Author: Jones Jones

Please join Jones Jones in congratulating Associate Kevin Moy and his team on their successful effort to disallow a controverted construction claim before the New York State Workers’ Compensation Board.   

In this case the claimant alleged they were working as a carpenter for the client’s insured when they injured their neck, back, right shoulder and both knees on the job site as a result of tripping over some pipes. The claimant also alleged they gave oral notice of the injury to the foreman on the date of the injury and had witnesses onsite. Moy and his team questioned the validity of the claim based on documented evidence the claimant worked the full day on the alleged date of accident, contrary to the claimant’s testimony that it happened in the middle of the day and that they stopped working immediately after the accident to seek medical treatment. 

During trial, Moy and his team took extensive testimony of the timeline of events on the alleged date of accident and how the alleged accident took place. Moy’s team also provided documented evidence and testimony that the claimant worked the entire day. During both examination and cross-examination, the claimant stated they were sent home from work early and drove to the hospital but provided no actual evidence or witness testimony in support of this statement. Moy and his team argued the claim should be disallowed as the claimant’s testimony and allegations were unsupported with documented evidence. The Law Judge agreed with Moy and his team and disallowed the case. On appeal, the New York State Workers’ Compensation Board also cited the claimant’s allegations were unsupported. 

Moy and his team presented compelling evidence that overcame the hurdle of the section 21(1) presumption that an accident took place in the course and scope of the claimant’s employment. The display from Moy and his team also highlighted a lack of supporting evidence from the claimant, saving the client from both financial and reputational burden in the face of a high exposure case. Well done to the entire team. If you are in need of assistance with a workers’ compensation case, please contact our appellate team at concierge@jonesjonesllc.com.  

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Please join us in congratulating Jones Jones LLC Associate Kevin Moy and his team on completing a successful appeal before the New York State Workers’ Compensation Board.

The claimant in this construction case incurred an injury to their left elbow in 2012 while pulling a heavy pipe. In 2022, the claimant was examined by their orthopedic physician who indicated a loss of range of motion with flexion to 140 degrees and no loss of extension. The orthopedic physician re-examined the claimant stating they had reached maximum medical improvement and that the injury is amenable to a 20% schedule loss of use (SLU) of the left arm.

When the carrier’s orthopedic consultant examined the claimant in 2023, they indicated the claimant’s injury resulted in muscle strain. They found that while the claimant’s left elbow did have a loss of range of motion, it was the same range of motion as the right elbow. The carrier’s orthopedic consultant stated the claimant’s injury to the left elbow is amenable to a 0% SLU of the left arm.

In 2023, the workers’ compensation Law Judge found the claimant’s left elbow injury is amenable to a 20% SLU of the left arm, granting over $48,000 in compensation, less payments already made and $7,200.00 in attorney’s fees. Later in 2023, the judge awarded 40% SLU of the left arm.

Moy and his team argued upon the firm belief that the carrier’s orthopedic consultant was a more credible source than the claimant’s orthopedic physician. The claimant’s legal team attempted to argue for 20% SLU, resulting in a payout of $24,000, and medical reports to remain open. Moy’s team was successful in securing the appeal on the basis that the claimant had no permanent impairment related to the injury and that there was no basis for future treatment, alleviating the need for open medical reports.

Moy and his team presented a compelling argument that ultimately awarded our client with the best possible outcome. We applaud the entire team. If you are in need of assistance with a workers’ compensation case, please contact our appellate team at clientservices@jonesjonesllc.com

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Jones Jones LLC congratulates Associates Samantha Sharpe, Diandra Archbald and Diane Mandleur, and their team on securing a dismissal of a New York insurance claim under a New Jersey insurance policy.

In this case, the claimant alleged that while working for a car transport company, located in Englewood, NJ, they were involved in a motor vehicle accident in Brooklyn. As the claimant was employed in New Jersey, they were insured in New Jersey, however they filed the claim for New York.

The claimant testified that on the date of the injury, they were in Brooklyn after picking up a vehicle to bring back to New Jersey. When given the chance to cross-examine the claimant, the Jones Jones team dug deeper into the questions relative to the policy. This resulted in a testimony from the claimant that they were advised upon hire that they would be regularly sent out of New Jersey to pick up cars and would often be sent to different boroughs in New York to pick up cars.

Upon further research, our team discovered that the claimant only had New Jersey coverage on their policy. Further, the policy had very specific language dictating that if the insured had business in any other state, they were required to notify the underwriter within 30 days of the inception. The underwriter stated that for this case they were not notified of the New York relationship until after the injury was filed in 2023. As a result, this accident in New York was not covered under the New Jersey policy based on the insured’s failure to notify the underwriter of the true work being performed outside of New Jersey.

The Jones Jones team argued that between the claimant’s testimony and the underwriter’s testimony, there was in fact no coverage for New York based on the insured employer’s failure to disclose their business in New York. The Law Judge agreed with the Jones Jones team and found on behalf of the carrier that their New Jersey coverage did not extend to New York based on the insured’s failure to disclose their true dealings in New York and discharged the carrier.

Sharpe, Archbald and Mandleur showcased exemplary dedication to finding the right information for the client through their research and cross-examination skills in this case. Well done to the entire team. If you are in need of assistance with a workers’ compensation case, please contact our appellate team at clientservices@jonesjonesllc.com.

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