WINNING RESULTS: LOIS Prevails on Recreational Injury Defense

Christian Sison recently secured a disallowance of a claim filed by a Sales Executive of a technology company that LOIS defended. The claimant suffered admittedly serious injuries when he left a Happy Hour event hosted by an entity who did work with the technology company. Specifically, the claimant was walking the streets of Manhattan when he was struck by 2 motorized bicyclists.

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WINNING RESULTS: LOIS Secures Disallowance of Back Claim

The Claimant alleged he sustained an acute injury to his low back on March 31, 2022. Thereafter, the Claimant received an out of work note from his chiropractor removing him from work until May 18, 2022. The Carrier chose to deny the claim since the Claimant has a thirty-year history of filing back complaints with the Employer.

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WINNING RESULTS: LOIS Proves Fraud at Trial and Gets Four Year Ban on Indemnity Benefits

Lois Law Firm successfully obtained a fraud penalty against a claimant, which resulted in the claimant being barred from receiving any workers’ compensation indemnity benefits for a period of 4-years, as a result of the claimant failing to disclose prior injuries involving overlapping body parts. The claimant suffered neck, back, left shoulder and post-concussion injuries as a result of her work accident, but on repeated occasions she denied having any prior injuries to the same body parts, despite suffering similar injuries in a personal motor vehicle accident 1 ½-years prior to her work accident.

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WINNING RESULTS: LOIS Succeeds in Arguing for Disallowance in Construction Case With a Third-Party Component

LOIS attorney, Meisha Powell successfully argued for disallowance of a claim involving two claimants who alleged injuries from a coordinated accident on a construction site. Attorney Powell was able to convince the Judge at the trial level that the claim should be disallowed because of the numerous inconsistencies of what was alleged to have happened. This accident involved two claimants who filed a workers’ compensation claim and a third-party general liability claim. Both claimants hired the same the law firm to represent them in both lawsuits. Under oath, the first claimant testified to being on a ladder, while his coworker stood on a bucket, both falling to the ground, while attempting to install sheetrock on a ceiling of a building covered by the Carrier’s wrap up policy. According to claimant number one, the sheetrock fell on their heads and knocked them both to the ground and he sustained multiple injuries. The second claimant was called as a witness to testify as to this alleged accident, but his version of events was vastly different. During cross-examination, Meisha Powell was able to elicit testimony that resulted in the disallowance of the first claimant’s workers’ compensation claim. She was able to use the claimant’s testimony against his witnesses’ version of events, to call into question the credibility of both individuals.

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WINNING RESULTS: LOIS Wins on Lack of Jurisdiction Argument

Lois Law Firm was able to secure a disallowance of an alleged occupational disease claim at the Trial Court level after the case was initially filed over four (4) years ago. LOIS attorney, Dan Gillis, was able to achieve this result through effective cross-examination of the claimant and the claimant’s attending physician along with a persuasive argument that the Board did not have sufficient jurisdiction over this case and the New York employer was not the last injurious exposure to the claimant’s reported neck and back disabilities.

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WINNING RESULTS: LOIS Prevails on Medical Treatment Guidelines Defense in New York

Lois Law Firm was recently successful in procuring a denial of a request for a spinal fusion. The claimant’s treating doctor submitted a request for a spinal fusion a few months after the Claimant underwent a lumbar laminectomy. The Claimant subsequently underwent a post-operative MRI that showed multiple bulges without stenosis. After the MRI, the Claimant attended an examination with the doctor, at which time he reported trouble walking without pain and could not stand for more than a minute without pain. The doctor concluded that the Claimant was a candidate for a transforaminal lumbar interbody fusion with instrumentation and a request was submitted. The Carrier denied the request via a record review which noted that per the Medical Treatment Guidelines, which that spinal fusion is not recommended for the treatment of radiculopathy resulting from herniated nucleus pulposus. Further, there is no instability on x-rays.

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WINNING RESULTS: LOIS Attorney Prevails on a Nuanced Coverage Issue Involving a PEO

Lois Law Firm successfully challenged and won on a coverage argument that seldomly comes before the Board. Attorney, Meisha Powell was able to bring attention to the file very early on in the case, that there was a possible coverage issue, involving a “leased employee” who was injured on a site covered by our client’s wrap-up (OCIP) policy. The claimant in this case suffered injury to the back, leg, and ankle when he slipped and fell at the jobsite. Prompted by the claimant’s own prehearing conference statement, which listed a PEO company as an “interested party” to this litigation, attorney Powell asked that the Carrier for the PEO be placed on notice. She argued that the claimant may be a leased employee and based on our knowledge of a previous case we were successful in defending against coverage, we requested development on the record on this coverage issue. The Carrier for the PEO was placed on notice, and at a subsequent hearing vehemently denied coverage for the claim, arguing that the wrap up policy must cover the claim! At that hearing, the Law Judge directed all policies to be submitted to the file, a memo of law from both parties on the issue of coverage, and case law supporting said argument(s).

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