Winning Results

Claim Disallowed Based on Lack of Timely Notice pursuant to Section 18

The Claimant was a delivery man in his position for approximately eight months at the time of the alleged injury. The Claimant alleged in his initial C-3.0 that he suffered back pain, but was not sure how it happened. He alleged that he woke up the next morning and could barely move. He assumed it must have been because of his job duties. He told his doctor about two months later that the pain began five months earlier and that there was no inciting incident. However, as the Claimant began to treat with the same doctors, he eventually stated that an acute accident occurred, that he tripped while loading boxes, fell, and injured his lumbar spine. The employer denied the claim, as the Claimant failed to provide notice of the accident until over two months after the alleged accident. Further, despite denying prior treatment to the lumbar spine, the Claimant had a history of sciatica.

At trial, the testimony of the Claimant was taken. During the trial, it was clear that the Claimant could not remember key details regarding the incident, his treatment and his reporting of the incident. During cross-examination, the Claimant conceded that he had been working for the employer for almost a year, but denied that he was notified of how to report an accident. He testified that he orally reported the incident the next day, and did not assert it was work-related. He testified that he did not recall the last name of his direct supervisor and that he was not directed to fill out any paperwork, despite it being company protocol. He says he eventually called the claim after his doctor told him he needed some insurance to bill, but even then, he waited another month. He stated that no one told him to complete any documents.

The Law Judge ultimately disallowed the claim based on lack of notice, noting the Claimant’s testimony that he cannot recall anyone’s last time, did not fill out any paperwork and did not call in the claim until May even though the alleged accident took place in March. The Law Judge found that the Claimant’s failure to timely report the incident hampered the Carrier’s investigation into the claimed accident. As a result, the Carrier was prejudiced, and the claim was disallowed.

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New York Workers’ Compensation Defense at Lois Law Firm

We represent insurance carriers, self-insured employers, third party claim administrators, and employers before the New York State Workers' Compensation Board. We handle cases from cradle-to-grave. We want to be by your side, moving cases aggressively to closure from the start of litigation all the way through to settlement.

We only assign one attorney and one paralegal to each case. This means that your team members always have one contact to go to for any questions. We do not have 'hearing attorney' or a 'negotiation attorney' or 'appeal department' or anything else! All of our attorneys handle all of those roles – meaning cases are not 'passed around' as they move through the litigation process. Your risk professional or adjuster always knows who is assigned – because the attorney does not change.

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