Author: Jones Jones

Welcome to Part Three of the Jones Jones LLC’s Loss Transfer Series! In this final installment of this series, you will learn how to successfully secure the actual loss transfer funds associated with your claim.  Previously, in Part One, you were given a primer on the basics of loss transfer; who can seek reimbursement and when does loss transfer apply. See: Loss Transfer Series: Part 1 – The Basics – Jones Jones LLC .   Part Two focused on what kind of benefits you may recover as a result of utilizing all that loss transfer has to offer. See: Loss Transfer Series: Part 2 – The Recovery.  Now, let’s focus on the details required in order for you to secure the loss transfer funds.

HOW DOES A CARRIER SEEK THE LOSS TRANSFER FUNDS?
The carrier or the self-insured employer must first serve the Respondent with an “Inter-Company Reimbursement Notification Form” as soon as reasonably practicable before filing for arbitration.  Note that the Respondent is the carrier or self-insured owner responsible for providing No-Fault benefits for the vehicle responsible for the underlying motor vehicle accident. The carrier or self-insured employer asserting the loss claim (often referred to as the “Applicant”) must file for arbitration with Arbitration Forums, Inc. The Applicant must also be aware of the timeline as the statute of limitations for filing for arbitration is three years from the date of each payment sought.

WHAT EVIDENCE IS NECESSARY TO PROVE CASE AT ARBITRATION?

• A copy of the timely served Inter-Company Reimbursement Notification Form.
• Proof of liability –Examples: Police report, internal accident documents, deposition transcripts, DMV expansions, etc.
• Proof of Damages- Minimum proof required is a printout or ledger of benefits paid with the following information for each payment:
  • Name of payee
  • Amount paid
  • Date of service
  • Date paid; and
  • Total amount paid.

Once the case is decided by an arbitrator, an arbitration award is usually published within one to three days. If the Respondent fails to issue payment of the arbitration award, the applicant has one year from the date of publication to file a petition to confirm the arbitration in court. If a party wishes to appeal an arbitration award, they must file a petition to vacate or modify the arbitration award within 90 days of publication.  Thank you for taking the time to read our educational series on Loss Transfer.  If you have any questions or would like to discuss further; please connect with us at clientservices@jonesjonesllc.com.

Have an idea for an education series? Would you like to learn more about a certain area of subrogation, New Jersey & New York Workers’ Compensation defense, or No-Fault? Contact us with what you want to hear more about today at clientservices@jonesjonesllc.com!

Welcome to Part Two of the Jones Jones LLC’s Loss Transfer Series! In Part One of this series, you were given a primer on the basics of loss transfer; who can seek reimbursement and when does loss transfer apply. See: Loss Transfer Series: Part 1 – The Basics – Jones Jones LLC .  Now we will review what kind of benefits you may recover as a result of utilizing all that loss transfer has to offer.

WHAT BENEFITS ARE RECOVERABLE VIA LOSS TRANSFER?
All No-Fault benefits are recoverable.   Additionally, Workers’ Compensation benefits are also recoverable, but only to the extent that that those Workers’ Compensation benefits are considered to be paid in lieu of No-Fault.  What does this mean?

Unlike No-Fault benefits, which are all recoverable, the benefits distributed under a Workers’ Compensation claim are only recoverable if No-Fault would have provided those same benefits.  This means that any indemnity, medical and death benefit that was paid as a Workers’ Compensation benefit in lieu of No-Fault benefits may be recovered via loss transfer. Also, please note that other benefits may be recovered (example: disability benefits) if those benefits were also paid in lieu of No-Fault benefits.

WHAT BENEFITS ARE PROVIDED UNDER NO-FAULT?
Any of the below benefits paid on a Workers’ Compensation claim are considered to be in lieu of No-Fault:

• Up to $2,000.00 in death benefits.
• Up to $50,000 of the following (combined, not separate):
  • Medical (as long as the medical benefit was paid in accordance with NYS Workers’ Compensation Fee Schedule); and/or
  • Lost Wages
    • Up to $2,000.00 per month
    • For 3 years following the date of accident

EXCEPTIONS: There is no benefit under the No-Fault law that is similar to the Schedule Loss of Use (“SLU”) award provided under NYS Workers’ Compensation Law. However, the Department of Financial Services (DFS) issued an opinion letter stating that a SLU award may be recovered via loss transfer even though there is no equivalent to a SLU under the No-Fault law.  Working alongside an attorney that is well versed in the benefits of a No-Fault claim, as well as any exception that may be present, is a key component to your loss transfer reimbursements being fully realized.

Stay tuned for Part Three of the Jones Jones LLC’s Loss Transfer Series to learn about the details of securing the actual loss transfer recovery funds. As always, the attorneys of Jones Jones LLC are beside you every step of the way and welcome any questions or thoughts you may have on this most important topic.  Contact our team today at clientservices@jonesjonesllc.com.

