Employers quickly learn workers’ compensation is full of surprises, nearly all unpleasant. Compensation premiums are a good example. Taking Control of workers compensation is only the first step. As you proceed, you’ll begin to ask questions like why your premiums go up if you have no claims. Ask what your “mod” is. When was the last time there was an independent audit of your premium calculation to see whether your employees might be misclassified and you are entitled to a lower premium?
Private insurance companies are regulated on how they price premiums. The rates are set by a rating board. Large states have their own boards but many smaller states use the National Council on Compensation Insurance (NCCI), located in Boca Raton, Forida, to set rates.
Rates vary according to what industry the business fits into. There are several hundred classifications given designations in the “Standard Industrial Classification” system (SIC code).
Every year, rates for each industrial classification are changed, according to data sent by carriers, self-insured, the compensation board and the insurance department. If an industry has had more claims and longer periods of disability the rate for ALL businesses in that industry rise.
Smaller businesses often go years without a claim. The expectation is the premium should continue to fall. Sometimes, however, it rises anyway. Why?
There is a lower limit to what a premium can be, even without claims. In low-risk, small businesses with no claims, most of the premium pays for necessary administrative handling required regardless of claims. These costs inevitably rise over time. Then there are the raises dictated for the industry as a whole, even for employers with no history of work-related injuries.
Following 9/11, there was an emergency meeting of the New York Compensation Insurance Rating Board to deal with the consequences of the largest workers’ compensation event in history. Nearly all the victims were clerical workers, normally the least expensive for compensation insurance. Nearly all the claims were death claims at maximum rate. Special formulas, never used before or since, had to be created to prevent economic devastation of businesses otherwise not affected. The only solution was to create special surcharges for many other industries throughout the state. (workersxzcompxzkit)
There is a saying among loss-prevention specialists, “It’s hard to improve on zero!” If you indeed have no workplace injuries, check with your carrier to make sure your industrial classification and your reported payroll are correct. Keystroke errors, changing an accounting firm into a medium factory, are to occur. Adding a zero to the total payroll is also a typewriter hazard.
Author: Attorney Theodore Ronca is a practicing lawyer from Aquebogue, NY. He is a frequent writer and speaker, and has represented employers in the areas of workers’ compensation, Social Security disability, employee disability plans and subrogation for over 30 years. Attorney Ronca can be reached at 631-722-2100.
Click on these links to try it for yourself.
WC Calculator: www.ReduceYourWorkersComp.com/calculator.php
TD Calculator: www.ReduceYourWorkersComp.com/transitional-duty-cost-calculator.php
WC 101: www.ReduceYourWorkersComp.com/workers_comp.php
Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs.
©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
Employers will be affected by the ending of a little understood law: The Second-Injury Fund, scheduled for termination of payments on July 1, 2010.
The law (Sect. 15-8 of the Workers’ Compensation Law) protected employers from the higher costs of compensation in juries where the employee had a prior permanent disability at the time of a work injury. Common examples were workers who had been in auto accidents and who later were hurt at work.
In such situations, the employer (through its compensation carrier) only paid for the first 2 years (recently changed to five years) after which payments would be reimbursed from the Second-Injury Fund. However, many states, New York included, are experiencing rising costs in all areas of workers’ compensation, resulting in closing down of these funds. The New York fund will terminate payments on 7/1/10.
What impact will this have on employers? There will be both increased litigation on nearly half of all claims involving serious injuries, as well as increased litigation of claims involving workers over 50 years of age.
A publication by the Surgeon General 20 years ago showed nearly 30% of the workforce had a permanent medical impairment. This is precisely the group most likely to sustain a later career-ending work injury.
In New York, compensation claims will be heavily litigated on the effects of prior injuries which, until now, were covered by the Fund. Employers must anticipate this and document periods of lost time from work due to permanent injuries prior to an accident. If there was no such lost time for years prior, there is a good chance a workers’ compensation rate will not be lowered by apportionment with a prior injury. (workersxzcompxzkit)
It is certain the most helpful testimony will come from the employer who can honestly testify a prior injury did not noticeably affect the worker’s job performance. Employees will need the employer’s loyal support more than ever.
Author: Attorney Theodore Ronca is a practicing lawyer from Aquebogue, NY. He is a frequent writer and speaker, and has represented employers in the areas of workers’ compensation, Social Security disability, employee disability plans and subrogation for over 30 years. Attorney Ronca can be reached at 631-722-2100.
