http://workerscompfl.net Lyle B. Masnikoff & Associates, P.A | Social Security Disability Lawyer, Workers Compensation, Personal Injury Protection, PIP Attorney, West Palm Beach, Orlando, Pompano, Miami Tue, 11 Sep 2018 22:43:13 +0000 en-US hourly 1 Worker’s Compensation In West Palm Beach http://workerscompfl.net/workers-compensation-west-palm-beach/ http://workerscompfl.net/workers-compensation-west-palm-beach/#respond Tue, 11 Sep 2018 22:40:53 +0000 http://workerscompfl.net/?p=3335 Worker’s compensation is an item where many people need assistance or an advocate. You may not notice what is going on with your case before it is too late, but you can still have an advocate or attorney step in for you.

When the attorney takes over your case, they are going to follow procedure that is going to provide for best results. You will not be able to do this work on your own, and you need to trust that your attorney know the law like the back of their hand. Work with your attorney on each step of the process so that you can get the most in return for your worker’s compensation claim.

The Injury

The injury that you suffered at work must be documented well before you ever file a claim. You need to be able to provide documentation that you were at work when the injury occurred, and you need to be able to show your attorney these documents when you meet with them. If you cannot prove that you were at work, there is going to be no way for you to prove your case.

The Investigation

Only your attorney can look into your case to see what happened when you were injured. They will need to prove that you were at work, but they may also need to prove that your employer was negligent. You cannot do this investigation with a conflict of interest arising. However, an attorney can look into the case on your behalf so that there is no confusion in the matter.

When your attorney uncovers evidence in your case, they can use this evidence to make your worker’s compensation claim more appealing. They are compiling all the paperwork to make sure that you will not have to handle that part of the case.

Going Before The System

Your attorney will represent you before the worker’s compensation panel, and they will argue your case. You will need a lawyer present because your employer surely has a lawyer on their staff. You want to have someone on your side who is going to protect your rights, and you cannot represent yourself when you are trying to get your worker’s comp approved.

When you are injured at work, you need to take every step you can to make sure you are represented well in the case. Your employer is going to have a lawyer working for them, and you need an attorney who is going to work for you. Let your attorney investigate your case, advocate for you and get you the compensation you need for your injury. You should never pursue these cases alone, and a lawyer can advocate on your behalf.

Throughout Mr. Masnikoff’s twenty-year career, he has represented numerous injured workers who have had to leave their employment for one reason or another and have had their indemnity benefits cut off.  If you or a loved believe that your missed wage benefits have been unjustly terminated, or are receiving benefits and thinking about leaving your employment but have questions regarding your ongoing benefits, we would love to discuss your case and explain all of your options to make sure that you receive everything that you are entitled to.  Please give us a call at (877)817-4127 or visit our website.

Lyle B. Masnikoff, Esq.
Law Offices of Lyle B. Masnikoff & Associates,
P.A.1645 Palm Beach Lakes Blvd #550
West Palm Beach, FL 33401
561-598-7120

 

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Insurers Need Proper Evidence in Order to Prove Material Misrepresentation http://workerscompfl.net/insurers-need-proper-evidence-in-order-to-prove-material-misrepresentation-2/ http://workerscompfl.net/insurers-need-proper-evidence-in-order-to-prove-material-misrepresentation-2/#respond Tue, 11 Sep 2018 22:34:18 +0000 http://workerscompfl.net/?p=4328 A recent case came out, Jarvis McKiver v. Windhaven Insurance Company, 26 Fla. L. Weekly Supp. 320a (13th Judicial Circuit in and for Hillsborough County, June 7, 2018), in which the Court granted summary judgment in favor of the insured on the issue of material misrepresentation.
In finding for the insured, the Court held that the insurer’s opposing affidavit, on which the insurer relied as evidence that the premium rate would have changed if the insurer’s co-resident grandmother had been listed on the application for insurance, is inadmissible hearsay and not based on personal knowledge of the affiant.

