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Home > Archives for workers comp

Jones Jones LLC Back to Basics: RFA-2 Requirements

05.07.2022

The RFA-2 is a New York State Workers’ Compensation Board form. Specifically, it is a “Request For Further Action” by the carrier or employer and can be found here. This form would be filed by the carrier or employer when a need for a hearing arises.  Recently, the NYS Workers’ Compensation Board has been taking a closer look at RFA-2 forms to ensure that they are properly and fully completed prior to granting a request for a hearing.

How can you make sure that your RFA-2 is proper and complete?

  • The RFA-2 must be filled out in its entirety. If there are missing fields, the Board will reject the entire RFA-2.
  • On the ‘Compensation/Medical Issues/Other’ tab, the person filing the form must check off the appropriate box and fill in the associated fields. In addition, the person filing must fill in the box labeled: **Document reference information (date, name / title, form ID).
  • On the ‘Sign’ tab, the person filing must certify that they have either discussed the issue with the opposing party, or attempted to contact the opposing party. These fields must be completely filled out, or the Board will reject the RFA-2. Further, the Board is now requesting proof that the opposing party was contacted. This requires the person filing the RFA-2 to email or call opposing counsel, and properly document same. Proof of contact should be sent to defense counsel in preparation for hearing.
  • The person filing the RFA-2 should monitor the Board file for the ERFA-2.1 (Board response to the RFA-2) and ensure that the Board has accepted the RFA-2 and taken the actions requested (scheduling a hearing, issuing an EC-81.7, etc.).

The attorneys at Jones Jones LLC are  always happy to assist with the RFA-2 process.  We are available to personally file the RFA-2 document as well as to contact the claimant’s attorney to advise them of the RFA-2 issues.

Contact us today at clientservices@jonesjonesllc.com for assistance today!

Filed Under: Blog Tagged With: workers comp

News Bulletin: NYS Workers’ Compensation Benefit Increase

05.01.2022

On April 20, 2022, the New York State Workers’ Compensation Board announced that the maximum weekly benefit rate for workers’ compensation claimants is $1,125.46 for injuries sustained from July 1, 2022 through July 30, 2023.  See the Board’s announcement here.

The attorneys of Jones Jones LLC are experienced litigators and defense specialists and are eager to work with you and your team in order to mitigate the ever increasing cost of claims.

Reach out to a Jones Jones LLC partner today for guidance in developing a solid strategy to make a difference on your case load at clientservices@jonesjonesllc.com.

Filed Under: Blog Tagged With: workers comp

News Alert: NYS WCB Issues Bulletin on 32s and Releases

10.15.2021

On October 8, 2021 the NYS  Workers’ Compensation Board issued a bulletin in regards to Section 32 Agreements: https://content.govdelivery.com/accounts/NYWCB/bulletins/2f633a4.  The main points of the Board’s announcement are as follows:

  • The Board will disapprove a Section 32 Agreement if it becomes aware that as a condition of entering into the Section 32 Agreement, the parties entered into a separate agreement or contract that contains terms which are not included in the agreement submitted to the Board;
  • As of 12/6/21, all 32 Agreements must be accompanied by an affidavit (if signed by attorney) or affirmation (if signed by non-attorney) executed by the person who has signed the 32 Agreement on behalf of the carrier, self-insured employer, or TPA. This affidavit /affirmation will affirm, under penalty of perjury, that the agreement submitted to the Board contains all terms and conditions and that no separate agreement or contract has been entered into by the parties that are not reflected in the agreement submitted to the Board;
  • The Board will give “significant scrutiny” to any term in the Section 32 Agreement providing for a general release to all claims against the carrier, self-insured employer, or TPA.

What does this mean for your settlement program? If your insured, carrier, or self-insured employer wishes to move forward with a Section 32 agreement along with any other agreement, such as a release- all terms must be included within the language of the Section 32 Agreement.  Please contact us at clientservices@jonesjonesllc.com to discuss the implications of this Board bulletin and how it may affect how your Section 32 Agreements are written and their subsequent review by the Board.  As always, the attorneys of Jones Jones LLC look forward to working with you and your team to navigate your settlement program towards great success.

Filed Under: Blog, News Tagged With: New York, workers comp

Workers’ Compensation & General Liability: The Power of an Integrative Litigation Approach

10.11.2021

New York’s Second Department recently issued a decision, Lennon v 56th & Park (NY) Owner, LLC, regarding collateral estoppel in workers’ compensation and personal injury suits. This decision illustrates the importance of a unified workers’ compensation and general liability defense.

The Second Department held that a plaintiff’s general liability claim may be barred by the doctrine of collateral estoppel when there is a prior determination from an administrative board involving the same subject matter. The doctrine of collateral estoppel precludes a party from re-litigating an issue clearly raised in a prior action and decided against that party. The collateral estoppel doctrine gives conclusive effect to prior determinations when two conditions are met: there must be an identity of issue, which has necessarily been decided in the prior action, and is decisive of the present action, and there must have been a full and fair opportunity to contest the decision now said to be controlling. The “full and fair opportunity” factors considered include the nature of the forum and the importance of the claim in the prior proceeding, the incentive and initiative to litigate, the actual extent of the prior proceeding, the competence and expertise of counsel, the availability of new evidence, and the foreseeability of future litigation.

In Lennon v 56th & Park (NY) Owner, LLC, the claimant alleged that he was injured while working at a construction site. A hearing was held before a Workers’ Compensation Law Judge, and the claimant was represented by an attorney. The claimant and employer witnesses were sworn in and testified under oath. The Law Judge ultimately held that the claim was denied.

Subsequently, in the general liability claim, the defendants argued that the Workers’ Compensation Board’s finding that the underlying event was not causally related to the claim effectively collaterally estopped the plaintiff from re-asserting the same claim before the Supreme Court. The Supreme Court agreed and granted summary judgment.

The plaintiff appealed the Supreme Court decision. The Second Department ultimately held that the findings in the workers’ compensation matter were material and pivotal to the core viability of any personal injury action that the plaintiff could pursue in a court at law regarding the same incident. The Second Department held that the Supreme Court’s award of summary judgment was proper.

This Second Department decision reinforces how closely the insured, the general liability defense attorney, and the workers’ compensation defense attorney must work together in preparation for the workers’ compensation trial. The thorough review of the investigative materials, witness statements, and initial medical records, as well as discussion of the claim with the witnesses and with general liability defense counsel, are crucial to defending workers’ compensation claims, and may ultimately be used to attain summary judgement in the general liability action.  Jones Jones LLC attorneys are experts at litigating the complexities of workers’ compensation and general liability litigation and will work to mitigate both claims for your caseload.  Contact us today at clientservices@jonesjonesllc.com to discuss an integrative litigation plan.  

Filed Under: Blog Tagged With: New York, workers comp

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

07.17.2021

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.

Filed Under: Blog Tagged With: New Jersey, workers comp

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