Click on these links to try it for yourself.
WC Calculator: www.ReduceYourWorkersComp.com/calculator.php
TD Calculator: www.ReduceYourWorkersComp.com/transitional-duty-cost-calculator.php
WC 101: www.ReduceYourWorkersComp.com/workers_comp.php
Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs.
©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
Lifetime payments of workers comp for permanent disability are no longer guaranteed in NY. For accidents prior to 3/13/07 the Board used medical standards which were not linked to realistic estimates of earning capacity and had lifetime duration. For accident after 3/13/07 the Board will attempt to measure true wage loss and earning capacity. A worker whose loss of earning capacity is less that 15% of the wage at time of injury will receive a maximum of 225 weeks of compensation. For loss of greater than 95% of earning capacity a maximum of 525 weeks will be paid. For earning capacities in between there is an ascending scale of weeks of disability. Therefore, a worker earning $800/wk at time of injury will receive 225 weeks of benefits if his/her wage earning capacity is greater than $680/wk after the injury. However, they receive 2/3 of the difference, or $80/wk or less, for a maximum of 225 weeks. At the other end, a worker with $800/wk at time of injury who can earn even $40/wk is limited to 525 weeks of future benefits. A worker with a loss of more than 80% of earning capacity can request additional payments for "hardship". However, our $800/wk worker would not qualify if they can earn more than $160/wk, less than is paid for a minimum wage job. Changes in claim strategy are easily foreseeable. Attorneys will have to argue for permanent total disabilities or their clients will sooner or later be faced with economic disaster. The Board will need any objective information it can get to resolve the coming disputes. Vocational experts will soon replace the medical professionals in most trials. However, it is the employer who has the most valuable information, IF it is provided to the Board and carrier ASAP. The Board will happily incorporate useful information from the employer. Therefore, the employer, on every claim for extended disability, should inform the Board and carrier of offers of work and how much they pay. If the employee cannot be accommodated the employer should compose a letter explaining why work in the industry is not available to this employee given their physical condition. A short letter will go a long way to resolving the new disputes. And it may prevent an economic disaster for many families. Author: Attorney Theodore Roncais a practicing lawyer from Aquebogue, NY. He is a frequent writer and speaker, and has represented employers in the areas of workers' compensation, Social Security disability, employee disability plans and subrogation for over 30 years. Attorney Ronca can be reached at 631-722-2100. Try the WC Cost Calculator at www.ReduceYourWorkersComp.com/calculator.php Look at WC 101 for basics www.ReduceYourWorkersComp.com/workers_comp.php Workers' Comp Kit® is a web-based online Assessment, Benchmarking and Cost Containment system for employers. It provides all the materials needed to reduce your costs significantly in 85% less time than if you designed a program from scratch. www.ReduceYourWorkersComp.com Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs. ©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
A three-day series in the New York Times recently discussed frustrations with all participants: employees, employers, medical providers, insurance companies and the Workers’ Compensation Board. Many have asked, “How accurate is this story?”
If the series had been run three or four decades ago it would not have been substantially different. The deficiencies described are due to the entrenched sub-culture of a system perceived as small compared to negligence or group medical benefits but having out of proportion effects upon businesses and families.
The articles portrayed the hearings as seen from the point of view of a New York City hearing. The sheer volume of hearings at these points accounts for the system’s resemblance to small claims or traffic court although the consequences to the parties are orders of magnitude greater. (workersxzcompxzkit)
The employers’ viewpoint was seen from substantial long-standing businesses up-state, a region where a town, city or county may depend on the health of a single industry or employer.
The real message for the reader is there is a sector of the health and disability industry which must address problems that it is only now acknowledging and beginning to understand.
Author: Attorney Theodore Ronca is a practicing lawyer from Aquebogue, NY. He is a frequent writer and speaker, and has represented employers in the areas of workers’ compensation, Social Security disability, employee disability plans and subrogation for over 30 years. Attorney Ronca can be reached at 631-722-2100.
Try the WC Cost Calculator to show the REAL COST of work comp. www.ReduceYourWorkersComp.com/calculator.php
Look at WC 101 for the basics about workers comp. ww.ReduceYourWorkersComp.com/workers_comp.php
Workers’ Comp Kit® is a web-based online Assessment, Benchmarking and Cost Containment system for employers. It provides all the materials needed to reduce your costs significantly in 85% less time than if you designed a program from scratch. www.ReduceYourWorkersComp.com
Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs.
