Our Loss Transfer Department Passes $2 Million in Client Recoveries in 2021

Jones Jones LLC is an industry leader in identifying and securing mitigation opportunities for carriers, TPAs, and self-insured employers.  Loss transfer is a perfect example of how the winning litigation strategies utilized by our attorneys will bring you and your team the very best savings available for your claims.

Just in the first half of 2021 alone, the experienced Jones Jones LLC loss transfer team-lead by Partners Jacqueline Mancino and Agnes Neiger,  have recovered over $2.3 million dollars for clients by way of loss transfer. In fact, our recovery rate is over 96% for the amount of loss transfer recovery sought. Moreover, the Jones Jones LLC team has saved millions of dollars for clients in the defense of loss transfer claims brought against them. This is a major win for many clients as loss transfer is a vital mitigation tool that should always be reviewed, and if applicable, utilized fully in the claims process.

What is loss transfer? How can you ensure that you and your team are taking full advantage of loss transfer opportunities?

Loss transfer is the process by which an insurer or self-insurer that pays No-Fault benefits or Workers’ Compensation benefits in lieu of No-Fault benefits can recover reimbursement from the insurer of the party at fault for the accident. For a claim to qualify for loss transfer, the underlying loss must arise from a motor vehicle accident involving a vehicle for hire or a vehicle weighing in excess of 6,500 pounds. Loss transfer claims are resolved either by way of a settlement or they are heard via mandatory inter-company arbitration.   Arbitration Forums, Inc. is the sole forum designated by the State of New York to hear loss transfer matters.  A Workers’ Compensation carrier or self-insured employer can seek reimbursement of up to $50,000.00 in past payments on each Workers’ Compensation claim. However, a No-Fault carrier can seek over $50,000.00 via loss transfer if they have Optional Basic Economic Loss coverage. The Jones Jones LLC team is excellent at identifying and protecting clients’ rights in rare situations where Workers’ Compensation carriers can assert a lien for the first $50,000 paid on a claim arising from a motor vehicle accident. Our team guides clients  in order to avoid making common mistakes that can cost them thousands or even millions of dollars over time.

The loss transfer attorneys of Jones Jones LLC have nearly three decades of combined experience in working in the loss transfer arena, from inter-company arbitration hearings up to the highest appellate courts in the State of New York.  They have also served as arbitrators with Arbitration Forums, Inc.  Additionally, Partner Jacqueline Mancino is the Secretary for the New York State Loss Transfer Advisory Committee.  Partners Neiger and Mancino, and their highly skilled team, have the experience and knowledge to ensure that all of your claims with a loss transfer opportunity are fully vetted to obtain the maximum amount of recovery afforded to each claim.  Our attorney and paralegal team reviews each case referred to the loss transfer department to confirm that the claim is eligible for recovery. They then undertake an extensive review of the payments made on qualifying claims to identify all recoverable payments and review all accident documents to determine how best to prove liability.

The loss transfer attorneys of Jones Jones LLC are excited to assist you in the loss transfer process.   Contact us today at clientservices@jonesjonesllc.com for all of your loss transfer needs.

Jones Jones LLC Major Win Alert : Learn How Our New Jersey Practice Saved a Client Six-Figures

We are excited to announce a major win secured by Jones Jones  LLC Attorney Christine Diana.  This win highlights:

  • The importance of reviewing all medical bills and location of treatment in order to determine proper payment of medical bill; 
  • The successful jurisdictional arguments Jones Jones LLC has brought as it relates to New Jersey surgical centers attempting to assert a “usual and customary” review of medical bills; and
  • The skillful litigation tactics utilized by the New Jersey attorneys of Jones Jones LLC in order to bring about a successful resolution of your medical bill disputes. 

 

Attorney Christine Diana recently litigated a New Jersey medical provider claim, saving an insurance carrier client over $170,000.00 in medical bill costs.

