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Workers Compensation

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. 

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.

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

Brett - Workers' Compensation claim attorney

What To Expect When Appealing A Workers’ Compensation Board Decision

By | Workers Compensation

Everyone hopes that their Workers’ Compensation claim is won on the first instance in front of a Workers’ Compensation Law Judge (“WCLJ”). However, unfortunately, this is not always the first outcome. Furthermore, even if a case is still won on the first instance, an appeal can still be filed by the carrier or opposing party. So, what can a claimant expect when their case is being appealed?

Initially, the party appealing the decision will file their appeal. The party opposing the appeal will file what is known as a rebuttal. The rebuttal will generally request that the initial decision rendered by the WCLJ be affirmed in its entirety.

The appeal and rebuttal will then go to a Three Board Panel Member (“Board”) review board. At that time, the Board has a host of options. The first option available to the Board is to affirm the decision of the WCLJ. This affirmance can occur in two separate fashions. The first fashion is an unanimous decision, meaning all three Board panel members agree with the WCLJ’s initial decision. If this occurs, the appellant (the party maintaining the appeal) can file what is known as a discretionary appeal to the next level of appeal in New York State Workers’ Compensation, the Full Board. If the appeal is discretionary, the Full Board has the option either consider the appeal or deny consideration of the appeal.

The second way the Board can affirm an initial Decision of a WCLJ is through a split decision. Essentially, this means that out of the three Board Panel Members, there is a dissenting opinion from one that will argue for a different holding than initially made by the WCLJ and his or her fellow Board Panel Members. At this time, the appellant may file a mandatory appeal to the Full Board. A mandatory appeal is an appeal that must be considered by the Full Board.

The third option available to the Board is to issue a decision that will modify the WCLJ’s initial decision. In this instance, the Board Panel agrees with some aspects of the initial decision but feels it is appropriate to alter other aspects of the initial decision. In this instance, the parties may still file an appeal to the Full Board based on the holdings that are potentially modified.

During the appeal process, it is also important that claimant’s counsel protects the rights of the claimant to bring his or her appeal to the New York State Supreme Court, Appellate Division, Third Judicial Department. As Workers’ Compensation Board Decisions are issued within the realm of Administrative Law, a claimant has the right to seek relief with the New York State Supreme Court. In New York State, the Third Judicial Department Appellate Division is vested with the authority to hear appeals that originate in New York State Workers’ Compensation. To properly protect a claimant’s right to maintain an appeal to the Third Department, there are multiple time filing requirements and notice requirements that must be met following the initial decision from a WCLJ. If these time requirements are not met, a claimant may be denied his or her right to seek relief to the Appellate Division for the Third Department of the New York State Supreme Court.

As highlighted by the above, the appeal process within the New York State Workers’ Compensation Board is timely and complex. The Law firm of Losi & Gangi has extensive experience in maintaining appeals in the New York State Workers’ Compensation Board as well as to the Appellate Division for the Third Department of the New York State Supreme Court. We have litigated cases from their initial inception and through the appeal process with success. Although it is our goal to win in the first instance, our team is dedicated to seeing every case through until the proper determination is made or all avenues of relief have been exhausted.

Brett - Workers' Compensation claim attorney

What Injuries or Illnesses will be covered by Workers’ Compensation?


By | Workers Compensation

What injuries or illnesses will be covered by workers’ compensation?

The nature and cause of a work-related injury greatly ranges and must be assessed on a case by case basis. A work related injury can stem from a single isolated event; such as lifting a heavy object and feeling pain in your back or other part of your body, or development of an injury over a long period of time, such as carpal tunnel syndrome or occupationally related hearing loss. Regardless of the incident, each case deserves the appropriate resources to ensure that the injured worker’s rights are properly protected and to ensure the greatest recovery possible. 

What benefits can a claimant expect to receive following a work-related injury?

In a workers’ compensation claim, a claimant’s recovery is limited to wage indemnification benefits for actual time lost from work, awards for permanent impairment, and payments of all related medical and vocational treatment.  A claimant’s wage indemnification benefits will be limited to up to two-thirds of the claimant’s average weekly wage for the year preceding the injury. A claimant’s ongoing medical care must also be consistent with specific rules and regulations, as promulgated in the New York State Medical Treatment Guidelines.

