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New York Workers' Compensation Blog For Small Business Owners

Court rejects NYPD officer's workers' compensation appeal

Many in Troy might assume that employers approve any and all workers’ compensation claims in an effort to remain in their employees’ good graces. Yet what is overlooked in this assumption is the fact that companies pay for their workers’ compensation coverage, and an abundance of claims can impact the rates they pay. Thus, it is in their best interest to encourage the investigation of claims to ensure that the cause of their employees’ injuries are indeed work-related.

If it is determined that they are not, then benefit providers may feel justified in denying claims. Claimants can object to this, but if the denial is legitimate, such objections are likely to be struck down in court. That is exactly what happened in the case of a New York City police officer. The woman’s job as an evidence control specialist required that she store and retrieve items submitted as evidence. She eventually began to develop pain in her arm, elbow and wrist and claimed that this was due to the repetitive motion and heavy lifting that her job required her to do. However, her subsequent workers’ compensation claim was denied.

The 'going and coming' rule may disqualify a worker's claim

As a small business owner, you may have a closer relationship with your employees than someone who runs a large corporation. This is because your employees are a critical part of the success of your business, which is ultimately your personal success. If one of your employees becomes ill or injured, you may feel almost as much concern as you would for your own family. If that injury takes place on the job, you have many more concerns to deal with.

Understanding how your workers' compensation insurance works is vital to keeping your employees safe and healthy as well as keeping your business financially sound. New York's workers' compensation laws require coverage for a generous number of injuries and conditions related to work activities. However, are you responsible if your employee has an accident on the way to or from work?

How do you form a corporation in New York?

Your ultimate goal in forming a small business in Troy may be to grow it into an enterprise that employs many people and eventually is open to ownership acquisition through public markets. Yet first things first; you and your business partners need to follow the appropriate process when filing articles of incorporation with the state. This is something that you can choose to do on your own, yet given the importance of this action in the legal establishment of your corporation (and the complexities involved in the process), it may be to your advantage to seek assistance from the appropriate legal professionals.  

According to the Division of Corporations, State Records and UCC of the New York Department of State, you and your fellow incorporators must file a Certificate of Incorporation with that very department. If you and your partners are planning to provide professional services that you are legally authorized to render (such as legal services or medical care), then your corporation must be formed as a professional corporation. Whatever entity you choose to file as, your Certificate must be signed by each individual incorporator. 

Former firefighter seeks workers’ comp for cancer

Ask most in Troy what is covered under workers’ compensation, and the likely response will be injuries that occur on the job. Indeed, this benefit is meant to help those people who are injured at work afford the cost of the care needed to overcome such injuries. While for many companies carrying workers’ compensation benefits is a legal requirement, most are assumed to be happy to offer as a sign of the care they have for their employees. Yet at the same time, employers do not want to be taker but advantage of and made to pay for a benefit that members of their staffs then attempt to abuse. 

One might think that an employee citing an illness or chronic condition as something that should be covered by workers’ compensation as an attempt at such abuse. Yet some states do indeed have statutory requirements that mandate such benefits be offered in the event of an illness. Oklahoma, for example, offers such coverage to firefighters who become disabled due to cancer. Yet a firefighter from the state is currently suing the city that once employed him for denying this benefit. Despite genetic testing indicating that the man was not predisposed to developing cancer, the city continues to insist that it be proven that his job caused the condition. 

You can request an examination for employees after an injury

When an employee is injured on the job, it can result in lost time and money in the day-to-day operations of your business. Worse yet, it might test your insurance coverage and result in a costly claim. Employees who are injured may seek medical treatment for themselves after an injury, but how do you know when they will be able to return to work?

Employees may not be forthcoming about the nature of their injuries or their plan for recovery. However, as their employer and the party responsible for a claim, you can request that employees receive an independent medical examination (IME). An IME can be done at an occupational health clinic and may be covered under your business insurance plan. During an IME, a physician may ask an employee about their pain level, executive functions and test their ability to perform certain tasks or movements.

Can a company terminate a contract for convenience?

As a small business owner in Troy, you rely heavily on the security that comes from having service contracts with your clients. A contract signifies stability in that as long as your business is able to meet its terms, you will have work to do. Thus, having a partner try to terminate a contract can be potentially devastating. If you are like most, then you hold the assumption that a party to a contract can only end it prematurely if it has a valid cause to do so. Unfortunately, that may not always be the case. 

There may circumstances where a contractual partner attempts to an agreement for its convenience. For private companies, this option is only available to them if it has been stipulated in the contract itself. However, per the Congressional Research Service, government agencies are automatically afforded the right to do this. 

What are signs of possible insurance fraud?

Insurance fraud is unfortunately an all-too-common occurrence. While most policyholders are honest when making claims, others may falsify information to receive compensation under fraudulent pretenses. That's why it's crucial for insurance companies to be on the lookout for potential red flags. Doing so can possibly heady off fraudulent claims and prevent payouts that aren't warranted for legitimate reasons. 

A list of suspicious loss indicators was established by the National Insurance Crime Bureau to help insurance agents. These indicators should trigger a more thorough review of a claim, especially when multiple indicators are present in a single claim. For example, is the person reporting the claim in a calm manner even though the loss was substantial? Most people exhibit some level of stress when reporting a claim, especially when it involves their house or vehicle. Also, is the person attempting to provide handwritten receipts to establish proof of ownership? Was the insurance amount increased shortly before the claim was made? 

How can I identify workers' comp fraud?

According to Business News Daily, fraudulent workers' compensation claims cost a staggering $7.2 billion per year. That's why it's crucial that employers are able to properly identify common red flags indicating a work injury is not all it seems. The following are a few signs you can look out for if you suspect your employee is making a false claim in order to receive compensation. 

While work injuries can occur at virtually any time, many false claims have a pattern of falling on certain days. For instance, a worker in search of an extended weekend might file a claim first thing Monday morning while claiming the accident or injury actually took place on Friday. Work injuries should be reported to the appropriate parties as soon as they occur, and it stands to reason that workers would want the matter attended to quickly. That's why unexplained delays are often considered suspicious.

Defending blocked workers’ compensation claims

New York workers sustain injuries on the job every day. Whether you run a construction business or have a small office, accidents happen. However, not all injuries sustained while on the job or company property are compensable. At Stockton, Barker & Mead, LLP, we often assist clients with a wide range of workers’ comp issues.

FindLaw reports that accidental injury and occupational disease issues are the most common claim categories. Depending on the circumstances, there are a variety of defenses that can apply to a particular claim.

  • The deadline for notifying an employer of an injury ranges from 30-90 days. Failure to do so within the time frame may make your employee ineligible for a claim.
  • Time limits for filing a claim is different from a worker notifying you of their injury. Statute of limitations ranges from one to three years.
  • Independent contractors injured on the business premises may be ineligible for compensation benefits. This is true even if the company is negligent.
  • Employee negligence occurs when they perform duties while intoxicated or while engaging in “horseplay.” This term applies when a person’s injuries result due to their own carelessness.
  • To have a workers’ compensation claim approved, employees must have an independent medical exam. It verifies the case is authentic and is the basis for the benefits paid. If an employee fails to have this exam, they may receive a claim denial.

Workers compensation claims rise during the summer months

The hot months, June through September, are a volatile time for on-the-job injuries and loss productivity due to the filing of workers compensation claims. Employers need their staff on site, not on the mend. For employers, hurt staff often leads to lost revenue.

The Bureau of Labor Statistics found that 40% of the injuries sustained were sprains, strains and tears. An added 11% were surface wounds like scrapes or abrasions and 10% of the injuries were open wounds like punctures or cuts.

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