As a result of the Court’s finding that the affidavit was based on inadmissible hearsay and not based upon the affiant’s personal knowledge, the Court struck the affidavit.
This case illustrates an important point.  Very often, medical providers will write-off PIP cases as being lost causes, particularly in situations such as material misrepresentation cases.  The medical provider gets notice from the insurer that the policy of insurance is rescinded due to material misrepresentation, and that there is no policy to provide coverage.
As with many other cases, the insurance company made a huge mistake in this material misrepresentation case: they did not have the proper evidence.  In many cases, the insurance company has incorrect information on which they base their rescission.  In other cases, the insurance company has an ambiguous policy and/or insurance application, which could be read any number of ways.  Still, in other cases, the correct information could have been relayed to the insurance agent, but the insurance agent put down incorrect information.
It is important for medical providers to send all PIP cases to a qualified PIP attorney.  While there is no guarantee of success in every case, a qualified PIP attorney will help a medical provider to maximize the recovery of PIP benefits.  If you need help with a PIP case, please do not hesitate to contact The Law Offices of Lyle B. Masnikoff and Associates, P.A. at 877-817-4127

Throughout Mr. Masnikoff’s twenty-year career, he has represented numerous injured workers who have had to leave their employment for one reason or another and have had their indemnity benefits cut off.  If you or a loved believe that your missed wage benefits have been unjustly terminated, or are receiving benefits and thinking about leaving your employment but have questions regarding your ongoing benefits, we would love to discuss your case and explain all of your options to make sure that you receive everything that you are entitled to.  Please give us a call at (877)817-4127 or visit our website.

Lyle B. Masnikoff, Esq.
Law Offices of Lyle B. Masnikoff & Associates,
P.A.1645 Palm Beach Lakes Blvd #550
West Palm Beach, FL 33401
561-598-7120

 

© Copyright 2018. All Rights Reserved.

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PIP Insurance Companies Are Still Denying Manual Therapy http://workerscompfl.net/pip-insurance-companies-are-still-denying-manual-therapy/ http://workerscompfl.net/pip-insurance-companies-are-still-denying-manual-therapy/#respond Sat, 08 Sep 2018 18:42:21 +0000 http://workerscompfl.net/?p=4309 By Claiming It Is Massage

Medical providers who perform and bill for manual therapy (CPT code 97140) are having insurance companies deny the CPT code, alleging that it was actually massage therapy (CPT code 97124).

The CPT Codebook definitions of manual & massage therapy are as follows:

97140 manual therapy: The CPT Codebook considers manual therapy to be specialized techniques, mobilization, joint manipulation, manual lymphatic drainage, manual traction, myofascial release, etc.  that are performed on one or more body part for at least 15 minutes each.

97124 massage therapy: The CPT Codebook considers massage therapy to be a number of specific techniques such effleurage, petrissage, and/or tapotement methods like stroking, compression, percussion.

In order to avoid denials for manual therapy, medical providers need to educate themselves on the differences between manual therapy and massage therapy.  In addition, they need to be specific in their medical records as to what therapies were used.

Lyle Masnikoff & Associates, P.A.

If you have a CPT code denial for manual therapy, make sure you have a PIP attorney handle your case.  We would love to discuss your case and explain all of your options to make sure that you receive the benefits that you are entitled to.

Personal Injury Protection Attorney West Palm Beach

Throughout Mr. Masnikoff’s career, he has represented numerous injured workers who have had to leave their employment for one reason or another and have had their indemnity benefits cut off.  If you or a loved believe that your missed wage benefits have been unjustly terminated, or are receiving benefits and thinking about leaving your employment but have questions regarding your ongoing benefits, we would love to discuss your case and explain all of your options to make sure that you receive everything that you are entitled to.  Please give us a call at (877)817-4127 or visit our website.

Lyle B. Masnikoff, Esq.
Law Offices of Lyle B. Masnikoff & Associates,
P.A.1645 Palm Beach Lakes Blvd #550
West Palm Beach, FL 33401
561-598-7120

 

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Can I Still Receive My Medical Benefits if I No Longer Work for My Employer? http://workerscompfl.net/can-i-still-receive-my-medical-benefits-if-i-no-longer-work-for-my-employer/ http://workerscompfl.net/can-i-still-receive-my-medical-benefits-if-i-no-longer-work-for-my-employer/#respond Mon, 27 Aug 2018 21:54:02 +0000 http://workerscompfl.net/?p=4303 Can I Still Receive My Benefits?

