occurred
  • Detailed eyewitness statements explaining where, when and how the injury happened
  • Photographs and evidence from the accident
  • Records of all medical treatment that was given due to the injury
  • Documentation of time missed at work and your income to support your lost wages claim
  • Testimony from a doctor or medical professional regarding the cause of your injury

Should You Talk to a Lawyer?

Figuring out if you have sufficient evidence to bring a lawsuit can be difficult especially if you are not sure what type of evidence you need and how to obtain it.  In most cases it is best to seek out an experienced personal injury lawyer who can help determine if you have a valid case.  If you have any questions you can reach out to Losi & Gangi.  One of our attorneys will be able to help.  Call us at 716-854-1446.

Tips to Make Sure You Are Being Paid Your Workers’ Compensation Benefits

By | Workers Compensation

When you get hurt on the job, your injuries may last longer then you might have expected. It is important to make sure you are not wrongfully denied benefits to receive the maximum amount of compensation you can. Without legal representation, you are at the mercy of the insurance carrier and the adjuster who is handling your claim. Insurance companies may find ways to delay, limit, or even discontinue your benefits for many different reasons. Some adjusters do right by the injured employee by approving medical expenses and paying the correct benefits on time. However, sometimes adjusters hide information from you and will not tell you the whole truth about your claim. For example, do not ask an adjuster how much your benefit checks are worth, keep in mind that they are the ones who chose that amount.  The adjuster will tell you the amount you are receiving, whether or not it is the amount it should be. The only way to make sure you are receiving all of the benefits you are entitled to, is by speaking to an experienced workers’ compensation lawyer.

Here are some tips to follow:

Report the injury as soon as possible

According to workers’ compensation laws, you must report the injury as soon as possible or within the next 30 days. Some workers’ compensation lawyers may deny claims simply because the injured employee did not report the injury immediately. If you think you are unable to work the next day, report the injury to your supervisor as soon as possible. This will help better your chances of getting your benefits promptly. Your employer will also require you to fill out and sign an accurate accident report.

Write down the names of any witnesses

Witnesses are crucial in work related injuries to prove that you were actually hurt on the job. If anyone witnessed your accident, get their names and contact information. 

Get medical treatment

Make an appointment to see a doctor after the injury. Insurance companies like to assume that if you did not receive medical treatment, you were not hurt. Additionally, it is important to attend your appointments and follow up with the prescribed medication and treatments. If insurance companies notice a pattern of missing medical appointments they will assume you have recovered and will start looking for ways to terminate your benefits.

Explain in full detail how you got hurt

Insurance companies will deny workers’ compensation claims if your medical records do not adequately describe the accident and injury.  If you tell your supervisor how it happened one way but then tell your doctor it happened another way it will hurt your case.  Make sure your statements match up and stay consistent. By clearly explaining the injury to your health care provider, they are able to keep their records more accurate. You do not have to elaborate the injury in full detail, keep it basic so the doctor can write it down correctly.  Make sure you say that the injury happened at work. The insurance company may ask you to sign a limited medical authorization allowing them to receive copies of your medical records. This request is reasonable, however, they are only entitled to record and bill related to your work injury. You should not sign any other authorizations because insurers are not entitled to those records without discussing the them with a workers’ compensation lawyer. 

Attend All Scheduled Legal Proceedings and Appointments

Unless you have a workers’ compensation lawyer, you must attend every legal meeting or court date during an appeal. If you do not appear at one of your scheduled legal appointments, you risk losing your benefits.  Even if you have a lawyer, you will need to show up for key appointments such as your deposition and independent examination.  If you have to miss an appointment, you should notify your insurance company and state agency beforehand. 

Finally, talk to a workers’ compensation lawyer.

You may not need a lawyer if your workers’ compensation claim is very simple or if the insurance company voluntarily pays the claim.  Consider hiring an experienced lawyer to help you understand the benefits you should receive from your work related injury or if you are having trouble getting any information from your insurance company. 

If you have questions or think you may have a workers’ compensation case, you can always speak to one of the attorneys at Losi & Gangi. Call us at 716-854-1446.

Personal Injury vs Workers Compensation

By | Personal Injury, Workers Compensation

When someone gets injured at work they assume their only option is to file for workers compensation. However, in some situations the injured worker is able to file a personal injury claim. Understanding the differences between a personal injury and a workers compensation claim are essential for obtaining maximum benefits. Although a personal injury can occur during work hours, filing them as a personal injury lawsuit or a workers compensation claim depend on different factors. The three main factors include:

Damages: One key difference in damages is workers compensation is not entitled to receive pain and suffering benefits. In a workers compensation case, the injured worker receives impairment benefits, medical bill coverage, and weekly compensation. However, in a personal injury lawsuit, you may receive all the damages that you suffered such as pain and suffering, lost earnings, and loss of enjoyment of life.