©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
While this article applies specifically to New York, the concepts are applicable in every state. Attendance at hearings supports the employee and gives the employer a whole new perspective of the situation.
When the NY comp law was passed in 1914 hearings were held only when there were unanticipated problems to resolve. Other than a hearing officer (then called a “referee”) the only people to attend were the employer and the employee. If an award was made , the employer often paid it on the spot, in cash.
Gradually, that all changed. Today the hearings are attended by the employee, a carrier’s representative (often an attorney), perhaps an attorney for the employee, a law judge and a stenographer. But rarely an employer.
Employers are almost never seen unless they are called to testify in a contested claim – hardly a pleasant introduction to a system that one employee in thirty encounters every year. Yet employers are not barred from attending. And why should they be since in truth, they are the only ones paying, through premiums, for everyone and everything seen at a hearing?
So, what reason, other than curiosity, would an employer have for being at a hearing? The presence of the second most important party to a claim, the employer, forces all other persons present to behave in a far more professional manner and produces faster and more accurate adjudications. This is precisely why many persons prefer the lax, informal setting when the employer is not present.
The most important service the employer can provide is support for a valued worker in a time of need. Often the employer’s presence can bring to a halt an unwarranted contest of a claim before it becomes entrenched. The employer makes an impression on the law judge that is dangerous to ignore.
The knowledge gained by going to hearings will result in far less disruption to the workplace in future hearings. Without occasional attendance the employer is inviting higher comp costs, at least, and deadly misunderstandings. Listening to a person, often a worker, trying to describe their experiences in the comp system will make little sense without actual knowledge of the process.
In 1993 an FBI agent in the New York City office was assigned to create an insurance fraud unit and wanted to know how to learn the essentials of the work comp process as accurately as possible. He was told to dress in casual clothes, bring a newspaper and sit in the area where the workers were waiting for their hearing to be called. After two hours he agreed that he was unlikely to learn that much in any other way.
Attorney Theodore Ronca is a practicing lawyer from Aquebogue, NY. He is a frequent writer and speaker, and has represented employers in the areas of workers’ compensation, Social Security disability, employee disability plans and subrogation for over 30 years. Attorney Ronca can be reached at 631-722-2100.
WC Cost Calculator www.ReduceYourWorkersComp.com/calculator.php REAL COST of work comp.
WC 101 www.ReduceYourWorkersComp.com/workers_comp.php for the basics about workers comp.
Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs.
©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
When your employee has a comp claim they will be required to attend hearings. They will often become extremely frustrated by these. Here are the basics of understanding the system and lowering anger and frustration in your work force. 1-New York annually has 200,000 hearings in its work comp system for 150,000 claims filed annually. It has 56 judges who must handle these hearings. The hearings, therefore, are necessarily very short. 2-Workers imagine that the judge will be happy to listen to their complaints and take appropriate action. In fact, the regulars at the hearing speak in an abbreviated code unintelligible to outsiders. When the hearing ends the worker hardly understands what has been said and is rarely asked to participate. 3-If your worker has an attorney, the attorney will likely be with the next worker awaiting a hearing and will have little time to talk to your worker. 4-Your workers will spend half a day travelling and waiting for a proceeding that usually lasts only 15 minutes. 5-Payments for lost time, in work comp, do not count days lost from work to attend hearings. Therefore, do everything to lessen the number of hearings that your workers have to attend. Always ask the worker before and after a hearing if there is anything you can do. Make sure the carrier has total wages for the year prior to the accident before the first hearing. Pay small bills (travel expenses, etc.) for the employee. Communicate with the carrier. Ask to speak to the lawyer they select to handle the hearing. Attend hearings by phone. Ask the carrier to call you during the hearing to resolve questions. (This is a new Board procedure designed to make it easier for doctors but it can also be used by employers.) Attorney Theodore Roncais a practicing lawyer from Aquebogue, NY. He is a frequent writer and speaker, and has represented employers in the areas of workers' compensation, Social Security disability, employee disability plans and subrogation for over 30 years. Attorney Ronca can be reached at 631-722-2100. WC Cost Calculator www.ReduceYourWorkersComp.com/calculator.php REAL COST of work comp. WC 101 www.ReduceYourWorkersComp.com/workers_comp.php for the basics about workers comp. Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs. ©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
Can I charge for that report? — Sometimes, if is Workers’ Compensation in New York
No medical services delivery system is more time consuming, for fewer dollars, than New York workers’ compensation. It comes as a surprise, therefore, to many that there are exceptions. Evidentiary reports are one of them.