The short answer to the above question is yes.  An injured worker is entitled to benefits regardless of whether or not she is still working for the employer.  With some caveats.  If an employee is injured on the job, files a claim, and the insurance carrier starts providing medical benefits, the employment status with the employer will not affect the medical treatment.  If an injured worker leaves the employer due to retirement, better employment, termination, or due to the company going under, the medical treatment will continue, baring any other extenuating circumstances.  

The real question is whether or not an injured worker will still be entitled to indemnity, or missed wage benefits once she leaves employment.  The answer to this question could depend on how and why the employment ended.   Entitlement to Temporary Total Disability, the benefits you receive while on a no work status will continue as long as you remain on a no work status, regardless of why you left the job.  However, the Temporary Partial Disability, or “light duty” indemnity benefits may be affected by your loss of employment.

Entitlement to the Temporary Partial Disability benefits, or those missed mage benefits that you are receiving due to being on a light duty work status may rest on how and why your employment ended.   Some employers have a certain amount of time that an employee can be out due to restrictions, receiving indemnity, before their employment is terminated.  For example, Company A has a policy that an injured worker can be out for six months due to no job being available within the doctor’s restrictions, before the employer can no longer hold the job open.  In this scenario, your indemnity benefits would continue after employment.

What if I quit my job?  You may still be entitled to indemnity benefits.  According to Dubreuil’s Florida Workers’ Compensation Handbook, the law previously allowed a carrier to suspend Temporary Partial Disability benefits if you voluntarily left your employment.  On October 1, 2003, the Florida Legislature amended this law to essentially state that if a Claimant leaves the job, without just cause, the Claimant would be entitled to only those benefits that would have been due and owing, had the Claimant remained with the employer.   The key in this scenario is that you must voluntarily leave and without just cause.  Typically, the “just cause” caveat will be determined on a case by case basis.

The next big issue when it comes to entitlement to Temporary Partial Disability benefits is when an injured worker is dismissed for misconduct.  Too frequently, an injured employee’s indemnity benefits are suspended due to being terminated.  Just because you are terminated from your employment, does not necessarily mean that you are not entitled to indemnity benefits.  In order for your dismissal to count against you, as far as continued entitlement to indemnity benefits is concerned, you must have been dismissed for misconduct.  In order for the carrier to deem earnings, the misconduct in question must meet the statutory definition.

Florida Statute §440.02(16) states that misconduct includes: conduct evincing such willful or wanton disregard of an employer’s interest as is found in deliberate violation or disregard of standards of behavior which the employer has the right to expect of the employee; or carelessness or negligence of such a degree or recurrence as to manifest culpability, wrongful intent, or evil design, or to show an intentional and substantial disregard of an employers interests or to show an intentional and substantial disregard of an employer’s interests or of the employee’s duties and obligations to the employer.

There are many questions that have to be answered if you leave your employment that will determine whether or not your indemnity benefits will continue.  Did you retire?  Where you fired for cause?  Did the company go out of business?  Were you fired for misconduct?  Did you voluntarily leave the position, unjustly?  Are you voluntarily limiting your own income?  The law is extremely complex, especially when it comes to entitlement to indemnity benefits.

Throughout Mr. Masnikoff’s career, he has represented numerous injured workers who have had to leave their employment for one reason or another and have had their indemnity benefits cut off.  If you or a loved believe that your missed wage benefits have been unjustly terminated, or are receiving benefits and thinking about leaving your employment but have questions regarding your ongoing benefits, we would love to discuss your case and explain all of your options to make sure that you receive everything that you are entitled to.  Please give us a call at (877)817-4127 or visit our website.

Lyle B. Masnikoff, Esq.
Law Offices of Lyle B. Masnikoff & Associates,
P.A.1645 Palm Beach Lakes Blvd #550
West Palm Beach, FL 33401
561-598-7120

 

© Copyright 2018. All Rights Reserved.

