Author: Jones Jones

Congratulations to Jones Jones Associate Diandra Archibald on the successful disallowance of a workers’ compensation claim on behalf of an insurance carrier client before the New York State Workers’ Compensation Board Panel.

This case involved a claimant who alleged injuries to the left knee obtained in a workplace incident in March 2025. The claimant alleged that while walking to his work vehicle, he stepped off a curb, causing injury to his knee. The Workers’ Compensation Law Judge initially established the claim based upon claimant testimony and medical opinions finding causal relationship.

On appeal, Jones Jones argued on behalf of the carrier that the alleged injury was idiopathic in nature and did not arise out of the claimant’s employment. The Jones Jones’ team emphasized there was no evidence of any work-related hazard, traumatic event, fall, slippery surface or employment-related cause contributing to the alleged injury. The Board Panel agreed and rescinded the established finding due to a lack of credible evidence to demonstrate that the injury resulted from a work-related incident.

As a result of Jones Jones’ successful argument, the Board Panel reversed the prior decision and fully disallowed and closed the claim. By arguing against the causal relationship of the injury, Jones Jones secured a complete defense victory for the client, saving more than $100,000 in potential indemnity and medical exposure. Given the difficulty in prevailing idiopathic injury defenses at the appellate level, this decision represents a significant victory.

Congratulations to Diandra and the Jones Jones team on securing this major win on behalf of an insurance carrier client. If you are in need of assistance with a workers’ compensation case, please contact our team at concierge@jonesjonesllc.com.

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Congratulations to Jones Jones partner, Samantha Sharpe for the complete reversal of an occupational disease claim in front of the New York State Workers’ Compensation Board.

The claim was established for injuries to both hips, alleged to have been obtained through years of physically demanding work, including extensive walking, climbing, bending, lifting heavy equipment, operating machinery, and using tools such as jackhammers. In an initial hearing, the Workers’ Compensation Law Judge (WCLJ) established the claim for both hips and awarded the claimant a 55% schedule loss of use (SLU) to each hip, resulting in a total award of $336,774.

Jones Jones successfully argued for a cross examination of the medical foundation supporting the claim and claimant’s award. As a result of Jones Jones’ challenging the claimant’s medical evidence, the board ruled that the claimant’s medical expert failed to prove adequate knowledge of the claimant’s occupational duties, including critical details such as hours worked, equipment and tools used and time spent bending, lifting or otherwise straining his body throughout the workday. The board found that this lack of knowledge rendered the evidence insufficient to support an occupational disease claim, and as a result, reversed the original award of 55% SLU and total award of $336,774 entirely and closed the case.

Through careful litigation and development of the medical record, the team secured a complete reversal and an outstanding defense victory. Congratulations to partner Samantha Sharpe for the successful reversal of this case and for securing major financial savings on behalf of the client.

If you are in need of assistance with a workers’ compensation case, please contact our team at concierge@jonesjonesllc.com.

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Congratulations to Stacee Vaikness and the Jones Jones team on a significant victory before the New York State Supreme Court, Appellate Division, Third Judicial Department, on behalf of a large public transportation entity.  

In this important appellate decision, the Third Department affirmed the denial of a workers’ compensation claim involving alleged psychological injuries arising from a January 2021 workplace incident. Of particular significance, the Court held that the employer’s filing of a First Report of Injury using an “L” code — indicating liability — did not constitute a binding acceptance of the claim and did not prevent the employer from later controverting compensability.  

The claimant alleged that she developed anxiety, panic attacks, and post-traumatic stress disorder following an interaction with a customer while working. After the incident, the claimant sought medical treatment, took a leave of absence from work, and later asserted that she was unable to continue performing her job duties due to ongoing psychological symptoms.  

Although the employer initially filed injury reports utilizing an “L” code, the claim was subsequently controverted, leading to litigation over both compensability and whether the employer had already effectively accepted the claim through its filings. Following litigation, the Workers’ Compensation Law Judge determined that the claimant failed to establish that the stress experienced was greater than the ordinary stress routinely encountered by similarly situated employees, and the claim was disallowed.  

On appeal, Jones Jones successfully defended the Board’s decision and argued that the employer’s initial filings did not constitute a binding acceptance of liability under the Workers’ Compensation Law. The Third Department agreed, affirming both that the employer retained the right to controvert the claim despite the filing code utilized and that the claimant’s alleged psychological injuries were not sufficiently extraordinary to warrant compensation under New York law.  

This decision represents an important appellate victory addressing both compensability standards for psychological injury claims and the legal effect of employer filing codes in workers’ compensation proceedings. Congratulations again to Stacee Vaikness and the entire Jones Jones team on this impressive result before one of New York’s most influential appellate courts.