Determining Fault: Accidents happen everyday but in order to recover damages in a personal injury case, you and your lawyer must prove that the other person neglected the safety of his/her property. However, because workers compensation is a no fault system, you do not need to prove you, your employer, or co-workers did anything wrong in order to receive benefits.

Right to Sue: Once the injured worker files for workers compensation they cannot file a lawsuit against their employer. They forfeit their right to sue once they are in the process of receiving workers compensation benefits. However, in a personal injury case, the injured worker may sue for their injuries and suffering.

An easy way to determine whether to file for personal injury or workers compensation is to figure out who is liable for the injury. The difference between personal injury and workers compensation has to do with liability. Once you understand who is liable for the injury you can quickly see which position to take.

Workers’ Compensation Benefits

By | Workers Compensation
A work-related injury can cause major disruptions in ones life. It is an unfortunate reality that work can be dangerous. Although some jobs may be more hazardous than others, every job is at risk of injury or illness. Some injuries may be temporary but others can be long-lasting. This may require the injured worker to take time off to recover and file for workers compensation. The New York State Workers Compensation law is a no-fault system. This means that injured workers can receive benefits even if they were partially responsible for the accident to cause the injury. Furthermore, even if the injured worker is partially responsible for the injury, the amount that the claimant is awarded is not decreased by their carelessness. However, if the injury results solely from being intoxicated by drugs or alcohol or from the intent to injure themself or someone else, the worker loses their rights to workers’ compensation benefits.

 

The claim is paid by the employers insurance if the employer or the insurance carrier agrees that the injury or illness was work related. However, if the employer or insurance carrier disputes the claim, the injured worker does not receive benefits until the Workers’ Compensation Law judge determines who is right. If the verdict results in favor of the injured worker but is not receiving benefits because the employer or insurance company does not agree with the verdict, the injured worker may be eligible for disability benefits in the meantime. However, if eligible, the payments they receive from the disability program will be subtracted from future workers’ compensation benefits.

 

Workers compensation benefits are available both for injuries caused by accidents and illnesses, such as lung diseases for workers who are exposed to respiratory dust. Injured workers must prove that the accident or occupational disease arose during working hours in order to qualify for workers’ compensation benefits. Workers compensation also covers illnesses or injuries that are developed over a long period of time. For an example, back problems developed from repetitious movement.

 

Time is limited to file a workers compensation claim so give us a call as soon as possible to talk about your claim.

Hurt on the job? What are your next steps?

By | Personal Injury

Getting hurt on the job can be a stressful and frightening experience. Millions of workers are hurt on the job every year and injuries may be serious or potentially life threatening. Therefore, it is important to take action right away. There are certain steps and procedures that must be fulfilled in order to receive workers compensation benefits.

The first step after being hurt on the job is to notify your employer. If you are unable to notify them right after the injury has occurred, do so in the next 30 days. However, if the injury has accumulated over time, such as cancer from chemical exposure, you have 30 days after the diagnosis to let your employer know. If you do not notify your employer within 30 days of the injury you may lose the right to compensation benefits. Although a written notification is not required, it should be safeguarded for future reference.

The second step is to obtain medical treatment for the injury as soon as possible. Injured workers can receive treatment from their employers with the company doctor. After the initial treatment it is advised to follow up with additional appointments. The injured worker does not pay for the medical treatment(s) because it is required by law that employers carry workers compensation insurance to cover expenses.

The third step is to keep records of when you missed work. This allows you to keep track of money you are entitled to receive. If you have missed at least seven days of work you are entitled to receive lost wages benefits equal to two-thirds of your lost income.

The fourth step after an on-the-job injury is to keep a detailed account of your medical treatment and process. Keeping a record of your medical treatments, progress, and recovery will help to identify the state of your condition. This will prevent employers from encouraging you to come into work when you are not ready.

The final step is to follow up on your claim. The approval process is quick and benefits are received within weeks. However, if your claim has been denied you must call an attorney immediately. You have limited time to respond so it is important to take action promptly.

Do you have additional questions? We are here to help

 

2017 New York State Workers’ Compensation Changes

By | Uncategorized

On April 10th, 2017, Governor Cuomo and the New York State Legislature made changes to the New York State Workers’ Compensation Law. The law suggests several changes affecting injured workers since the enactment of the NYS Workers’ Compensation Reform Act of 2007.