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The Social Security Administration New Rule http://workerscompfl.net/the-social-security-administration-new-rule/ http://workerscompfl.net/the-social-security-administration-new-rule/#respond Fri, 24 Aug 2018 11:32:03 +0000 http://workerscompfl.net/?p=4299 The Social Security Administration has recently enacted a new rule that requires all evidence be submitted 5 days before the court hearing. The new rule is called the Five Day rule.  The rule states that if you do not submit evidence 5 days prior to your court date, the judge does not have to consider the evidence which can be very hurtful for many clients.  There are however exceptions to the rule:

 

  • The Social Security Administration misled you;
  • You had a physical, mental, educational, or linguistic limitation(s) that prevented you from informing Social Security about submitting the evidence;
  • Some other unusual, unexpected, or unfavourable circumstance beyond your control prevented you from informing Social Security about submitting the evidence earlier.

It is more important now than ever to keep your file up to date so that you do not have to worry about the Judge not accepting late medical evidence.

Social Security Disability Attorney in Florida

Throughout Mr. Masnikoff’s career, he has represented numerous injured workers who have had to leave their employment for one reason or another and have had their indemnity benefits cut off.  If you or a loved believe that your missed wage benefits have been unjustly terminated, or are receiving benefits and thinking about leaving your employment but have questions regarding your ongoing benefits, we would love to discuss your case and explain all of your options to make sure that you receive everything that you are entitled to.  Please give us a call at (877)817-4127 or visit our website.

Lyle B. Masnikoff, Esq.
Law Offices of Lyle B. Masnikoff & Associates,
P.A.1645 Palm Beach Lakes Blvd #550
West Palm Beach, FL 33401
561-598-7120

 

© Copyright 2018. All Rights Reserved.

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Scholar Career Coaching http://workerscompfl.net/scholar-career-coaching/ http://workerscompfl.net/scholar-career-coaching/#respond Sun, 19 Aug 2018 11:29:26 +0000 http://workerscompfl.net/?p=4296 On June 3, 2018, Associate Attorney, Shakayle Grant and Legal Assistant, Benjy Delian had the pleasure of attending Scholar’s Career Coaching 4th Annual Scholarship Award Ceremony & Luncheon.

Scholar Career Coaching is a non-profit organization that coaches, motivates and supports students through mentoring services and scholarships.  Founded in 2012, Scholar Career Coaching was created to help South Florida High School students in Title I schools with a focus in ESL (English as a Second Language). At this year’s ceremony, seven deserving students were awarded scholarships ranging from $500.00 to $1,500.00 to assist with tuition expenses; this was made possible by the generosity of numerous donors.

If you are interested in becoming a mentor with Scholar Career Coaching, please contact Shakayle Grant or Benjy Delian at (877) 817-4127 for more information.

Workers Compensation Attorney West Palm Beach

Throughout Mr. Masnikoff’s twenty-year career, he has represented numerous injured workers who have had to leave their employment for one reason or another and have had their indemnity benefits cut off.  If you or a loved believe that your missed wage benefits have been unjustly terminated, or are receiving benefits and thinking about leaving your employment but have questions regarding your ongoing benefits, we would love to discuss your case and explain all of your options to make sure that you receive everything that you are entitled to.  Please give us a call at (877)817-4127 or visit our website.

Lyle B. Masnikoff, Esq.
Law Offices of Lyle B. Masnikoff & Associates,
P.A.1645 Palm Beach Lakes Blvd #550
West Palm Beach, FL 33401
561-598-7120

 

© Copyright 2018. All Rights Reserved.

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“Extra Protection Coming to Those Who Protect Us” http://workerscompfl.net/extra-protection-coming-to-those-who-protect-us/ http://workerscompfl.net/extra-protection-coming-to-those-who-protect-us/#respond Wed, 08 Aug 2018 20:47:02 +0000 http://workerscompfl.net/?p=4292 First responders are often put in situations that the rest of us could not even imagine. Day in and day out the brave men and women in the ranks of Florida’s Fire Departments and law enforcement agencies knowingly and willfully go into extremely volatile situations in order to protect, to serve, and to save. At times, they are exposed to the most severe and heartbreaking scenes. Scenes that can shake the strongest of them to the core. These brave men and women deserve the utmost respect and protection from any potential health effects these horrible situations may have on them. Florida just took a huge step in ensuring our first responders are protected and get the treatment they deserve when suffering from a mental and/or nervous condition caused by their employment.

