7

NEWS FOR
THIS WEEK

December 31, 2015
Thursday

COMMENTARY: A few thoughts as the year ends and some suggesions for next year.

DECISIONS: There are no decisions from the Third Department this week but seven new cases have been added to the Third Department's January hearing calendar.

Week
#367

Issue
#1

Contact The Insider at:    TheInsider@InsideWorkersCompNY.com                                                                         212-734-9450

Table of Contents§32 Book Cover

WORKERS COMPENSATION SECTION 32 SETTLEMENTS

 A Treasure or A Trap?

 

Below is a detailed list of the all the subjects covered by this book, both CHAPTERS and Sub-Chapters. For example, Chapter 3 includes a proposed, generic Section 32 agreement I drafted in meetings with the New York State Insurance Fund and representatives of the claimants' bar.


INTRODUCTION: WHY AM I WRITING THIS BOOK

        The Layout of This Book
        What this book is not

CHAP 1 -  WHAT IS A §32?

        Settlements by Status of the Claim

CHAP 2 -  SETTLEMENTS PRIOR TO §32'S

        Workers Compensation Law
        Lump Sum Settlement - Prior to §32's
        Lump Sum Legal Fees

CHAP 3 - A BASIC §32 AGREEMENT

        The opening paragraph
        Waive further claims for compensation
        Ongoing medical
        Social Security - Medicare offset
        Fee
        Special Funds Conservation Committee
        Third party suits - WCL §29
        Income tax
        Liens
        English language
        General release
        No other attachments
        Closing paragraph
        Hand written edits
        Summary

CHAP 4 - DO YOU NEED AN ATTORNEY

        Yes
        Why can’t you represent yourself?
        Do you need a specialist or just a general attorney?
        Where can you find a qualified attorney?

CHAP 5 - ISSUES RESOLVED BY §32'S

        WAMO Waiver Agreement Management Office
        Samples of issues that can be resolved
             (1) Two widows
             (2) Illegal employment of a minor
             (3) Life-long medical account
             (4) Special medical treatment
             (5) Missing checks            

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             (6) Death claims
             (7) Claimant dies at time of settlement
             (8) Minor Children
             (9) Claims involving fraud
             (10)Discrimination under §120
        Issues that can not be resolved
             (11) Sites of injury
             (12) Quitting, resigning, or retiring
             (13)Reapplying for employment
             (14) Make a third party part of the agreement
             (15) Other jurisdictions
             (16) Future injuries or claims
        Settling a claim versus keeping it open
        Stipulations
        Summary

 

CHAP 6 - WHAT IS A GOOD DOLLAR VALUE

        COMPENSATION AND MEDICAL EXPENSES
        COMPENSATION
        Established and claimant classified
        ATF (Aggregate Trust Fund
        Mortality Tables
        Established but compensation rate not yet fixed
        Controverted, i.e., not yet established
        Claim established but not anything else
        Established but compensation rate not yet fixed
        Some prior settlements as a guide
        Summary

CHAP 7 - MEDICAL EXPENSES

        Established Sites of Injury
        Bills for disputed sites of injury
        Expenses for expected future medical treatment
        Expenses for unexpected future medical treatment
        Other medical insurance the claimant may have
        Medicare
        Summary

CHAP 8 - AGREEMENTS WHICH EXCLUDE MEDICAL

        Options

CHAP 9 - §32 LEGAL FEES

        What is the law on fees?
        From whose money is the fee paid?
        Who writes out the check for the fee?
        What is a fair fee?
        If the claimant thinks the fee is unfair?
        Can an attorney not in the agreement ask for a fee?
             • Prior attorney seeks a fee
             • Current attorney is left out of agreement
        Law judges and legal fees
        Summary

CHAP 10 - HEARINGS

        Pre-Hearing Coaching
        Summary

CHAP 11 - IS THE MONEY ALL YOURS

        Child support liens can be deducted
        Disability Claims & Liens can be deducted
        Taxes or credit card bills can not be deducted
        Third-party law suits
        But ... after the check is deposited
        Monthly Payments
        Annuity Accounts
        Other investments

CHAP 12 - WHO PARTICIPATES IN THE AGREEMENT?

        Parties of Interest
             • UEF: Uninsured Employers Fund
             •     Special Funds
             • Second Injury Fund
             • Another Carrier
             • Self-Insured Employer
             • Self-Insured Group Trusts
             • New York City, counties, towns
             • Guardianships
        Interested Parties
             •     Claimant’s attorney
             • Medical provider
             • Claimant’s spouse and/or children
             • The employer

CHAP 13 - MEDICARE & SET-ASIDES

        Medicare Set-Asides
        Medicare set aside disclosure form
        Medicare Regulations
        Medicare Review
        How is the Set-Aside calculated?
        What happens to the Set-Aside funds?
        None-work related medical needs
        When the Set-Aside is gone
        Summary

CHAP 14 - FREQUENTLY ASKED QUESTIONS

             • What if I have more than one case?
             • What if more than one carrier is involved?
             • If I am a widow(er) can I settle my portion and not my children’s portion of the claim?
             • Can I Settle only one of two cases
             •  ‘Consequential’ injury and a ‘Casually Related’ injury
             • What happens if there is an appeal in process on an issue being resolved with the §32
             • Can I change my mind once the settlement is approved?
             • Can I ever get my case reopened?
             • What if there are questions about the interpretation of the agreement?
             • Out-of-pocket expenses
             • What if my medical provider has not sent in all his bills by the date of the settlement?
             • What if I need expensive surgery which no one contemplated at the time of the settlement?
             • What if my private health carrier or Medicare insist that the treatment I need is covered by
                my §32 settlement and they won’t pay for it?
             • What if they insist I pay for my treatment & I don’t have the money?
             • If I accept an agreement, what is the latest I can change my mind?
             • Can anyone stop me from getting the settlement or interfere in the negotiations?
             • Can anyone take the settlement money away from me?
             • Do I pay income taxes on the money I get from a settlement?
             • Can anyone find out the size of my settlement or see the actual agreement?
             • Can I return to work?
             • Does the settlement effect my Social Security or Medicare?
             • What is “Money Moving”?

CHAP 15 - A FEW FINAL WORDS

 

APPENDIXES

        Appendix A: The 10 Basic Questions for the §32 Hearing
        Appendix B: My Lump Sum Speech
        Appendix C: My Lump Sum Hearing Questions
        Appendix D: WAMO Guidelines
        Appendix E: A Generic §32
        Appendix F: C-4 Medical Report & Bill
        Appendix G: Social Security Mortality Table
        Appendix H: Annuity Agreement
        Appendix I: NYCRR §300.36
        Appendix J: Closed means "CLOSED"
        Appendix K: Medicare SetAside Disclosure Form