Okay, everybody, thank you for joining us today.
The webinar has a special edition series.
Today is a work accident occurs.
What happens first?
Okay.
Okay.
So that's me, Christian Cison.
I'm a trial attorney in Garden City.
And I mainly focus on workers' compensation defense.
So for you guys, all you have to know is I'm 100% devoted to you.
Now, what we're doing in this webinar is figuring out how we can review your intake process and package.
And this is a questions bar that is available somewhere near your screen.
Essentially, today's goals are going to be to review your intake process, right?
Review your intake package, use defense counsel, that's me,
and how we can do both of those things to defend from day one.
That's my theme for today.
Now, day one is a little bit different in this scenario.
Day one is not the pre-hearing conference.
It's not the day that you give the file to your defense counsel.
Day one is the first time you hear those magical words where a dutiful employee becomes a claimant, right?
How do we go from there?
Okay.
So as we know, there's a presumption of compensability in New York, right?
Faithful consumers of this webinar series have seen this graphic before.
A work accident happens and you do nothing.
Unfortunately, that's going to be presumed compensable and that's section 21 of the New York Workers' Compensation Law.
Penalties, okay?
Let's talk about the stakes, right?
Reporting to the board has a situation where if you don't do it timely, you can actually be hit with a misdemeanor.
So a claimant's first words, right?
To whom is the employee reporting the accident?
Oftentimes, it's going to be an individual and human resources, but it may be a supervisor or even a witness, right?
And what I like to do here is start some group therapy, right?
Group therapy never hurt anybody.
Bring the person in front of the people that he or she works with every day and make sure that they are forced to state what may be a false allegation in front of the people that know their facial cues, know their body language, and then start the process of defending the claim.
Recorded statements is also something that we've seen.
They can be very helpful to find out what the claimant is going to say from day one and whether or not he changes his or her story going forward.
Now, a claimant or employee can always refuse to submit to the recorded statement, which is fine, because then that always perks our ears up, too.
Why would he or she not want to give a recorded statement if they're not telling the truth?
Okay.
Now, the internal incident report, okay?
This is something that almost everybody does, but we want to make sure it's beefed up to the biggest possible level, okay?
So, what we want here is to have the supervisor and any witness, even if they didn't see anything, assist everybody, right?
Because we don't want to insert a report just to state the facts as they're reported by the employee, right?
So, even if you have an unwitness accident, can a supervisor tell you if this accident could have feasibly happened under the facts given by the claimant, right?
Can the human resources individual tell us?
Based on my report with the claimant, based on my conversations with the supervisor and the witness and the team, is this something that I feel we should investigate further, right?
Because when that person gives a little bit of doubt onto that report, I want to talk to that person immediately, figure out where this goes.
Okay.
So, Form C3 is obviously something that everybody has seen here before.
It's what's going to get the process started for the claimant in New York.
Now, I've zoomed in on a couple of screenshots here for you.
And if you can see here, it's a bare minimum example of what can start a claim.
Maybe a little bit of hyperbole, but if we go through it, we have an employee just stating that I got hurt at work because my job was too hard and now I don't feel good.
Again, maybe a bit of a stretch, but we have seen bare minimum C3s being filed.
And this is where we go back to our own internal report to help us because we don't want to start from scratch based on something like this.
This is also something similar, right?
We see notice given to supervisor in writing, but without a copy of the notice.
We don't have a date.
We have an allegation that there are witnesses, but no names of people to investigate.
So essentially, the internal report comes in handy to supplement the document that the claimant is filing to the board.
And it's very helpful to compare one with the other.
Now, this something we should always, always be looking for in the C3 is prior treatment, right?
So they are forced to tell us whether or not they have had a similar injury or illness, whether the same body parts were involved.
What we want to do in that first moment, right?
Defend from day one is to have the claimant execute a HIPAA right then and there, right?
A lot of times we get cases where we don't have that release of past medical records.
We then have to forward a new copy to them, maybe to their attorney, and maybe we might not even get a copy until the first hearing before the board.
That kind of curbs our efforts in trying to be aggressive in defending claims, especially contraverted ones.
Okay, first medical treatment, right?
We are always going to recommend that the claimant seek medical.
Why? Because we need that medical to substantiate their claim.
And sometimes we air too far over the fence and tell them that they need to see a specific doctor, right?
Now, under the rules, we can only advise them to go see these doctors.
We can't require them.
So be careful with the language that you're putting into that intake package.
Of course, the exception is a preferred provider organization, simply a network of doctors that have already been approved by the board,
in which case the claimant is required to see treatment within that organization within the first 30 days.
Pair compliance might not be something that applies to you too often, but I'm putting it in there just in case your only denial is based on the fact that you don't have medical treatment.
And pair compliance in New York requires you to pay the claimant minimum rate, minimum statutory weight per week if the claimant has lost time exceeding seven days.