Previously, the Florida workers’ compensation law afforded for medical benefits only when a first responder was suffering from a mental or nervous injury arising out the employment, even when not accompanied by a physical injury. This is different from other industries where there must be a physical injury in order for the mental or nervous injury to be compensable. The issue was that the previous law, allowed for medical benefits only. This created a situation where a first responder could be undergoing treatment for a mental and or nervous injury caused by her employment, not be able to currently work due to the condition, but not able to receive any missed wage benefits in order to pay for bills, food, gas, clothes, diapers, etc… When injuries occur and we are unable to work, the world does not stop turning and our creditors do not stop sending bills. In this situation you essentially have two choices, continue to get treatment and be out of work but not able to provide for yourself or family, or go back to work pre-maturely putting yourself, co-workers, and the public at risk.

On March 27, 2018, Governor Rick Scott signed a bill that will allow first responders such as firefighters, paramedics, and law-enforcement officers to receive treatment under workers’ compensation for Post Traumatic Stress Disorder, commonly known as PTSD. One of main goals this law achieves, is to ensure that first responders who are suffering from PTSD receive, not only medical benefits, but also indemnity or missed wage benefits.

Florida Chief Financial Officer and State Fire Marshal Jimmy Patronis, called PTSD a “hidden killer.” This law will help to make sure our first responders are protected and receive the proper benefits.

Throughout Mr. Masnikoff’s sixteen-year career, he has represented many first responders suffering from mental and nervous injuries. Mr. Masnikoff takes the time to make sure you fully understand the law and will fiercely advocate to ensure that our first responders receive the proper medical and indemnity benefits. If you or a loved one are a first responder suffering from conditions caused by the rigors of your employment, we would love to discuss your case and explain all of your options to make sure that you receive the benefits that you are entitled to. It is our goal to serve those who serve all of us without question. Please give us a call at (877)817-4127.

Throughout Mr. Masnikoff’s career, he has represented numerous injured workers who have had to leave their employment for one reason or another and have had their indemnity benefits cut off.  If you or a loved believe that your missed wage benefits have been unjustly terminated, or are receiving benefits and thinking about leaving your employment but have questions regarding your ongoing benefits, we would love to discuss your case and explain all of your options to make sure that you receive everything that you are entitled to.  Please give us a call at (877)817-4127 or visit our website.

Lyle B. Masnikoff, Esq.
Law Offices of Lyle B. Masnikoff & Associates,
P.A.1645 Palm Beach Lakes Blvd #550
West Palm Beach, FL 33401
561-598-7120

 

© Copyright 2018. All Rights Reserved.

 

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Out and About for the Community http://workerscompfl.net/out-and-about-for-the-community/ http://workerscompfl.net/out-and-about-for-the-community/#respond Tue, 03 Oct 2017 17:36:01 +0000 http://workerscompfl.net/?p=4278 On July 29, 2017, Lyle B. Masnikoff & Associates had the privilege of being a top sponsor for the First Annual Heathcote Botanical Gardens Showdown on the Green which took place at Indian Hills Golf Course in Fort Pierce, Florida.

Heathcote Botanical Gardens is a not for profit organization whose mission is to educate and inspire by providing a place of botanical beauty and to serve as a resource for the conservation of our environment. The Gardens consists of an assortment of specialty gardens including a Japanese Garden, Reflection Garden, Herb Garden, Rainforest Display, Native Plants Garden and a Palm & Cycad Walk. The day was filled with fun, golf and camaraderie for an excellent cause.

Throughout Mr. Masnikoff’s sixteen-year career, he has strived to provide the best service possible, with the highest regards to his clients and the community. He takes the time to make sure his clients, and the community, are as educated as possible when an unexpected injury occurs so as to mitigate any potential hardships that may arise as a result. We take the to make sure you fully understand the law and the complexity of the workers compensation system in Florida.

If you or anyone you know has any questions regarding an injury at work, we would love to discuss your case and explain all of your options to make sure that you receive the benefits that you are entitled to so you can avoid as much hardship as possible. Please give us a call at (877)817-4127.

