Category Archives: New York

Who is an “Employer” who requires Workers’ Compensation Insurance in New York?

Virtually all employers in New York State must provide workers’ compensation coverage for their employees. WCL §§ 2, 3. An employer can be a natural person, an association or partnership, a corporation, or a municipal organization. Although circular, an employer is defined as “anyone who has employees.” Even just one. Continue reading Who is an “Employer” who requires Workers’ Compensation Insurance in New York?

Video: Penalties and “No Coverage” Exposure in New York

This video from our March 19, 2018 webinar presentation is designed to answer the following questions:

  • “What are the most common causes for penalties in New York?” and
  • “How do we avoid case-level penalties?” and
  • “What can we do to mitigate or resolve a penalty issue?”

Presenter Greg Lois has years of experience representing employers and carriers before the Board. At the end of the presentation, the attendees will have a basic understanding of the common penalties, tactics to avoid penalties, and the potential to mitigate or resolve some penalties.

Continue reading Video: Penalties and “No Coverage” Exposure in New York

Calculating Average Weekly Wage Under Section 14 of the New York State Workers’ Compensation Law

Attorney Nidhi Shetye joins LOIS.
Attorney Nidhi Shetye joins LOIS.
The claimant’s average weekly wage (“AWW”) lays the foundation for calculating weekly indemnity payments. It is, therefore, imperative to correctly calculate a claimant’s average weekly wage under the (not-so-clear) provisions of the New York Workers’ Compensation Law (“WCL”). Section 14 (4) of the WCL defines the claimant’s AWW as one fifty-second (1/52) of the claimant’s average annual earnings. Put simply, this means, the claimant’s yearly gross income divided by 52, the number of weeks in a year. This raises the question of calculating a claimant’s yearly income.

Section 14 (1) guides in calculating the annual wage for claimants who worked in the same employment at the time of the accident, whether for the same employer or not, during substantially the whole of the year immediately preceding his injury. WCL §14(1). For section 14 (1) to apply, the claimant needs to have had the same job for most of the year preceding his work-related injury, regardless of whether he had the same employer. Id. Once the claimant meets this criterion, his annual earnings are the product of his daily wages and either 260, if he worked 5 days a week, or 300, where the claimant worked six-day weeks. Id. Continue reading Calculating Average Weekly Wage Under Section 14 of the New York State Workers’ Compensation Law

Appellate Division Issues Decision Clarifying How To Calculate Schedule Loss of Use For Shoulder Injuries

Case: Matter of Maloney v Wende Correctional Facility

Issue
In determining the Schedule Loss of Use (SLU) percentage applicable to a shoulder injury, whether it is appropriate to assign separate loss of use values for deficits in anterior flexion and abduction or if this is duplicative and results in an inflated SLU percentage.

Facts of Case
Claimant was a Correctional Officer who injured himself while working in July 2013. The claim was established for a right shoulder injury. At permanency, the claimant’s treating physician opined claimant had 90% SLU of the right arm while an IME opined the claimant had 50% SLU of the right arm. Following litigation of the issue, the law judge credited the IME opinion over that of the treating physician and found claimant to have 50% SLU of the right arm. The Workers’ Compensation Board affirmed the Law Judge’s finding and the claimant appealed to the Third Department.

Decision
Board decision is affirmed, finding claimant to have 50% SLU of the right arm. The Court noted “the Board is vested with the authority to resolve conflicting medical opinions concerning the SLU percentage to be assigned to aspecific injury.” Additionally, the Court noted “judicial review is limited, and the Board’s determination will not be disturbed as long as it is supported by substantial evidence.” Continue reading Appellate Division Issues Decision Clarifying How To Calculate Schedule Loss of Use For Shoulder Injuries

Medicare Secondary Payer Set-Asides and Conditional Payments in New York Workers’ Compensation Cases

Attorney Declan Gourley leads a presentation designed to help the attendee answer the following questions: “Can I settle this case?” and “Does Medicare have a current interest I need to consider?” and “Do I need to consider Medicare’s future interest?” Presenter Declan Gourley has years of experience representing claimants before the Social Security law judges and employers and carriers before the Workers’ Compensation Board. At the end of the presentation, the attendees will have a basic understanding of Medicare Secondary Payer exposure and when they need to consider Medicare’s interest in a lump-sum settlement.

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Video: New Schedule Loss of Use Guidelines in New York

LOIS Partner Christian Sison leads a presentation on the new-for-2018 New York Guidelines for Determining Impairment. The new Guidelines replace the prior methods of determining Scheduled Loss of Use for all claims where an impairment report was not submitted before January 1, 2018 and will have an impact on exposure join all future claims. Attorney Sison provides examples including side-by-side exposure analysis of the same impairment under the old and new Guidelines and answers questions live from the webinar audience.

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