WORKERS’ COMPENSATION IN NEW YORK STATE: STATE OF …

[Pages:196]WORKERS' COMPENSATION IN NEW YORK STATE: STATE OF THE SYSTEM 2008

Dated: April 28, 2008

By: Robert E. Grey

Grey & Grey, LLP 360 Main Street Farmingdale, New York 11735 (516) 249-1342

277 Broadway ? Suite 400 New York, New York 10007 (212) 964-1342

118-21 Queens Boulevard ? Suite 618 Forest Hills, New York 11375 (718) 268-5300



Email: RGrey@

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TABLE OF CONTENTS Page

Introduction ..................................................................... 1 PART ONE..................................................................... 3 I. Executive Summary ................................................... 3

A. The Purpose of This Paper ................................... 3 B. Background ..................................................... 5 C. Issues in the Workers'

Compensation System .......................................... 6 D. The 2007 Legislation ........................................... 10 E. The Streamlined Docket Task Force ........................ 12 F. The Medical Guidelines Task Force........................ 13 G. The Return to Work Task Force.............................. 15 H. The Insurance Department Report............................. 16 I. Workers' Compensation Board Procedures .................. 17 J. Claims Involving Immigrant Workers ......................... 18 K. World Trade Center Claims ..................................... 19 L. Recommendations ............................................... 20 II. Issues in the Workers' Compensation System ......................... 26 A. Availability and Accuracy of Data ............................. 26 B. Access to Benefits ................................................ 37 C. Wage Replacement Benefits...................................... 42 D. Medical Treatment Issues......................................... 51 E. Return to Work Policy .......................................... 53

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F. Employer Fraud .................................................. 57 G. Premium Costs ................................................... 60 H. Self-Insurance Issues ............................................ 63 III. Recommendations........................................................ 67 IV. Conclusion ................................................................ 73

PART TWO ? APPENDIX .................................................... A-1 I. The 2007 Legislation ..................................................... A-1

A. Benefits ............................................................ A-2 B. Medical Care and Treatment ................................... A-16 C. Procedural Changes ............................................. A-19 D. Employer Fraud .................................................. A-22 II. The Streamlined Docket Task Force ................................... A-25 A. WCB Forms ...................................................... A-26 B. Indexing ........................................................... A-30 C. Controverted Case Procedures ................................. A-33 III. The Medical Guidelines Task Force.................................... A-36 A. Medical Treatment Guidelines ................................ A-37 B. Impairment Guidelines ........................................ A-41 IV. The Return to Work Task Force.......................................... A-44 V. The Insurance Department Report........................................ A-51 A. The Methodology of the Report ................................ A-51 B. The Conclusions of the Report ................................. A-64 C. Recommendations .............................................. A-82

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D. Conclusion ....................................................... A-90 VI. Workers' Compensation Board Procedures ............................ A-92

A. Indexing ........................................................... A-93 B. Controverted Cases .............................................. A-95 C. Basic Issue Determinations ..................................... A-98 D. Post-Establishment Disputes ................................... A-99 E. Conclusion ........................................................ A-104 VII. Claims Involving Immigrant Workers ................................. A-105 VIII. World Trade Center Claims .............................................. A-108 A. Primary Legal Obstacles ........................................ A-108 B. Supporting Data .................................................. A-111 C. Proposed Statutory Amendments .............................. A-113

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INTRODUCTION Due to its length, we have divided this paper into two parts. Part One consists of

four sections: the executive summary, a discussion of issues in the workers' compensation system, our recommendations, and a conclusion. Part Two is an extensive appendix intended to serve as a reference source on a number of issues.

In Part One, the executive summary (Section I) may be read independently. It summarizes problems in the workers' compensation system and offers a brief tour of the various governmental responses (primarily through legislation and task force reports). Reference is made to the portions of Section II where these problems are discussed more fully, as well as to sections of the Appendix that include a full treatment of the particular governmental response. The executive summary also includes a list of our recommended solutions.

Section II provides a full discussion of each of the major issues confronting workers, employers and insurers in New York's workers' compensation system. Reference is again made to the portions of the Appendix which relate to each of these issues.

Section III contains a summary of our recommendations for possible resolution of these systemic problems.

The issues discussed in Part One have been addressed through legislation and the reports of various Task Forces. Some of the Task Force reports address a single issue; others touch on multiple issues. Part Two consists of an Appendix divided into eight sections which address the Task Force reports and other governmental responses to the issues in the system. These sections may be read either independently or as a whole.

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We hope that Part One will be useful in understanding the nature and the causes of the problems that prevent the New York workers' compensation system from achieving its intended goals, and that Part Two will serve as a reference point for intensive analysis of particular governmental responses to these issues.

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