In most cases, a medical provider claim involves an injured worker with an established New York State Workers’ Compensation claim with treatment being rendered out of state, in this case, New Jersey. Doctors in New York State are bound by the New York State fee schedule for bills; which oftentimes presents itself as much less costly in New York as opposed to higher bill cost for same services in New Jersey. New Jersey reviews medical bills through the “usual and customary” standard.

For this particular claim, the claimant lived, worked, and was injured in New York State.  Her only connection to New Jersey was that she underwent surgery in a New Jersey surgical center.  The surgical center took the position that the insurance carrier must pay the “usual and customary” amount for services; in this case a bill amounting to over $184,000.00.  Our carrier client paid $14,000 towards the medical bill as per the New York State fee schedule.  The surgical center brought a suit in the New Jersey Court System asserting that  New Jersey had jurisdiction over the issue of the medical bill.   Through Attorney Diana’s skillful litigation of the matter, she was able to secure a major win for the insurance carrier.   She argued that New Jersey had no jurisdiction over the medical bill as there is an established New York Workers’ Compensation claim and there was simply a lack of connection between the claimant and New Jersey.

Ultimately, the New Jersey Court dismissed with prejudice the New Jersey surgical center’s argument that the carrier had to pay $184,000.00 in medical bills and the $14,000 payment per New York’s fee schedule was deemed appropriate.

Ensuring that medical bills processed by your team for review of expense and location of treatment is very important as oftentimes there are mitigation opportunities available to you.  The attorneys of Jones Jones LLC have seen the dispute of proper bill payment raised many times in the New Jersey Courts and are experts in arguing the proper payment of such medical costs.  The surgical and treatment centers in New Jersey continue to make the argument that New Jersey has jurisdiction over their bills despite clear case law that holds otherwise. The New Jersey attorneys at Jones Jones LLC  are excited to navigate you and your team through these jurisdictional issues in order to bring about medical cost savings.

Contact us at clientservices@jonesjonesllc.com today to set up a consultation.

Jones Jones LLC Major Win Alert: SLUs

We are excited to announce a major win secured by Jones Jones  LLC Attorney Samantha Sokoloff.  This win highlights:

  • The aggressive approach needed on occupational disease claims that are filed after a regular retirement has been taken by a claimant;
  • The need for a knowledgeable and aggressive  litigation plan on potential high dollar schedule loss of use claims; and
  • The importance of bringing to the Board’s attention that the burden of demonstrating a link between an alleged condition and distinctive feature of employment is on solely on the claimant.

 

Attorney Samantha Sokoloff recently litigated a New York State workers’ compensation claim involving an retired public transit worker.  This particular claimant had worked with a transit authority for almost 30 years in a somewhat physically demanding job.  After the claimant took a regular retirement, he then proceeded to file a workers’ compensation claim alleging occupational disease to the legs, ankles, and feet.

With no witness available, Attorney Sokoloff was able to execute a stellar cross-examination of the claimant.  With this testimony, she was able to highlight to the Law Judge that the claimant had not lost any time from work prior to his retirement due to any pain or injury to any of the alleged body parts.  She was also able to have the claimant concede that he had not seen a doctor about these alleged conditions until after his regular retirement began and that he had a choice to take a disability type of retirement but declined to go that route. Attorney Sokoloff asked that claimant whether he had ever discussed the alleged physical injuries with his primary physician; to which he said he had not. Finally, the claimant was unable to articulate as to what his job duties with his employer was and how he was unable to perform them anymore.

Upon summations, Attorney Sokoloff argued to the Law Judge that the claimant had failed to demonstrate a recognizable link between his condition and a distinctive feature of his employment.  Additionally, the testimony of the claimant’s treating doctor was also highlighted during summations.  The doctor had failed to know any specifics about the claimant’s work history or medical treatment history.  The Law Judge disallowed the claim entirely based upon the winning litigation strategy of Attorney Sokoloff.

