As we have discussed throughout our blog; payment of the agreement is subject to various delays and legal formalities. The quickest way to modify your benefits has become the WISC settlement. These formal written agreements must be approved by a Law Judge before the carrier can be compelled to make appropriate payments pursuant to the agreements.The normal time, post signing of the written WISC agreement for a hearing, is less then three weeks after all parties to the agreement have signed same. The procedure starts with a request for a hearing by one of the parties and has been running within two weeks of the request with payment following the written publication of the agreement by the Workers' Compensation Board. The publication of the approved agreement usually takes a week to ten days post hearing.
A more detailed settlement is usually done by way of a Section 32 Agreement. This procedure has many delays to wit: formal writing of the agreement and the signing of same by all the parties. Occasionally when individual beneficiaries are on Medicare or Medicare eligible a formal application and review has to be conducted by vendors for the Insurance Company and then reviewed by the CMS unit responsible for Medicare cases. This has now been taking approximately 4 weeks for the Vendors review and and additional 4-6 weeks for CMS approval when no glitches develop. Once the CMS approval document is issued by CMS then hearings are generally set by the compensation board and held within 5-7 weeks post filing. Once the Judge approves the agreement at a hearing a decision is published within 2-3 weeks and payment is made by the carrier within 10 days of the published decision date.
As stated throughout our blogs, these blogs are both written for educational and informational purposes and not formal legal discussion of your specific case. Individual delays sometimes occur depending on the specifics of the instant claim. It is always best to contact your attorney for full and formal discussion of your claim and benefits associated with same.
Monday, December 29, 2014
Saturday, December 27, 2014
The firm continues to be a ground level litigation firm handling court appearances and trial work from start to finish. The reality is that Workers' Compensation has devolved into settlement negotiations or long fought litigation. We try to negotiate good results without jeopardizing our clients benefits. We believe the assistance of veteran trial attorneys will help in this new era of Compensation and Civil Litigation.
Over the last many years we have been working with individual attorneys assisting us with complex Negligence cases. We are now reviewing additional routes for handling lighter cases with visiting attorneys.We'll let you know how this develops. I am investigating my options?
Thursday, May 29, 2014
It's been some time since I was able to write to this blog. My daughter got married, my wife and I took a vacation. I hired two different attorneys and now continue serving my clients with three attorneys on staff and a few associates at various hearing locations; we're now back on the beam.
As previously stated we continue to provide legal services in the fields of New York State Workers' Compensation, Federal Social Security Disability and Negligence. Veterans' disability claims are presently on hold as you may have noticed, there appears to be an extensive back up in that system and efficiency seems delayed.
The Workers' Compensation Board has gone through some recent geographical changes. The Riverhead hearing point has been closed. Cases previously assigned to Riverhead are now being heard in Hauppauge. Claimants are given the right once they evidence a hardship to attend their hearing via phone. Wisc Settlements and Section 32 Agreements once written and filed can also be approved by a law judge with the claimant attending by phone. This practice is subject to a case by case and judge by judge decision. It further appears that claimants who live along the western border of Suffolk County will be having their hearings held in the WCB Hearing Point located in Hempstead. This is also subject to telephone appearances upon judicial prior approval. It is always best to attend your hearing / case in person.
The medical treatment guidelines professed by others to exist as a means to expedite treatment has proven a cog in the system which required correction permitting some chronic care with stated limits. It is always best to have your doctors thoroughly review the Medical Treatment Guidelines posted by the Workers' Compensation Board and to follow them explicitly. The forms C4 Auth should be used as detailed by the treatment guidelines where applicable. If additional treatment beyond that which is stated in the "Guidelines" is required; your doctors will have to file MG 2 forms with explanations why the treatment desired or requested is medically necessary and they must document in detail why the present form of treatment is showing improvements but further care is necessary. Most of the health providers seem to be able to comply with the Guidelines or document why additional treatment should be approved. Regrettably, some insurance carriers have elected to refrain from being required to give prior approval to treatments listed under the guidelines.This has proved to be a vexing condition for the health providers who may not provide treatment unless and until it is sanctioned by the guidelines or a variance has been approved by a law judge. All of these obstacles continue to thwart the professed intention of the act which has always been to promote quick and early treatment to injured workers allowing them to successfully return to their respective places of employment. We hope the WCB comes to regain this philosophy.