All posts by Lois LLC

Defending Employers in New York, New Jersey, and Longshore.

Risk Transfer Schemes That Complicate Case Handling: Construction Defense Webinar

Join Us for This Live Webinar on Monday, April 6, 2020 at 12PM EST

In this live webinar, “Risk Transfer Schemes that Complicate Case Handling,” Tashia Rasul, partner at Lois Law Firm, will discuss the various ways that construction project risk transfer plans can result in convoluted case handling. Tashia will explain the nuances of “wrap up” insurance plans and how the subrogation and reimbursement rights of the parties can be affected.

Tashia will discuss the following:

  • How a “wrap up” insurance program works and is created.
  • Coverage issues unique to wrap ups.
  • Types of risk typically covered by wrap ups.
  • Complications in case handling for defense counsel and risk professionals.

To register for our Construction Litigation Webinar Series, a monthly discussion of recent case law developments and best practices for handling construction accident claims in New York, click the button below (or register here).

Continue reading Risk Transfer Schemes That Complicate Case Handling: Construction Defense Webinar

Video: Fraud Case Updates New York Workers’ Compensation

In this video, Greg Lois provides an overview of claims fraud in New York workers’ compensation cases! This video is from a live presentation on March 16, 2020.

In this video, Greg provides answers to common questions, such as:

  • Recent case law decisions on fraud.
  • Tactical and strategic considerations in raising fraud.
  • Red flags for fraud in New York workers’ compensation cases.
Continue reading Video: Fraud Case Updates New York Workers’ Compensation

The Second Injury Fund: New Jersey Workers’ Compensation Webinar

Join Us for This Live Webinar on Monday, March 23, 2020 at 12PM EST

In this LIVE webinar on March 23, 2020 at 12 PM EST, Greg Lois will present on the role of the Second Injury Fund in catastrophic and total disability cases. We will discuss:

  • What New Jersey’s Second Injury Fund is and how it was intended to function to reduce employer’s exposure.
  • What types of cases qualify for contribution from New Jersey’s Second Injury Fund.
  • Practical aspects of seeking contribution from the Second Injury Fund.

To register for our New Jersey Workers’ Compensation Webinar Series, a monthly discussion click the button below (or register here).

Continue reading The Second Injury Fund: New Jersey Workers’ Compensation Webinar

Coronavirus (COVID-19) and Workers’ Compensation: Your Questions Answered!

Video taken from live Q & A led by Greg Lois on March 9, 2020.

Download the handout, with cases and statutory citations, from the live training on COVID-19 and workers’ compensation here:

Question: What are the state's laws regarding the compensability of exposure to a virus? Could illnesses caused by coronavirus be covered in this jurisdiction?

NEW YORK: Yes, a disease contracted by an employee within the course of employment may be compensable. For example, illnesses or infections caused by specific workplace exposure such as a needlestick incident will be found compensable. In general, illnesses or infections caused by exposure to co-employees or general workplace risks will not be compensable. Most coronavirus claims will not be compensable.

NEW JERSEY: Yes, an infection caused by exposure in the workplace can be compensable as an occupational disease. For non-first responder employees, illness or infection will be compensable where there has been a specific, documented incident resulting in infection. For first responders, mere 'potential exposure' triggers a presumption of compensability. Most coronavirus claims will not be compensable.

LONGSHORE: Yes, infections caused by exposure in the workplace are compensable. To be found compensable, the exposure must be the result of a specific incident and not simply exposure to a general health risk. Most coronavirus claims will not be compensable.

Question: When would the condition be covered, when would it not be covered? What is the standard of proof the claimant must meet?

NEW YORK: A disease is considered to be compensable if it 'is the result of a distinctive feature of the kind of work performed by claimant and others similarly employed, not an ailment caused by a peculiar place in which particular claimant happens to work . . . or caused by ordinary contact with a fellow employee.' In general, ailments contracted from common exposure not specific to the workplace should not be found compensable. However, where the employee can show that the nature of the employment brought with it exposures to specific causes of disease or infection, then the resulting condition can be compensable. Examples of diseases that have met this standard includes pulmonary diseases such as bronchitis, infectious hepatitis, and staph infections. In those cases, the employee was able to demonstrate or allege a very specific exposure that was unique or peculiar to the employment. Additionally, where there has been a specific definite exposure, for example a teacher who contracted mumps after exposure to pupils during an epidemic, that illness was found compensable. Because the risk of coronavirus infection is not peculiar to any one workplace, with the exception of perhaps some medical or emergency response employments, a theory of general workplace exposure is unlikely to succeed for claimants alleging they contracted the disease due to exposure to co-employees or the general public in their workplace.

NEW JERSEY: The Act defines the phrase “compensable occupational disease” to 'include all diseases arising out of and in the course of employment, which are due in a material degree to causes and conditions which are or were characteristic of or peculiar to a particular trade, occupation, process or place of employment.' A petitioner has the burden of proving by a preponderance of the evidence that his or her environmental exposure was a substantial contributing cause of the alleged occupational disease. A petitioner must prove legal causation (the injury is work-connected) and medical causation (the injury is a physical or emotional consequence of work exposure). It is sufficient to prove that the risk or danger in the workplace was a contributing cause. Direct causation is not required. Activation, acceleration or exacerbation of disabling symptoms is sufficient. In general, it is extremely unlikely that a New Jersey petitioner will be able to satisfy this requirement by alleging contacts with co-employees or the general public resulted in contracture of the disease. The exception, discussed below, is New Jersey's 'first responders' in light of the recent (2019) law change granting them a presumption of compensability (see below).