Have an idea for an education series? Would you like to learn more about a certain area of subrogation, New Jersey & New York Workers’ Compensation defense, or No-Fault? Contact us with what you want to hear more about today at clientservices@jonesjonesllc.com!

Welcome to Part One of the  Jones Jones LLC’s Loss Transfer Series! The purpose of this three part series is to educate and inform our readers on the importance of this application of the law.  Understanding and utilizing loss transfer will make a major impact on your mitigation recovery – which will equate to large savings to your clients.  You may have already read about Jones Jones LLC’s major success with our Loss Transfer Department—with over a 96% recovery rate on amounts sought via loss transfer.   Now, this three part series will take you through the basics of loss transfer under NY Insurance Law Section 5105(a) so that you can find opportunities in your own caseload to begin your journey towards loss transfer success.

WHAT IS LOSS TRANSFER?

Loss transfer is a carrier or self-insured’s right under NY Insurance Law Section 5105(a) to seek reimbursement  from another carrier or self-insured for benefits paid on certain claims arising from motor vehicle accidents.

WHO CAN SEEK REIMBURSEMENT VIA LOSS TRANSFER?

No-Fault carriers, as well as Workers’ Compensation carriers and any other carrier who provides benefits that could be considered to be “in lieu of No-Fault”.

WHO DO YOU SEEK LOSS TRANSFER REIMBURSEMENT FROM?

The carrier or self-insured owner responsible for providing No-Fault benefits for the vehicle responsible for the underlying motor vehicle accident.

WHEN DOES LOSS TRANSFER APPLY?

Loss transfer applies when ALL of the following criteria are met:

1. The underlying claim arose from a motor vehicle accident that was caused by a “covered person” as defined under NY Insurance Law Section 5104;
2. The motor vehicle accident occurred in New York State; and
3. At least one of the vehicles involved in the loss meets one of the following criteria:
   1. 1. 1. 1. Weighs 6,500 lbs unloaded; OR
            2. Is a Livery vehicle

WHO IS A COVERED PERSON?

A covered person is an operator of a motor vehicle that was either:

• An authorized self-insured company in New York;
• Insured by a companies authorized to issue No-Fault policies in New York (note: almost all major auto insurance companies fall under this category); OR
• Insured by an out-of-state company which has filed with the NY Commissioner of Motor Vehicles authorizing the commissioner to accept service of process on their behalf and stating that their policies will be varied to meet NY insurance requirements.

Stay tuned for Part Two of the Jones Jones LLC’s Loss Transfer Series to learn about what kind of benefits can be recovered under loss transfer! As always, the attorneys of Jones Jones LLC are beside you every step of the way and welcome any questions or thoughts you may have on this most important topic.  Contact our team today at clientservices@jonesjonesllc.com.

Have an idea for an education series? Would you like to learn more about a certain are of subrogation, New Jersey & New York Workers’ Compensation defense, or No-Fault? Contact us with what you want to hear more about today at clientservices@jonesjonesllc.com!

Jones Jones LLC Partner Kathleen (Kassy) Ginnane provided her expert opinion as part of a panel discussion at the New Jersey Self Insurer’s Association (NJSIA) Conference May 13th, 2022 in Atlantic City, New Jersey. Kassy provided the New York perspective as part of a panel discussion entitled, “What Really Happens when you Presume: Presumption Laws and their Impact”

Kassy is often asked to provide her legal analysis to clients and conferences alike on a variety of workers’ compensation issues. At Jones Jones LLC she is a Supervising Partner, meaning she leads a team of attorneys to tailor their practice to the needs of our clients. Kassy counsels clients and attorneys on the intricacies of workers’ compensation and insurance defense law. Kassy began her legal career at Jones Jones LLC as an associate, handling thousands of New York State claims from inception through closure. As a Supervising Partner, Kassy has spearheaded many successful settlement initiatives, often hosting bulk settlement days at our firm’s office. Kassy enjoys educating employer and carrier clients on various aspects of worker’s compensation law, most recently on issues including electronic claims filing and reporting, settlement strategies, and updates to the New York State Workers’ Compensation Board internal processes. Kassy earned her LL.M. in International Legal Studies from New York University School of Law, and her LL.B. from Queen’s University, Belfast, Northern Ireland.

The May 13, 2022 panel discussion at the NJSIA was a lively one! Kathleen educated the attendees on the current state of presumptions in the NYS Workers’ Compensation system; specifically as it relates to World Trade Center and Covid-19 claims. Kassy also provided an insight in to the possible future of presumptions – with a particular focus on what the legal future might hold for Covid-19 claims.

Kassy is happy to discuss presumptions and how they affect your claims in New York State—reach out to the firm today at clientservices@jonesjonesllc.com to schedule a time and talk tailored for you and your claims team!