There are a variety of factors and timelines in place that can impact a claimant’s wage indemnification and medical benefits. These factors and timelines must be adhered to in order to ensure that an injured worker’s rights are fully protected. If you have been injured on the job and have questions or concerns, please feel free to contact us!

About Losi & Gangi

The law firm of Losi & Gangi is professional limited liability company that concentrates the majority of their practice on workers’ compensation matters and personal injury law.

The firm consists of partners, Jeffery D. Gangi and Harry G. Modeas, with associate attorneys Thorice M. Jacobs, Brett Miller, and Philip Scaffidi. Furthermore, the firm employs Patrick Brown, Esq., of counsel.   In addition to our attorneys, the firm also employs a licensed workers’ compensation representative, Jay P. Boardway.

Workers Compensation and Personal Injury Lawyer - Harry

What’s The Difference Between A Workers’ Compensation Case And A Personal Injury Case?

By | Personal Injury, Workers Compensation

Burden of Proof

The most important difference is that a personal injury claim is based on fault and a workers’ compensation case is not.   In order to recover damages in a personal injury claim, such as a car accident, slip and fall, or construction site accident, the injured party must demonstrate that the offending party was negligent and at fault for the happening of the accident. 

In workers’ compensation cases, employees injured on the job are not required to show that their employers were at fault for the happening of the accident in order for them to claim and receive workers’ compensation benefits.  In other words, workers’ compensation claimants do not need to prove that their employers did anything wrong for them to claim and receive workers compensation benefits.  Even when a claimant’s own negligence has caused his or her injury, the Workers’ Compensation Law still allows the injured worker to claim and receive benefits.

Different Damages

In a personal injury case, you are entitled to recover all of the damages that you have suffered.  This includes lost wages, lost wage earning capacity, past and future medical expenses, loss of enjoyment of life, and past and future pain and suffering.

In a workers’ compensation case, a claimant’s recovery is limited to wage indemnification for actual time lost from work, awards for permanent impairments, and payment of all related medical and vocational treatment.  Workers’ compensation claimants do not receive compensation for pain and suffering or loss of enjoyment of life.  Also, all monetary awards for lost wages and permanent impairments are limited by the Workers Compensation Law.

Before states enacted workers compensation laws around the turn of the 20th century, injured employees had to bring personal injury claims against their employers and prove they were negligence before they could receive any compensation.   The enactment of workers’ compensation laws ensured that all employees who were injured on the job would get some weekly benefits and would get their medical bills paid. In return, employees lost the right to sue their employers and coworkers for negligence and lost the right to collect damages for pain and suffering.

Still have questions about Workers’ compensation or personal injury? Contact us.

About Losi & Gangi

The law firm of Losi & Gangi is a general partnership of attorneys concentrating the majority of their practice on workers’ compensation matters and personal injury law.

Tori explains work incidents that leave workers disabled

What Happens After A Workplace Incident That Leaves You Disabled?

By | Workers Compensation, Workplace Safety

You have been injured on the job and you are now being told that you will not be able to return to the work you have been performing.  What happens now?  Where do you turn, should you apply for Social Security Disability benefits?  How will Workers’ Compensation treat your permanent disability? 

Social Security Disability benefits are a federal program that one may turn to if they suffer a severe disability, illness or condition that prevents gainful employment.  According to the US Social Security Administration, state workers’ compensation programs provide approximately $60 billion each year in financial and medical-care benefits to work-related illnesses and injuries.  Social Security is also the nation’s largest disability insurance program, and each state has its own policies, for example, there are 13 states that tax social security — New York State does not carry a tax on social security.

To apply, you should be out of work for at least a minimum of 5 months with the expectation that you will continue to be out of work for 12 months, if not longer.  You can apply for ongoing benefits into the future based on your inability to return to work or also seek a closed period of benefits should you be able to return to work after a 12 month duration. 