Okay, reporting timeline.
This is where we have to give notice to the board that a work accident has occurred.
Now, this accident probably staged, I don't know how that box is balancing on this gentleman here, but essentially there are three timelines we have to be aware of.
18 days after the disability, 10 days after you know of the accident, or 10 days after you have provided notice to the carrier or third party administrator.
And whichever is greater, the board has to receive your notice by then.
Okay, notice of indexing.
We see these all the time.
And sometimes it comes where it wakes us up and we figure out we haven't done enough investigation as we should have.
Notice of indexing triggers 25 days for you to file an electronic denial with the board.
Now my note here is to work together.
And the reason why I do that is sometimes the board has only indexed one party of interest, maybe the employer or one party of interest.
It might be the carrier, but not the TPA.
So that should trigger an alert in your head where it says, I need to get everybody involved to make sure that our investigation is up to date.
And by that 25th day, we are denying a case that should not have been filed in the first place.
Okay, best practices.
There's a lot of bullet points here, so I'll try to be as concise as possible.
But first, reporting groups, right? This is the group therapy I talked about.
We want to make sure that the claimant doesn't feel confident in stating to an unknown human resources individual that an accident happened within the warehouse.
We want people to verify that.
Recording the statement, if applicable, if they consent to it, great.
If not, maybe it leads us to a further investigation.
Completing the internal investigation to confirm or deny the claim. That's a small bullet point for what is essentially a long process.
But what we want to do is back up our records and make sure that the claimant can't skirt by with a bare minimum C3, right?
Comparing the personnel file is important.
Has this person ever taken FMLA duty? Has he ever participated in volunteer activities that may result in injuries?
Providing C3 in the claimant's relevant language.
Now, what I like to do with this is actually give it a day after Defend from day one.
Give them the C3 after they fill out your internal incident report.
And what this does, it creates a time lapse for the claimant to then make the same allegation that he made the day prior or the week prior.
Give him an opportunity to create discrepancies, create omissions or additions that may not have been in your internal incident report.
Securing the hitbook. We talked about that.
Essentially, we want to get that as soon as possible so that we can investigate prior claims and not do so at the first hearing when we get to see the claimant in person.
The C430S is a document giving the claimant an idea of what his or her rights are.
And that may be something that protects the claimant in the event he doesn't hire an attorney, covers us.
We like to just give that immediately, although it's not required to do that at the outset.
Defend from day one. Back to that theme.
I want to thank everybody who has stayed with me while we had some technical difficulties.
Apologize for that.
But what we want to do here is review that intake process, review that intake package.
And I can do that.
We have plenty, plenty of opportunities to review your intake process and package in order to find out whether or not you can make it better.
Okay. War stories.
Okay.
We had a hand claim that turned into a back claim.
And our client asked us to review prior counsel's actions and the employee's personnel file to review what could have happened to avoid a hand claim becoming a back claim.
And digging through these records, we found out that there was an old coworker who was no longer with the company.
99 times out of 100, this person is not going to be reached.
But lucky, luck has it, we reached out to that person who then told us that the claimant was in a football game with him the week before the date of accident.
And we would not have found this out if we didn't turn over that leaf.
All right.
So a strong example, but an example nonetheless.
My contact information is there for you email and phone anytime I'll be able to help you and figure out what can we do better.
Okay. Questions.
It looks like we have a couple of questions.
A lot of them telling me that we lost audio and no sound.
So again, I apologize for that.
But Bill has a question that says, how can we use a personnel file to deny a case?
Okay.
Thanks, Bill, for that question.
A personnel file is very, very unlikely to be the reason that we deny a case, but it's always helpful to look through it and see possibilities where the claimant was not credible, right?
Did he extend FMLA leave too far?
Did he have any incidents with other employees?
Did he have any other attendance problems?
Those types of things can let us know what type of employee that is, and we can broach those topics at trial, right?
And tell a story that maybe this person isn't as truthful as he is based on what he had been doing before.
Okay.
Now, Tommy says, what does a C430 statement of rights?
I think we went over that, but thanks, Tommy.
You probably asked that before I got to it.
A C430S is a document that tells the claimant what his or her rights are, and it helps protect them in the event that they don't hire an attorney, right?
We don't want to be the people who are strangling the claimant, telling him he can't file a claim, telling him he can't find medical treatment.
He's entitled to what he's entitled to, unless, of course, he's not entitled to that, and that's where we come in.
Okay.
I think that's all the time we have for today.
It's about 15, 20 minutes.
Again, thank you so much for staying with me during the audio problems.
I hope we were able to fix it in time.
And if you weren't here, I'm hoping you don't get that in the copy that we send you later.
But if you have any questions, call email.
I'm available for you guys whenever you want.
Thank you.
