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.

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.