1. NYS Workers Compensation - 101 William S Jones- Jones Jones LLC

2. New York Workers Compensation LawIn New York, certain injuries and illnesses that occur while an employee ison the job qualify for workers compensation benefits.-Injury and personal illness mean only accidental injuries arising out of and in thecourt of employment- While the injury may be physical, or at least in some circumstance mental, there mustbe some direct relationship between the injury or disease and the employment- Liability for workers compensation benefits are imposed on the employer withoutregard to the existence of fault, however, the employers liability to the injuredemployee generally extends no further. 3. So, Whos Covered?Today, virtually all employees, other than casuallaborers, babysitters, real-estate brokers, and certainother sales associates, are covered under the NewYork Workers Compensation Law.*Additionally, independent contractors are notentitled to workers compensation benefits unlesscovered by their own policies of insurance 4. The Initial InvestigationANCR The foundation for each andevery claim! But what does this mean??1- A = Accident2- N = Notice3- CR = Causal Relationship 5. Things to look for when investigating a claim Was the accident witnessed? Was the accident reported immediately? Who was first notice given to? On what day did the accident occur and how long was the claimant employed? Did all the facts and events make sense? Was the claimant known to be disgruntled? Was the claimant treated for this accident and/or a similar injury or illness in the past?What if something doesnt add up What then?? 6. Denial Of a Claim Coverage Arising In and Out of Course of employment Employer-Employee Relationship Notice & Timely Claim Filing Lack of Prima Facie Medical Evidence 7. The Life of a ClaimThe worker obtains thenecessary medical treatment and notifies his/her supervisor;Notifies the employer, inwriting, within 30 days; The employee files a claim with the Board on Form Employee Claim (C-3)The doctor completes a preliminary medical report onForm Doctors Initial Report (C-4)The employer reports the injuryto the Board and the insurance company on Form EmployersReport of Work-Related Injury/Illness (C-2)The insurer provides the injuredworker with a written statementof his/her rights under the law. 8. If the claim is accepted (C-669) theinsurer begins payment of benefits if lost time exceeds seven days. If the claim isbeing disputed (C-7 and PH-16.2) , theinsurer must inform the WorkersCompensation Board and claimant/representative.The insurer continues to make paymentsof benefits to the injured employee (if thecase is not being disputed). The boardmust be notified of any changes inpayment (C-8.6). The doctor submits progressreports on Form Doctors Progress Report (C-4.2) to the Board. 9. Finally! Our world is safe and our claims are undercontrol Right? 10. Consequential Injuries: Wait a minute What?What are Consequential Injuries? - A consequential injury is an injury that occurs as a consequence of the original work related injury. - Consequential injuries come in many varieties from the obvious to subtle. *There is even case law that says that if a claimant goes to a doctor or therapist for an appointment to treat a Workers Comp injury and is injured, on the way to or from the appointment, the injuries thus sustained are considered consequential to the original injury and are added to the original Workers Compensation injuries.* - The claimant needs to produce prima facie medical evidence of the consequential injury. 11. A Solid Foundation for your defense Anything that is reasonable and inMatters that Matter good faithMatter of Jaquin v. Community Covenant Church , 2010 NY Slip Lack of casual relationshipOp 33, Jan 7, 2010 and Matter of Kot v. Beth Ameth HomeAttendant, 2010 NY Slip Op 773 Feb 4, 2010 Not Arising Out of and in theMatter of Zahm v. National Fuel, 2010 NY Slip Op 3018 April15, 2010 and Matter of Bigelow v. Wpac Prods., Inc. 2010 NY Slip Course of Employment Op. 8665 Nov 24, 2011Matter of Yarleque v. Sally Lou, Inc. 2010 NY Slip Op 4072, May Time Bars13, 2010 and Matter of Lavigne v. Peru Central SchoolDistrict, 2011 NY Slip Op 2089; March 24, 2011 12. For additional Workers CompensationInformation, please visit our new Webpage@ WWW.JONESJONESLLC.COM