LONGSHORE: Any disease arising out of exposure to harmful conditions of the employment, when those conditions are present in a peculiar or increased degree by comparison with employment generally. There is a three-step test for determining whether an employee has a compensable occupational disease:

  1. First, the employee must suffer from a “serious derangement of health” or “disordered state of an organism or organ.”
  2. Second, the specific working conditions of the employment must be the cause of the disease.
  3. Third, the hazardous conditions must be “peculiar to” one’s employment as opposed to other employment or general living. In other words, there must be something extraordinary about the work exposures that directly relates to the condition allegedly disabling the affected worker.

In general, a Longshore or Defense Base Act claimant will not be successful alleging a claim for infection or illness unless there has been a specific incident of exposure; general exposure to co-employees or the public will not meet the standard for compensability.

If an employee tests positive, does the WC policy cover the employer testing employees for the virus?

NEW YORK: Yes, if the underlying condition is compensable, then testing or diagnostic treatment necessary to detect or confirm the condition would be medical treatment and the responsibility of the employer/carrier. Negative test results and 'screening' or preventative testing is not covered by the WCL.

NEW JERSEY: Yes, where the illness is found compensable, medical treatment includes diagnostic testing and is the sole responsibility of the employer/carrier. Negative test results and 'screening' or preventative testing is not covered by the Act.

LONGSHORE: Yes, where the claimant has a compensable condition the employer/carrier has an absolute duty to provide all necessary medical care, which includes diagnostic testing. Negative test results and 'screening' or preventative testing is not covered by the Act.

What About First Responders?

NEW YORK: Pursuant to WCL 10(3)(a), testing and diagnosis for first responders is covered when 'in the course of performing his or her duties, [the first responder] exposed to the blood or other bodily fluids of another individual or individuals.' This is an exception to the general rule that 'testing' is not covered until/unless the underlying medical condition is compensable.

NEW JERSEY: N.J.S.A. 34:15-31.5 provides a presumption of compensability in subsection a. if a public safety worker can demonstrate exposure at work to 'the excretions, secretions, blood or other bodily fluids of one or more other individuals or is otherwise subjected to a potential exposure, by the other individual or individuals, including airborne exposure, to a serious communicable disease, or is otherwise determined to be infected with or at significant risk of contracting the serious communicable disease.' The Statute also states 'If it is ascertained that the public safety worker has contracted a serious communicable disease or related illness under the circumstances set forth in subsection a of this section, there shall be a presumption that any injury, disability, chronic or corollary illness or death of the public safety worker caused by, attributable to, or attendant to the disease is compensable under the provisions of R.S. 34:15-1 et seq.'

LONGSHORE: Not applicable.

What About Quarantine? How Are Employees Compensated for Lost Time Due to Quarantine?

Quarantine or isolation is a preventative/prophylactic measure that is not covered by workers' compensation. Lost time due to quarantine would be compensated either directly by the employer (if at all), or in the case of furlough or work shutdown, by the state unemployment remedy.

Questions about Coronavirus (COVID-19) and Workers’ Compensation?

Contact Greg Lois, managing partner at LOIS LLC with questions.

Learn More About LOIS

LOIS defends employers and carriers throughout New York and New Jersey. For more about the LOIS firm, click here.

More Information: Our Handbooks!

Our up-to-date handbooks are guides to workers’ compensation in New York, New Jersey, and Longshore. Our guides are available here.


Disclaimer

This website is not legal advice! The materials presented by this website are for informational purposes only and are not offered as legal advice as to any particular matter. No reader should act on the basis of these materials without seeking appropriate professional advice as to the particular facts and applicable law involved. The materials are not represented to be correct, complete, or up-to-date. Opinions presented by this web site are the opinions of the author. Neither the use of this web site nor the transfer of information to or from this web site shall create or constitute an attorney-client relationship between Greg Lois or LOIS LAW FIRM LLC and any person. You should not send any confidential information to this web site until after you have entered into a written agreement for the performance of legal services.

Video: Liens, Consents, & “Cramdown Motions” in New York

The “Major Monday’s” Webinar

In this video, “Understanding Verbal Threshold in New Jersey,” Christopher Major, Civil Practice Team Leader at Lois Law Firm, discusses what happens when the plaintiff and tortfeasor in a civil action attempt to resolve their case by settlement without the consent of the workers’ compensation carrier in New York. This video is from a live presentation on March 9, 2020.

Major discusses the following:

  • What are the rights of the workers’ compensation carrier under Section 29 to the proceeds of a third-party lawsuit?
  • What happens when the parties to the civil action do not obtain consent to settlement.
  • The remedy available to the third parties when the workers’ compensation carrier refuses to consent to a settlement.
  • How recent case decisions will impact the practice in 2020.

To register for our Civil Litigation Webinar Series, a monthly discussion of recent case law developments and best practices for handling civil claims and reimbursement actions, click the button below (or register here).

Continue reading Video: Liens, Consents, & “Cramdown Motions” in New York