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Each state within proximity of the Greater New York City area has distinct laws regarding workers’ compensation benefits. These laws can vary significantly regarding when and how much benefit a worker can collect, requiring a determination of jurisdiction as one of the first steps in reviewing a workers’ compensation claim.

 

What is jurisdiction?

In basic terms, jurisdiction is determined by looking at what meaningful contact the employee in question had within the state around the time of the injury. When a state is determined to have jurisdiction, that state’s legal representatives have a vested interest in the employee’s claim and the state’s laws regarding workers’ compensation will apply.

 

In some instances, jurisdiction will be clear but there will often be a variety of factors to consider when determining jurisdiction.

 

Common questions used to determine jurisdiction:

• Where did the incident occur? If the accident occurs in the state of New Jersey, New Jersey will automatically have jurisdiction.
• Where is the company’s headquarters? Jurisdiction may not automatically fall to the state or country in which a company is based.
• Where does the employee live? The employee’s primary address or where they received mail could be a significant determining factor for jurisdiction.
• What office or company building does the employee regularly report to? Given the proximity between New York and New Jersey, employees may live and work in different states.
• Was the employee traveling on business at the time of the incident? Past cases have shown that even when traveling internationally, jurisdiction can fall to the home base of the employee.
• Where did medical treatment occur? As medical treatment is not part of the employee’s job function, it is not typically a primary determining factor for jurisdiction but can affect future medical provider claims.
• Were there any other parties involved in this incident? For example, the employee could have been traveling out of state on a contract for a third party.

 

How can companies assist with determining jurisdiction?

• Keep accurate hiring records.
• Regularly review physical hiring paperwork to ensure dates, addresses and details are easily identifiable.
• Verify physical hiring records are transcribed correctly to digital forms.
• Keep detailed accounts of employees traveling in and out of the state.
• Make note of any unusual out-of-state situations. For example, conducting an interview or hiring an employee over the phone while in a different state could influence jurisdiction.

Jurisdiction Disputes

During a jurisdiction dispute, the parties involved in the workers’ compensation claim will look to make a case for the jurisdiction that benefits each of them more favorably. Further complicating matters, it is also possible for workers to collect benefits in more than one state.

 

In New York and New Jersey, jurisdiction disputes are common. The following are important areas of differentiation in terms of workers’ compensation benefits between the two states.

 

New York vs New Jersey

• Wages: In New York, indemnity benefits, or lost wages that you would expect to be paid while recovering from a work-related injury/illness, are tax-exempt and are calculated as a 35% reduction from the employee’s gross salary to a maximum or minimum; New Jersey provides 70% of an employee’s average weekly wages before the injury.
• Disability: In New York, compensation for permanent loss of use of an extremity (i.e., an arm or leg) is limited to a certain number of weeks based on a schedule loss of use (SLU); In New Jersey, claimants may receive a permanency award for their injury.
• Treatment: In New York, respondents (in this case the employers) do not direct or control where an employee receives medical treatment; In New Jersey, the respondent controls treatment of the petitioner (in this case the employee) in an accepted workers’ compensation claim.
• Out of office claims: New York has a “home office exception” for compensable accidents since 1968; New Jersey has several cases of work from home accidents which have been deemed compensable.

 

What is the impact of a jurisdictional dispute on a workers’ comp claim?  

A jurisdictional dispute can be costly to an employer, particularly when a company does not have sufficient insurance in the state in which jurisdiction is determined. In this case, the state’s Uninsured Employers Fund will assist with covering the costs of the workers’ compensation claims. The assistance the Uninsured Employer Fund can provide varies across all 50 states and employers that require its services can be sanctioned with high fines. For example, in New Jersey, companies can face fines up to $5,000 for each 10-day period without coverage and in New York companies can face up to $2,000 for each 10-day period without coverage.

 

Companies seeking expertise in workers’ compensation cases in New York and New Jersey should engage a specialist who knows the unique challenges of the local landscape. Jones Jones LLC has 100 years of experience in workers’ compensation law with offices in both New York and New Jersey to assist clients with jurisdictional disputes.

 

New Jersey Jurisdiction Primer

 

 

Jones Jones LLC Managing Partner Sarah Thomas is featured in Hotel Management Magazine, sharing her view on mitigating workers’ compensation claims for the hospitality industry – an industry, which in 2020, experienced 11,320 nonfatal occupational injuries and illnesses involving days away from work.  In addition to sharing her thoughts on minimizing such injuries and illnesses, Sarah discusses how lessons learned from the Covid-19 pandemic can help inform future mitigation tactics, and how to best set up a successful return to work program.

To learn more, you can view the full article here: https://www.hotelmanagement.net/operate/mitigating-workers-comp-claims.

 

Jones Jones LLC is excited to announce a major win secured by Partner Dana Sabghir and Associate Katherine Caracappa.

This win highlights:

• The necessity to thoroughly review medical records submitted by treating doctors. Oftentimes, these records have a detailed history of the claimant’s prior medical history and treatment. This review, coupled with the history as given by a claimant in initial claim documents (C-3) and history as given by claimant to IME doctors could vary greatly, and very well may be the basis of a fraud finding by the Workers’ Compensation Board;
• The importance of seeking full medical records by way of subpoena in order to obtain the full picture of the claimant’s health prior to the workers’ compensation accident date; and
• How detailed fraud litigation can have an impact on the workers’ compensation case as well as a corresponding costly general liability claim.
  Jones Jones LLC attorneys Dana Sabghir and Katherine Caracappa secured a major win for a construction company that resulted in the claimant paying a significant amount of money back to the carrier.

 

The claim involved a claimant construction laborer, who upon initial filings (C-3), denied any prior conditions or prior accidents. The claim was established for bilateral knees, elbow, and the back. Soon after this establishment of injury, the claimant’s attorney filed for a hearing with the intent of expanding the case to numerous body parts and conditions. Our Jones Jones LLC attorneys subpoenaed records from the doctors who had submitted medical evidence in support of expanding the case to numerous other body parts. Upon a thorough review of these records, it became evident that the injured worker actually did indeed have extensive prior treatment to the bilateral knees, elbow, and back. Additionally, these prior records made reference to multiple prior accidents, prior surgeries, as well as significant results on diagnostic tests pre-dating our injury date in question. The claimant had also begun denying prior injuries to several of his own doctors as well as the independent medical consultants on the case. The misrepresentation of the prior physical condition of the claimant was spread not just to the documentation filed with the NY Workers’ Compensation Board; but also to the doctors tasked with treating the claimant’s injuries.

Jones Jones LLC raised fraud under WCL Section 114-A and requested that the Law Judge enter a formal finding that the claimant committed a material misrepresentation. The fact that prior injuries, surgeries, and conditions were denied on the initial claim filing documents as well as denied to a variety of doctors during treatment and evaluation was the basis for this request for a fraud finding.

Following litigation, the Law Judge did find that the claimant violated Section 114-A fraud as the claimant committed a material misrepresentation as it related to his prior physical condition. The New York State Workers’ Compensation Board held that the claimant was required to pay the insurance company approximately $40,000.00 back in workers’ compensation benefits as well as be permanently disqualified from receiving future indemnity benefits.

Additionally, as the accident in question involved a construction site accident, the claimant had a corresponding general liability claim. The fraud finding on this claimant’s workers’ compensation case had had significant impact on the future of the claimant’s general liability claim and his ability to close that case with a monetary gain.

Contact our attorneys today at clientservices@jonesjonesllc.com for any need you have regarding a fraud evaluation.

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!