The Workers’ Compensation Law requires treating physicians to keep adequate records and file periodic reports. Therefore, payment for these is in the medical fee schedule, however inadequate it may be. However, some reports are necessary but are not the responsibility of the carrier. For these, a party can, and indeed must, pay directly.
Casual Relationship (death claim) The most common is a causal relationship report for a death claim. In most cases, the claim is made months, or even years, after death and the records make no reference to work, much less causal relationship. In those cases, a qualified physician is asked to review the records and provide a written opinion. A fee is charged directly to the claimant, usually a surviving spouse.
Therapeutic Report Another type of report, the “therapeutic report,” is no longer used but was necessary for closing a claim on a lump-sum settlement. The claimant was required to pay for the report. Many resisted and insisted their lawyers, who would be collecting a sizable fee, pay. The Board side-stepped the dispute by automatically adding $100 to the lawyers fee to cover the cost of the report prevailing in the 1960s. The lump sum legal fee was 10% plus $100. Few people remembered why the $100 was added and when the therapeutic report was abolished in the late 1970s the Board continued to award the $100, although it no longer knew why it was doing so.
Scheduled Loss Impairment A third type of report is now in a sort of limbo. When maximum medical improvement is reached, a patient may be examined for “schedule loss impairment.” Formerly, that was not asked of the treating physician or surgeon and claimants paid a non-treating doctor for the report. Currently, the question is asked on the C-4.3 form and the charge may now be subject to medical fee schedule.
Causal Relationship (occupational disease) A fourth type of report is a “causal relationship” report needed for occupational disease claims, since many diseases have no obvious connection to work. The report is similar to the report filed in death claims. However, a physician or surgeon is cautioned to avoid a type of abuse associated with occupational disease claims.
A few years ago, certain doctors would write the initial report and charge for it. If they were called to testify, the claimant had to pay for the doctor’s appearance directly. To get around this, the doctor would then begin minor treatment and claim to be a treating physician so that the testimony fee would have to be paid by the carrier. Such practices no longer work. The abuses were dealt with ten years ago and the memory is still fresh at the Board.
Another situation is where a worker has a work comp injury which is also the subject of a negligence claim. If a doctor is treating on both, the doctor may charge for reports which are needed for the negligence case even though the report can be used in the comp claim as well. Similarly, a doctor can be paid for reports necessary for a private insurance claim although the report can also be used in a work comp claim.
I want to emphasize the importance of communication among the workers, the employer and the medical community BEFORE the first hearing. Ground up claims “management” is the approach that works. I put “”management” in quotation marks because I don’t think of this as management but sensible cooperation and communication.
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Attorney Theodore Ronca is a practicing lawyer from Aquebogue, NY. He is a frequent writer and speaker, and has represented employers in the areas of workers’ compensation, Social Security disability, employee disability plans and subrogation for over 30 years. Attorney Ronca can be reached at 631-722-2100.
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WC Cost Calculator www.ReduceYourWorkersComp.com/calculator.php REAL COST of work comp.
WC 101 www.ReduceYourWorkersComp.com/workers_comp.php for the basics about workers comp.
Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs.
©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
On 4/1/09 a new set of forms to be used by medical providers will go into effect. They are:
1-C-4. Doctor’s Initial Report
2-C-4.2 Doctor’s Progress Report
3-C-4 AMR (Ancillary Medical Report) for providers of ancillary services
4-C-4.3 Doctor’s Report of MMI/Permanent Impairment
Get the FORMS – The forms can be found on the NY WCB website or Google “NY”, “WCB” and “C-4″
The C-4.3 is necessary for a judge to close a claim. Even if there is no permanent damage as a result of the injury, failure to have this form in the file will cause the judge to adjourn the claim for it to be produced.
The C-4.2 progress reports should be filed every two weeks to ensure that a employee’s benefits will not be halted. New Board procedure strictly enforces a policy that there is no longer an informal presumption that disability continues until a report says that it no longer exists.
A funding crisis in workers’ compensation is driving efforts at stricter laws and rules. Medical practices that comply will face far fewer problems since the majority of medical groups make good faith efforts which fall short of Board requirements. These result in delay of payments and duplication of efforts.
