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.

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.