To be clear, there is a difference between Workers’ Compensation and Social Security. Social Security is meant for workers who are severely impaired and cannot return to their previous work, and prohibits the worker from adjusting to other means of employment.  Workers’ Compensation is for those who suffered a work-related accident while performing their normal course of job duties. 

There are two major permanent disability classifications in Workers’ Compensation — temporary disability and permanent disability.   When you are classified as having a permanent disability under Workers’ Compensation, further inquiry must be made into the type of permanent injury that you have. 

Usually, if your injury involves an extremity, such as an arm, leg, hand, etc., you will be found to have a Schedule Loss of Use based on the permanent functional limitations opined by the treating physician.  Based on the medical evidence, you will be awarded a Schedule Loss of Use award (“SLU”) which means a lump sum of money based on the degree of permanent disability you are found to have.  Please note that there are exceptions where you may be found to have a permanent disability even if an extremity was involved.   This would entitle you to ongoing permanent disability payments as explained further below.

Permanent disability payments are typically for all other injuries that do not involve your extremities, such as to your back.  When you are found to have a permanent disability with ongoing future loss of wage payments an ongoing award will be made.   There are additional vocational factors that will be taken into account, such as your age, education, past relevant work, residual functional capacity and ability to transfer into a lesser demanding type of work given what you functionally can do. 

From here, temporary and permanent each include total and partial disability that will be determined by your health care provider and explain the amount of benefits you will receive.  It is very important to treat with a physician who understands Workers’ Compensation as the amount of your benefits are highly dependent on your physicians opinion of the degree of disability that you have, whether it be temporary or permanent. 

It is also important to remember that any costs related to the work-related injury that has ultimately caused a level of disability, including surgeries and medications, should be covered by your employer.

If you feel that you aren’t receiving the proper financial support, contact us so we can look into your situation and offer you the assistance you deserve. Take some time and review some of our verdicts & settlements related to social security claims here.

About Losi & Gangi

The law firm of Losi & Gangi is a general partnership of attorneys concentrating the majority of their practice on workers’ compensation matters and personal injury law.

The firm consists of partners David Paul Losi, Jeffery D. Gangi and Harry G. Modeas, with associate attorney Thorice M. Jacobs. In addition to our attorneys, the firm also employs a licensed workers’ compensation representative, Jay P. Boardway

What is workers' compensation

What is Workers’ Compensation?

By | Workers Compensation

“What is Workers’ Compensation?”

While many of us may have heard of Workers’ Compensation or know someone who might have received it, they may not know what Workers’ compensation is or the process in which it is distributed to workers.

Workers’ Compensation is a type of insurance that is required by state law to provide compensation to employees who are involved in an injury or accident on the job. Additionally, Workers’ Compensation is regulated at a state level — meaning New York State laws related to Workers’ Compensation are very specific, and will differ from the laws in surrounding states such as Pennsylvania, Ohio, Massachusetts, Vermont, Connecticut and New Jersey.



In addition to understanding New York’s laws on Workers’ Compensation, it is also important to understand some key points about Workers’ Compensation:


♦ Hospital and medical expenses related the treatment of your work related injuries are covered under Workers’ Compensation. This includes prescription medications and medical supplies.

♦ You must file your claim in New York with a C-3 Employee Claim document, and under very strict time limitations.

♦ Disability payments are covered through Workers’ Compensation and usually amount to two-thirds of your “regular” or pre-injury pay. These payments are non-taxable.

♦ Work-related overuse injuries like back problems or arthritic issues and carpel tunnel syndrome can be covered under Workers’ Compensation.

♦ Certain injured workers with permanent injuries may be entitled to a settlement of their claim.


Contact us if you have any additional questions related to Workers’ Compensation

About Losi & Gangi

The law firm of Losi & Gangi is a general partnership of attorneys concentrating the majority of their practice on workers’ compensation matters and personal injury law. The firm consists of partners David Paul Losi, Jeffery D. Gangi and Harry G. Modeas, with associate attorneys Thorice M. Jacobs and Brett A Miller. In addition to our attorneys, the firm also employs a licensed workers’ compensation claimant’s representative, Jay P. Boardway.