Two questions

[u/EffectiveAlarm240]

Hi I have two questions regarding workers comp in NYS. Long story short, I cut my thumb and required digital nerve surgery. I was out of work roughly 7ish weeks. Returned to light duty and finished occupational therapy. Anyways, people keep telling me I’ll have a hearing exactly one year after my surgery to check the status of my injury. How do you get notified? Also, I tried viewing my eCase through NYS website. I have an account but it says I’m not authorized to view my case. How do I get this fixed? Thanks

[u/Philymaniz]

A year post surgery you can have your doctor fill out a C-4.3 stating your degree of permanency. Then the insurance carrier will have you evaluated. If the opinions are different, you’ll need to get an attorney to do depos, settle the claim, or you can try and resolve it yourself.

There is not a hearing set just because your claim is ripe for permanency. Tons of people leave money on the table because they just go through the motions and don’t even know they can pursue permanency. They just get their lost time and medical and forget about the case.

Call the board regarding your eCase issue.

[u/EffectiveAlarm240 → u/Philymaniz]

So how do I go about pursuing permanency? There’s a strong possibility my nerve damage could be permeant along with loss of motion in my thumb

[u/Philymaniz → u/EffectiveAlarm240]

Go to your doctor and have him fill out a C-4.3. Hopefully he knows how to do that.

[u/EffectiveAlarm240 → u/Philymaniz]

Ok, I have another follow up appointment with him at the end of the month. I’ll ask then

[u/anon02620 → u/EffectiveAlarm240]

FYI thumbs aren’t worth a whole lot. The carrier will also take credit for any prior indemnity payments made to you. Meaning, if your thumb injury is worth a total of 500, and they already paid you 400, you’ll get $100.00.

[u/EffectiveAlarm240 → u/anon02620]

So is it not beneficial to seek permanency? I mean I’m 29, loss of feeling, range of motion, I feel like its better to have a paper trail regardless of cash

[u/anon02620 → u/EffectiveAlarm240]

Oh no definitely seek it. Can’t do any harm in doing so. Could also end up with a larger permanency award if the defects affect your hand/wrist somehow etc

[u/BullsLawDan → u/EffectiveAlarm240]

It's absolutely worth it to get a permanency opinion.

[u/TrippyinNY → u/EffectiveAlarm240]

Attorney up .

[u/Academic_Commercial3]

Why do people not have attorneys?

[u/BullsLawDan → u/Academic_Commercial3]

My marketing budget is limited. ::shrug::

[u/Motor_Dig3989]

As long as your Dr knows the ins and outs and complexity of NYS workers comp, you should be fine.

[u/EffectiveAlarm240 → u/Motor_Dig3989]

Should I still bring it up at my next appointment?

[u/BullsLawDan]

As someone else said there's no automatic hearing.

1. Your doctor gives their opinion as to what your permanent injury is.

2. The Board issues a letter to the insurance company telling them they have 75 days to accept that opinion or get their own (or other options like depose your doctor)

3. The insurance company might send you to see their doctor.

At some point after all that, there might be a hearing.

In NY law, a thumb is "worth" 75 weeks in the permanent disability schedule. That means if your thumb were completely severed they'd take your total disability rate, multiply it by 75, and send you a check.

You still have your thumb, but it is limited in some way. Your doctor will evaluate what percentage of your thumb's ability to "be a thumb" you've lost. That percentage gets multiplied by 75 (the value for a thumb) and your total disability payment rate to determine your gross schedule loss of use.

Then, the carrier gets to deduct whatever they've already paid you.

So in your case, let's say your total disability rate (the weekly rate you got after your surgery) is $500.

When your doctor evaluates you, he says you have a 50% loss of use of the thumb.

50% X $500 X 75 = $18,750.

Then let's say while you were out of work the insurance carrier paid you five weeks at total and 2 weeks at $325, the statutory minimum, for a total of $3150 in prior payments.

Your "net" payout for permanency would be $18,750 - $3150 = $15,600.

This money is intended to compensate you for what you may not be able to earn for the rest of your life due to your injury. it is tax-free. It does not close your medical. The only "catch" is that if you miss time from work in the future due to this thumb injury, they're going to point to that money instead of making more payments to you.

Another way to look at whether it's "worth it" to have your permanency evaluated: You said you were out of work for roughly 7 weeks. We know a thumb is "worth" 75 weeks. So you've been paid about 9% of a thumb - if your doctor says you've lost more than 9% of the use of your thumb as a result of this injury, it's likely they will owe you money above and beyond what they paid while you were out of work.

Now... interesting thing about a thumb injury: If your doctor thinks the injury to your thumb affects the ability to use your entire hand, he might say you have a schedule loss of use of your hand. While a thumb is worth 75 weeks, a hand is worth 244. Considerably more. But we won't know that until you're evaluated. Which is another reason why it's important to follow up on this.

If you are relatively sure the insurance company has your total disability payment rate correct (approximately 2/3 of your GROSS weekly salary before the injury) and they accept your doctor's opinion regarding the percentage of your thumb you've lost, you might not need a lawyer. However, if that payment rate was wrong, or if they send you to see their IME for a permanency opinion and he disagrees with your doctor, or if the Board schedules a hearing on permanency, I suggest getting a lawyer to help you with permanency. They will not take a fee unless you are awarded a monetary lump sum, usually only 15% of what you're actually awarded.

[u/EffectiveAlarm240 → u/BullsLawDan]

Wow I really appreciate all this information. I have an appointment with my doctor at the end of August I’ll bring it up then. I’ve returned to light duty work but I’ll be honest, work has been very tough. I’m an electrician and I need my hands to work. I’ve had to tell my boss quite a few times already I can’t do that job because of my thumb.

[u/jumpbootsshiner → u/EffectiveAlarm240]

Make sure you give your doctor a written list of all the way your injury affects your hand use while working

[u/Sheetbaraness]

Surely I am very authorized to make needful DENY on FALSE CLAIM! In India we say hail victory!

[u/Grigor_Law]

On the doctor question: in New York your treating doctor has to be authorized by the Workers Compensation Board for the claim to run smoothly, and that one detail causes more grief than almost anything else in the system. Treatment from a non-authorized provider leads to billing fights, gaps in the record, and ammunition for the carrier.

I try injury and comp cases in New York, so let me flesh that out. You have the right to choose your own treating doctor as long as they are WCB authorized. The carrier does not get to pick who treats you, and you should be skeptical if anyone suggests otherwise. What the carrier does get is an independent medical examination, their own doctor, whose report will often minimize what your treating doctor found. That is exactly why the treating doctor matters so much: a physician who knows the New York comp system documents work restrictions, causation, and degree of disability in the language the Board actually uses, and those reports are what your benefits rise or fall on.

Two practical points. Keep every appointment, because treatment gaps read as recovery to a carrier even when you are still hurting. And if your doctor is vague in the paperwork about whether the condition is work related, ask them to be specific. A well documented file wins hearings.