Attorney Theodore Ronca is a practicing lawyer from Aquebogue, NY. He is a frequent writer and speaker, and has represented employers in the areas of workers’ compensation, Social Security disability, employee disability plans and subrogation for over 30 years. Attorney Ronca can be reached at 631-722-2100.
WC Cost Calculator www.ReduceYourWorkersComp.com/calculator.php REAL COST of work comp.
WC 101 www.ReduceYourWorkersComp.com/workers_comp.php for the basics about workers comp.
Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs.
©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
A procedure for recovery of payment of medical bills in NY work comp exists but is little known outside of groups that handle a large volume of work comp claims.
The procedure is:
1- A bill for medical services must be sent to the correct comp carrier together with medical reports on an approved form (C-4, C-4.2, C-4AMR or C-4.3, new forms in effect since 1/1/09. After 4/1/09 all reports submitted must use these forms.)
2- If the bill is not paid within 45 days of the date sent, the medical group has 120 days, from the 45 day period, to file with the Workers’ Compensation Board Form HP-1 requesting administrative review of the bills and setting the appropriate fee.
3- Unpaid bills may not be “bundled”. Each unpaid bill requires a separate HP-1 form.
4- C-4 reports must be attached to the HP-1. Office notes should be attached if they clarify why the services are work related.
5- If the bill has not been paid because the claim is being contested requests for payment will not be considered until a determination is made. Requests for payment, under such circumstances, may be directed to a medical plan. The plan can seek repayment from the comp carrier if the comp claim is established as work-related.
6- Payment for services will be at medical fee schedule for NY work comp claims.
This is important because employers need the cooperation of medical providers, and employees want to be assured their medical bills will be paid. The process goes much smoother when medical bills are paid on time and this procedure will help.
Attorney Theodore Ronca is a practicing lawyer from Aquebogue, NY. He is a frequent writer and speaker, and has represented employers in the areas of workers’ compensation, Social Security disability, employee disability plans and subrogation for over 30 years. Attorney Ronca can be reached at 631-722-2100.
WC Cost Calculator www.ReduceYourWorkersComp.com/calculator.php REAL COST of work comp.
WC 101 www.ReduceYourWorkersComp.com/workers_comp.php for the basics about workers comp.
Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs.
©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
Attorney Diane Kinslow an attorney practicing law in NY with an emphasis on workers comp since 1980, says that in NY, an employer considering an offer of a trial return to work should have a face-to-face discussion with the worker prior to composing a written plan. The spouse should also attend the meeting.
1. The discussion should be informal and at the workers home to make it easier for all family members to be present.
2. Nothing should be proposed during or after the discussion. The meeting is to determine the worker’s motivations, abilities and hindrances.
3. The interviewer should write only essentials which need to be incorporated later. Writing will impede the ability to watch and listen, which are essential to getting to know the whole person. Bring only essential papers in a conference style folder.
4. Do not discuss details of the compensation claim or any other action.
5. Make it clear that you are trying to help a family and that the spouse’s concerns will be addressed.
6. Make sure the worker realizes that the treating doctor must approve of the effort and that the worker should ask the doctor if any effort can be considered at this time. (Physicians and surgeons will almost always tell a patient to make a reasonable effort and see what occurs )
7. Don’t appear to be spying or probing. Ask if they would prefer to meet at a public place close to the home.
8. Keep the meeting to less than 30 minutes unless they want it to be longer.
9. Tell them that a written “plan”, not an “offer”, will be sent if there are no objections by the treating doctor.
10. Leave a card and ask to be informed of any change of conditions.
11. Write a memorandum of the meeting as soon as possible but after you have left the discussion. Note the family’s objections, fears and concerns. Many of these will be about future financial security.
To summarize, a discussion before submitting a written plan will eliminate mistaken impressions and expectations, both of which will hinder an otherwise worthy plan. The specifics on the written letter can be much like the letter customized for Delaware by Margaret DiBianca in this blog (click here). All situations are different, however, so ask your own legal counsel before proceeding.
Diane B. Kinslow, Esq., Aquebogue, NY. Diane has been a lawyer practicing law in all phases of workers comp since 1980 with an emphasis on self-insured employers. She can be reached at 631-722-2100 or medsearch7@optonlin.net
WC Calculator www.ReduceYourWorkersComp.com/calculator.php
TD Calculator www.ReduceYourWorkersComp.com/transitional-duty-cost-calculator.php
WC 101 www.ReduceYourWorkersComp.com/workers_comp.php
Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel or other professionals before implementing any cost containment programs.
©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
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