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NY Governor Signs Legislation Allowing New Yorkers to Apply for Workers’ Compensation for Extraordinary Work-Related Stress

New York Governor Kathy Hochul recently signed new legislation allowing any New York worker to file for workers’ compensation for specific types of mental injury connected to extraordinary work-related stress. Bill S.6635/A.5745 expands an existing law enacted in 2017 which allowed for only first responders facing post-traumatic stress disorder (PTSD) to file for such benefits.

 

The new law will take effect on Jan. 1, 2025.

 

What this Means for Insurers

 

New York workers will experience expanded access to mental health benefits regarding work-related stress. This also means state insurers and employers can expect to see an increase in work-related stress claims as more employees file for coverage. Resulting cost increases in response to related claims and the burden of proof for work-related stress claims will likely also transfer to the employer.

 

Action by Jones Jones

 

As this new legislation takes effect, Jones Jones expects there to be an increase in related mental health claims. In anticipation of a surge of new claims, Jones Jones will closely monitor any changes related to the new law and any other changes that may come about because of this legislation. We will also closely watch any upcoming mental injury cases or decisions made on mental health injury cases to prepare for the influx of newly filed claims.

 

This development creates a new world for the workers’ compensation industry in New York. While we don’t know exactly how these new claims will shape future litigation, we can and will look to other states, such as Connecticut, with similar laws that may provide guidance. Regardless, Jones Jones will continue to provide the same level of excellence, experience, innovation and efficiency we have delivered for more than 100 years.

 

For more information on this new legislation, please visit the New York State website. If you have questions about how this new legislature may impact you, or if you have a mental injury connected to extraordinary work-related stress claim, please contact us at concierge@jonesjones.com.

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Major Win Alert: Jones Jones Associate Secures Disallowment in Assault Case

Jones Jones LLC congratulates Associate Kevin Moy and his team for successfully arguing before the New York State Workers’ Compensation Board that a controverted assault claim should be disallowed.   

 

In this 2023 case, the claimant alleged they were assaulted by their supervisor and injured their left shoulder. The claimant denied prior injuries, but received treatment, including x-rays in 2021 diagnosing osteoarthritis. Medical examination from the claimant’s doctor and an independent medical examiner (IME) found prima facie medical evidence or sufficient medical evidence conceding causal relationship based on the claimant’s history of being assaulted. However, the claimant also denied prior injuries to the left shoulder to the IME despite 2021 treatment. Additional evidence in this case includes a video of the site, which was precluded from the record and a previous write-up against the claimant for not wearing a safety vest.  

 

During the trial, Moy and his team took extensive testimony from the claimant and the supervisor which contradicted one another. The claimant said the supervisor roughly grabbed the claimant’s arm whereas the supervisor testified they only lightly tapped the claimant from behind. As the testimonies devolved into a he-said-she-said situation, Moy and his team centered their argument on credibility. Moy and his team argued that their witness, the supervisor, was more credible based on inconsistencies in the claimant’s statements and there was no assault that could have resulted in injuries. The Law Judge agreed with Moy and his team and disallowed the claim. 

 

Moy and his team conducted thorough cross-examination of the claimant at trial, overcoming the preclusion of the video evidence and the challenge of the section 21(1) presumption that an accident took place in the course and scope of the claimant’s employment. 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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Major Win Alert: Jones Jones Associate Completes Successful Controverted Construction Case


  
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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Major Win Alert: Jones Jones Associate and Team Complete Successful Appeal


  
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 Construction Practice: Guidance on NYS WC C-3 and employer identification


  
The Jones Jones construction team is pleased to share that to resolve confusion around Employee Claims (Form C-3) and reduce delays in cases where the identity of the proper employer or insurance payer is not immediately known, the New York State Workers’ Compensation Board (the Board) has created a new process to be used when the employer and payer are in dispute.


 


The New Procedure


Henceforth, when a complete C-3 form is filed, the law judge will direct the scheduling of a subsequent hearing, moving such claims forward more quickly.


While law judges currently direct the filing of a C-3 form at a hearing to collect data and move the form forward, a large percentage of all pre-hearing conferences were placed in “No Further Action (NFA)” status in 2023 due to the failure to file a complete C-3 form. Law judges directing the filing of a C-3 form prior to a hearing will ensure claimants and their legal representatives file the complete C-3 form with the Board.


 


Key Information and Filings


In claims where the proper employer and insurance payer are in dispute, certain information will be critical. Important information on the C-3 form includes:


    

  • Field B-1: The name of the employer or as much of it that is known
    • 

  • Field B-6: The full name of the person who hired the claimant or as much of it that is known
    • 

  • Field D-3: The full address where the accident occurred
    • 

  • Field D-5: A detailed description of the claimant’s work at the time of injury
    • 



Additional information important to determining the identity of the proper employer and insurance payer include:


    

  • Form PH-16.2: The Pre-hearing Conference Statement must be completed and include any evidence relevant to the identification of the proper employer such as:

      

    • Pay stubs,
      • 

    • Phone numbers,
      • 

    • Text messages, etc.
      • 

    

    • 

  • Form MV-104 (NYS DMV Report of Motor Vehicle Accident): If the work-related injury was the result of a motor vehicle accident this form must be presented to the Board if the case is controverted on the issue of whether the injury occurred in the course of employment.
    • 



 


Questions of Liability


When compensation is withheld solely because a controversy exists on the question of liability as between carriers, the Board may direct that any carrier shall immediately pay compensation, without prejudice, pending further development of the record on the issue of the proper carrier (see WCL Section 25[1][f]). Due to this it will be in the best interest of carriers to cooperate with the full extent of the Board’s efforts to determine the proper employer in a case.


 


What Jones Jones is doing:


To best cooperate with the Board and expedite all claims where the identity of the proper employer or insurance payer is not immediately known, Jones Jones will work to have any hearing that is scheduled without a properly filed C-3 closed with no hearing. Additionally, our PH16.2 team, led by Partner Stacee Vaikness will thoroughly review all C-3 forms for proper information and will contact the board to seek cancellation of any improperly set hearings.


The cancellation of hearings with improperly filed C-3 forms or inaccurate information will help move properly filed C-3 form hearings forward. Excellence is one of the four tenets we live by at Jones Jones, and we strive to have that excellence present in every aspect of every case we work, including the details of forms filed, such as the C-3. We will work to ensure every C-3 form filed and subsequent hearing moves as efficiently as possible by confirming all the necessary information is present.


For more information on this new process, please visit the Board’s webpage. If you have questions about how this new procedure may impact you, or if you have a case where the identity of the proper employer or insurance payer is not immediately known, please contact us at clientservices@jonesjonesllc.com




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