Legal Report

This month we will be addressing some issues relating to Workers’ Compensation claims.  As regular readers of this column know, it generally addresses issues related to the New York State Retirement System and applications for disability pensions.  The reason for that is because such claims are of utmost significance to the future lives of disabled police officers and the legal issues can be very complex.  We constantly try to make the issues clearer so the injured officer can best protect his/her rights.  Too often, a perfectly valid claim can be undermined by sloppy or insufficient claim reporting which occurs long before the attorney is involved.  We hope to minimize this situation through education.  As an aside, the legal fee payable by the disabled PBA member to our law firm for ADR (Accidental Disability Retirement) and/or POD (Performance of Duty) applications through the initial determination is a total of $300.00.  That fee is one of the greatest bargains in law.  The reason it is such a low fee is because the PBA subsidizes it by retaining our law firm.

Workers’ Compensation claims can likewise become complex and can be equally important to the future of injured and disabled officers.  All POD and ADR claims start out as Workers’ Compensation claims.  The information on claim forms in the Workers’ Compensation case can help or destroy a disability retirement case.  For those reasons, we invite all police officers involved in any work related injury to make an appointment at our office so that we can help you complete the C-3 Employee Report of Injury form.  Suffice it to say that, at this point, the information should clearly identify the specific instrumentality that caused the accident. The descriptive information should include anything that was unusual, out of the ordinary and unforeseen in connection with your injury. If you were performing some sort of extraordinary work, that should also be included in your accident description. You can refer to my last 100 or so Legal Reports for specific examples of what I mean so that the Workers’ Compensation claim form doesn’t torpedo a possible retirement claim.  Workers’ Compensation claims and reporting requirements generally aren’t as technical as the Retirement System demands.  Because of that, injured officers sometimes are less careful in their descriptions of accidents.  They do so at their own peril.  As opposed to disability retirement claims, whether the occurrences are an “accident” or an “incident” or a slow starting occupational disease, you receive the same level of benefits at the Workers’ Compensation Board.  Those benefits include lifetime medical care for that injury, transportation expenses, and monetary awards for specific periods of lost time and, depending on the nature of the case, cash awards in addition to actual time out of work.

Disabilities resulting from accidents which occur after 3/13/2007 are no longer eligible for lifetime weekly monetary benefits.  The actual duration of such benefits will be determined by the Administrative Law Judge after litigation.  Proper medical development of the case is of great importance in obtaining benefit payments for as long as possible.  Ultimately, they can be directed for periods as short as a few months or as long as ten years or more.  As in all legal matters, preparation is the key.  Legal fees in Workers’ Compensation claims are contingent and set by the Workers’ Compensation Judge.  We are not permitted to negotiate fees directly with Workers’ Compensation claimants.  The amount of the fee awarded generally is based upon the size of the award to the injured person, the complexity of the case and the work involved in effectuating the fee and protecting the rights of the worker now and in the future.  If there is no monetary award to the claimant, we receive no fee for services rendered.  The Judges do not award fees for obtaining authorizations for medical treatment, regardless of the time and effort involved.  The Judges are not particularly generous in awarding fees.  Generally, the legal fee ends up being approximately 15% of the amount awarded to the claimant.  That fee is paid directly to the law firm from the insurance company and deducted from the claimant’s overall award.  For that reason, the claimant will never receive a direct bill from our law firm for services rendered; as opposed to other areas of the law, representation in a Workers’ Compensation case is a relative bargain.

It should be noted that Workers’ Compensation representation is different from almost every other area of the law.  Most law cases have a beginning, middle and an end.  Workers’ Compensation matters involve lifetime medical benefits and often times additional claims for lost wages or increasing levels of disability.  Consequently, representation without additional fees is sometimes required for years or even decades into the future.  The Workers’ Compensation Judges are supposed to take those possibilities into consideration when setting fees.  Our law firm regularly fields questions and appears at Workers’ Compensation hearings, without additional fees, of behalf of PBA members who retired in the 1980’s yet still have medical problems and reimbursement issues that need to be addressed.  Handling such matters comes with the territory.

Federal Social Security Disability benefits may be available to members who sustain a career ending injury and, from a practical point of view, can’t work in any other occupation reasonably suited to them.  Such claims require that you be unable to engage in any substantial gainful activity.  Of course, any member who has a career ending injury should consult with us to determine whether they have a reasonable chance at obtaining Social Security Disability benefits.  Again, the consultation is free and any fees awarded are on a contingent basis.  We only get paid if we are successful in obtaining benefits for you.  As in Workers’ Compensation claims, all fees must be approved by the Social Security Administration or by an Administrative Law Judge if the award is made at the hearing level. Social Security benefits include monetary payments to the disabled applicant and his beneficiaries, which can be a spouse and children under the age of 16. Also, after being entitled to Social Security benefit payments for two years, the disabled applicant will be eligible for Medicare, which a Nassau County police officer must take. You should know that Social Security benefit payments can be made in addition to ¾, or ½ disability benefits, or even a service retirement.

If you suffer a disability as a result of an accident or an illness, it is important that you obtain legal advice as soon as reasonably possible.  There are strict requirements for each of the benefits to which you may be entitled, and there is great interplay between the various benefits.  Don’t rely upon the advice of friends, family members, or co-workers who have gone through a “similar” type of claim.  Each claim stands or falls on its own.  Our law firm agrees with the late Sy Syms whose motto was “the educated consumer is our best customer”.  We urge you to be an educated consumer in disability and accident claims.