This is an important win to consider as there has been an increasing trend within the workers’ compensation system of retirees seeking numerous and high value schedule loss of use awards for occupational diseases. Many of these claims involve no treatment nor notice of any such injury or condition until after the claimant has successfully retired from employment.  Additionally, many of these claims involve a number of body parts that are amendable to a schedule loss of use finding for permanency.  This could equate to a large lump sum award to the claimant post retirement when there is simply a lack of evidence to support any such claim up until their retirement is confirmed.  Due to the high value of these potential claims, it is important to defend post-retiree occupational disease claims with an aggressive approach.  The attorneys of Jones Jones LLC are prepared to navigate these retirement and occupational disease claims with you every step of the way.  The same aggressive and detailed approach that Attorney Sokoloff applied on this case will be applied to your caseload as well.

Contact us at clientservices@jonesjonesllc.com today to set up a consultation.

Jones Jones LLC Major Win Alert: Construction Litigation

We are excited to announce a major win secured by Jones Jones LLC Associate Ian Leaderman. This win showcases:

  • The aggressive approach needed on construction claims involving allegations of injury to many body parts and medical conditions;
  • The success that results from a detailed review of on-site and emergency room records; and
  • The importance of bringing to the law judge’s attention any change in claimant’s account of the mechanism of injury.

 

Attorney Ian Leaderman recently litigated a claim involving an injured employee of a construction company. The claimant was initially injured due to striking his face while at work on a construction site. The claim was established for the head and left eye only. Approximately, one month later after the establishment of his claim, the claimant alleged that in addition to the accepted and established body parts, he also injured his neck, back, bilateral knees, bilateral shoulders, as well as developed PTSD.

Attempting to establish additional body parts is an activity that defense carriers and attorneys often observe; especially when it comes to claims involving construction incidents. Why do we see this pattern of additional body parts repeatedly be raised on construction claims? Well, very often, the claimant not only has a workers’ compensation claim, but he or she may also have a general liability suit. This lawsuit enables the claimant to seek large monetary payouts by way of settlement or court decision. Expanding the workers’ compensation injuries on construction claims to as many body parts and conditions as possible may assist in this other lawsuit. Therefore, it is important to defend workers’ compensation construction claims with an aggressive approach to limit exposure on both the workers’ compensation claim and the general liability lawsuit.

Attorney Leaderman undertook the necessary aggressive approach on this case. He was able to gather and review the construction company’s on-site medical report and the emergency room records from the day of the accident. Upon a thorough review of these records, it became evident that the claimant had put forth two different version of the injury event. The initial emergency room records and on-site accident report detailed a strike to the face with injury to head and left eye. Subsequent medical reports began to list all of the additional body parts the claimant was attempting to amend the claim to include. Most interestingly, these reports also detailed a completely different mechanism of injury—involving an item falling from a ceiling. Attorney Leaderman was able to highlight these discrepancies to the law judge, which ultimately culminated in all of the additional body parts and conditions to be disallowed entirely. Jones Jones LLC is happy to guide you through the intricacies of construction litigation and apply this same detailed litigation approach to your claims.

Contact us at clientservices@jonesjonesllc.com today to set up a consultation.

NYS Workers’ Compensation Medical Marijuana – The Third Department Weighs In

The Third Department recently held in the Matter of Quigley v. Village of E. Aurora, 2021 N.Y. App. Div. LEXIS 1223 (3d Dept. Feb 25, 2021) that carriers are responsible for paying for, and reimbursing, a claimant’s medical marijuana use, regardless of federal law.

The Third Department Decision however noted that the Workers’ Compensation Law still requires that treatment be rendered in accordance with the Medical Treatment Guidelines and that the claimant would still need a valid prescription.

Furthermore, as medical marijuana is not specifically covered under the Guidelines, a variance request would be needed and the burden of proof to establish that a variance is appropriate and medically necessary is a burden that must be met by the claimant’s doctor. Carriers and self-insured employers can therefore object to medical marijuana requests on the basis that the doctor has not met his burden of proof or by obtaining a conflicting medical report (i.e. IME or record review).

If you have any questions or would like to discuss implications of this case law further, please do not hesitate in contacting us at clientservices@jonesjonesllc.com.
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