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  Jones Jones LLC is pleased to congratulate Associate Kevin Moy and his team on successfully securing a favorable reserved decision from the New York State Workers’ Compensation Board (NYSWCB), saving the client nearly $160,000.  

In this case, the claim was established for the exacerbation of the claimant’s prior neck injury during a physical confrontation with a supervisor. The identified carrier in this case filed several reports indicating it would accept the claim with liability and appeared at several hearings regarding the claim. The carrier later filed a notice claiming the employer listed in the report was different than initially thought and therefore it was not the proper carrier for the claim.   

During a hearing held on the matter, Moy and his team raised the issue of laches, a legal principle barring a claim when there is an unreasonable delay in filing, leading to prejudice in the opposition. Moy and team raised this issue as the claim was litigated and established before the issue of the correct carrier was considered. The status of the case would sway Jones Jones’ client if it was forced to accept liability. The carrier claimed all issues had been litigated to completion. Upon conclusion of the hearing, the WCLJ directed both parties to file memoranda of law, or a legal memo on the issue. Jones Jones’ legal memo reiterated that the carrier held possession of the full incident report containing the identity of the employer from the inception of the report’s creation. The WCLJ indicated a reserved decision would resolve the question of the correct carrier. 

In rebuttal, Moy contended that the carrier’s failure to contest its liability swayed the client by denying them the opportunity to properly investigate the claim. The carrier held possession of all primary evidence and the full accident report, appeared at hearings regarding the claim and failed to properly contest the findings despite deficiencies in the proffered medical reports. Moy argued the decision regarding the correct carrier should be affirmed.  

Moy and his team’s skilled testimony and summation secured an affirmation from the Board and saved their client more than $150,000. If you require assistance with a workers’ compensation case, please contact our appellate team at concierge@jonesjonesllc.com.  

Jones Jones LLC knows that Workers’ Compensation claims can be complex. In an industry bogged down by forms, statutes, and filings, we aim for efficiency in all we do. To that end, we wanted to make sure that you, our clients, had access to the most up-to-date pertinent information regarding New York workers’ compensation.

Are you an examiner that is looking for a quick reference? Are you a risk manager overseeing New York claims? Are you an employer addressing your first workers’ compensation case? Please look no further than the Jones Jones LLC New York Workers’ Compensation Fact Sheet.

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Congratulations to Jones Jones Supervising Partner Rosanna Shamash and her team on the successful appeal of a workers’ compensation law judge’s (WCLJ) decision in front of the New York State Workers’ Compensation Board (NYSWCB). This appeal reversed the claimant’s status as seeking employment in good faith, and instead, limited the claimant’s rights to benefits, opening the conversation for settlement.

In this case, the claimant received injuries to their right ankle with the most recent independent medical examination (IME) report stating a 75% degree of disability. At a previous hearing, the WCLJ found the claimant to be seeking employment in good faith and continued the awards. Despite the continuation of awards, the WCLJ also previously granted Shamash’s application to cross-examine the claimant.

In preparation for this hearing, Shamash dissected approximately 100 pages of the claimant’s submitted work search documents and googled each job posting to verify their requirements.  When questioning the claimant, Shamash asked about the job requirements for each listing and was able to show that the claimant’s experience clearly did not align with the jobs listed. Additionally, the claimant had not submitted any current evidence of a good faith work search from the time between the previous hearing and the most recent hearing. It was made clear that the claimant had been arbitrarily applying for jobs.

When asking the claimant about documentation from an employment center they had visited, the claimant shared that they only visited the center to use their computers and apply for jobs. The claimant did not meet with any job counselors or attend any workshops while visiting the center.

Shamash’s thorough research and close attention to detail contributed to securing the team’s win and paving the way to a settlement with the claimant in this case. 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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