Workers’ Compensation Claim Complexities

Maneuvering through the workers’ compensation claim process can be confusing. Seeking an experienced workers’ compensation attorney can assure you that recent laws and policies regarding claims are not overlooked.

In workers’ compensation cases, it must first be determined whether workers’ compensation law actually applies. The injured worker must fall into specific categories and meet the criteria needed to be considered an employee or an agent of the employer. As with many areas of the law, there are exceptions, such as clergy who are performing religious duties, volunteers at nonprofit organizations, certain foreign workers, employees who fall into an independent workers’ compensation system for their trade, and so on.

Additionally, there are several factors that must be taken into account in determining employee status, including the right to hire and fire the individual, whether there is a right to control (as in an employer-employee relationship), the character of the task performed, and the manner of employee compensation.

After it is determined that the worker is an employee of the company or business entity, multiple steps must be taken in a timely manner. The employee must notify his or her employer in writing about the injury, file a C-3 claim form and mail it to the Board District Office. There are also forms that the employer must submit to the insurance company and the Board within a certain timeframe.

Bennett v. Roman Catholic Diocese of Rockville Centre is an example of the complexities a workers’ compensation case may present. On January 25, 2010, an employee of the Roman Catholic Diocese of Rockville Centre fell from a ladder and suffered serious injuries. The employee was a maintenance worker and not performing religious tasks, so he qualified as an employee. The employee sought medical treatment soon after the injury, filing a claim for his left leg and back. Two years later the claimant started to have new pain in his neck and lower back and had an MRI of his cervical spine. After the MRI, it was recommended that claimant undergo surgery on his cervical spine. The Workers’ Compensation Law Judge found that surgery was barred because the claim arose after the two-year time limit and was only “casually-related” to the claims which were filed earlier on his left leg and back.

Workers’ Compensation Law § 28, requires that a claimant file within a two-year time period from the date of the accident. The MRI and recommendation for surgery occurred in March of 2012, past the two-year time limit. Additionally, the court reviewed the facts and the claimant’s testimony regarding the timely filings and the new pain, and found that they were only slightly related. The New York Supreme Court, Appellate Division for the Third Judicial Department, affirmed the lower decisions and found for the employer based on the procedural timeliness rule.

Bennett v. Roman Catholic Diocese of Rockville Center highlights the importance of following procedures to meet strict statutory deadlines. Employees may not know how future injuries will be categorized by Judges. Skillful workers’ compensation attorneys can better guide employees on which claims to file and how to link future related injuries to original claims. An attorney can help protect your rights and help preserve your coverage should further injury stemming from an accident become known later. The Law Offices of McIntyre, Donohue, Accardi, Salmonson, & Riordan, LLP handles workers’ compensation claims throughout the five boroughs of New York City, including Manhattan, Brooklyn, Queens, the Bronx, and Staten Island, in addition to both Nassau and Suffolk Counties on Long Island. Call (866) 557-7500 for a consultation.

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