The first change involves injured workers looking for work. This change reports that injured workers diagnosed with permanent partial disability (PPD) are no longer required to prove they were looking for work. This new change eases the stress of injured workers and eliminates the risk of losing lost income benefits.

A second change to the law affects first responders. First responders who suffer mental injuries on the job are now entitled to secure Workers’ Compensation benefits. Previously, first responders who suffered mental injuries were not entitled to WC benefits because their stress was not distinct in comparison to other first responders.

A third change involves permanency of injuries. Injured workers who have reached maximum medical improvement (MMI) are entitled to start collecting lost income benefits once permanent injury is classified.

Please do not hesitate to contact our offices with concerns regarding the new changes to the New York Workers’ Compensation Law.

LOSI & GANGI ADDS THREE ATTORNEYS

By | Uncategorized

Buffalo, NY – Lost & Gangi, a Buffalo-based workers compensation and personal injury law firm has added three new associate attorney to the firm’s workers’ compensation practice. The announcement was made by Jeffrey D. Gangi, managing partner for Lost & Gangi. The new attorneys include Philip Scaffidi, Bryan Brooks and David Derrico.

Philip Scaffidi has been practicing law since his admission to the New York State Bar in 1996. A graduate of the University of Rochester where he earned a B.A. in economics, he obtained his law degree from Tulane Law School in New Orleans, Louisiana. Scaffidi has focused his legal work on representing injured workers. Mr. Scaffidi is a member of the Injured Workers’ Bar Association and the New York State Bar Association. He is also a member of the Bar Association of Erie County where he served as Chair of the Workers’ Compensation Committee. He has been recognized in Buffalo Business First’s “Who’s Who in Law” and was recently honored by the Center for Elder Law and Justice with their “Attorney Excellence Award” for his work assisting refugees with worker’s compensation claims.

Bryan Brooks is a 1999 graduate of SUNY Fredonia where he earned a BA degree in history and political science. He attended the University of Dayton School of Law and graduated in 2003. After practicing law in Washington State, Brooks relocated to New York and was admitted to the bar in 2005. Mr. Brooks has been practicing workers’ compensation law exclusively since 2007. He joined Losi & Gangi in September, 2017 to focus his practice exclusively on the protection of the rights of injured workers in Western New York.

David Derrico, a Buffalo native, earned his undergraduate degree from SUNY Buffalo in 1990 and his juris doctor from the University of Pittsburg School of Law in 1993. He has been admitted to practice law in New York, Washington State, the District of Columbia, and in Illinois. Derrico began his legal career representing individuals facing a wide range of criminal matters as an Assistant Public Defender. His practice has also included work in Chapter 7 and 13 bankruptcies, and during the foreclosure crisis he worked as an attorney for the Western New York Law Center representing homeowners struggling with the gravity of a pending foreclosure. More recently he began representing carriers in workers’ compensation matters prior to joining Losi & Gangi. His practice will now focus on representing injured workers and helping these individuals navigate workers’ compensation law.

About Lost & Gangi

Lost & Gangi is a leading workers’ compensation and personal injury law firm representing clients during all stages of a workers compensation of personal injury case. The firm employs 10 attorneys.

Tell the NYS Workers’ Comp Board to Stop Attacking Injured and Ill Workers!

By | Workers Compensation

The last thing an injured or ill worker wants to think about is bureaucracy and red tape. Recovery should be the only thing on their mind. Unfortunately the bureaucracy at the Workers’ Compensation Board is proposing changes to its guidelines along with regulatory proposals that will result in drastic benefit cuts for injured workers. Please tell the Board what you think about these planned cuts. It will only take a moment. We’ve provided a letter that you can use to submit a comment to the Workers’ Compensation Board using the link below. Let them know this attack on workers will not go unanswered.

The New York State Workers’ Compensation Law provides for awards to injured workers that lose use of an extremity due to a workplace illness or injury. These awards are made regardless of impact on earning capacity and are called schedule loss of use awards. Awards involving total loss of use such as an amputation or total paralysis of an extremity are controlled by statute, while calculation of partial awards is a matter of Workers’ Compensation Board guidelines.

Corporations have been lobbying hard to change those guidelines to shortchange workers. We can’t let that happen. Frankly, this plan is an insult to all working men and women. Benefit cuts for injured workers are wholly unjustifiable.

Take Action: https://actionnetwork.org/letters/tell-the-nys-workers-comp-board-to-stop-attacking-injured-and-ill-workers