Heathcote #1 Material Misrepresentation

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Am I entitled to benefits if I Violate a Safety Rule? http://workerscompfl.net/am-i-entitled-to-benefits-if-i-violate-a-safety-rule/ http://workerscompfl.net/am-i-entitled-to-benefits-if-i-violate-a-safety-rule/#respond Sun, 03 Sep 2017 17:43:29 +0000 http://workerscompfl.net/?p=4287 Are you  entitled to benefits if you violate a safety rule? The short answer is yes. It is extremely important that we adhere to our company’s safety regulations and rules while we are at the workplace. These regulations are in place to protect ourselves and our co-workers. At times, however, we may be extremely busy, under deadline, or have some other pressures associated with the job that cause us to overlook or forget about a safety regulation that in turn plays a part in causing an injury. This oversight is not due to any malicious, or intentional act, but is simply a mistake. What happens?  You are still covered.

How you are covered will depend on a couple of factors. First, let’s say that your employer gives you a harness, or some other safety device, and you refuse to use it. Florida Statute § 440.09(5) allows the insurance carrier to reduce your benefits by 25 percent in this instance. This could mean that your indemnity, or missed wage benefits, are reduced by 25%. This is very important because if you are on a no work status from your doctor, the most in indemnity payments you can receive is 66 and 2/3 percent of you average weekly wages. In essence, at best, your wages are already reduced by a third. If you knowingly refuse to follow a safety rule, the carrier can knock another 25 percent off the top. This could severely affect your ability to pay bills and put food on the table.

This also means that instead of receiving medical treatment at no cost to you based on your work injury, you may have to pay 25 percent of your medical bills. Your private health insurance would not cover the difference. Depending on your injuries, this could get very expensive. What is a “willful refusal” of following a safety rule or using a safety appliance? This is where it gets tricky. The Florida Supreme Court has previously stated that the mere violation of a statute, ordinance, or regulation is not willful misconduct as a matter of law. The Court went so far as to say that mere negligence and even gross negligence, fall short of willful misconduct. Arguably, the carrier must show that the employee also knew that the refusal would likely lead to injury.

This also holds true for violation of traffic laws. Traffic laws amount to safety rules when such laws are intended to protect the public from harm. You should think about this the next time you are driving as part of your employment and do not use your seatbelt. Even if there is willful refusal, the safety device at question must have been in working order and available to the employee.

Also, the employer must show that the safety rule in question was enforced. If the employer does not enforce the safety rules, the carrier is not entitled to the reduction.

Throughout Mr. Masnikoff’s sixteen-year career, he has seen carriers time and time again, attempt to use this defense, sometimes unjustly. We take the to make sure you fully understand the law and the complex issues that will arise. We would love to discuss your case and explain all of your options to make sure that you receive the benefits that you are entitled to and that those who wrongfully withhold those benefits are held accountable. If you or someone you know is in this situation, please give us a call at (877)817-4127.

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The State of Workers Compensation in Florida http://workerscompfl.net/the-state-of-workers-compensation-in-florida/ http://workerscompfl.net/the-state-of-workers-compensation-in-florida/#respond Sun, 12 Mar 2017 03:53:24 +0000 http://workerscompfl.net/?p=4224 The Florida legislative session began on March 7 th and is currently scheduled to run until May 5, 2017. Workers’ Compensation insurance rates were recently increased so along with many other “hot button” topics, the future of the Workers’ Compensation system in Florida is being hotly debated. If fact, one proposal of changes to the law did not make out of the committee stage, just this week.

What is at stake? The answer is “a lot”. The workers’ compensation system is meant to protect both the employer and the injured worker. The simple math is that with a rate increase, employers may not be able to hire as many workers, give raises, etc… The question becomes, what is the best way to ensure that rates due to not “explode” but still keep a system in place that gets the injured worker quick and efficient medical care and missed wage benefits, so that their financial burden is mitigated as much as possible while recovering, and get them back to work.

How is this done? This question is really the impetus of the debate. On one end of the spectrum, you have those that argue that the rate increase is due to a series of recent Supreme Court cases that changed the law regarding fees, most notably Castellanos v. Next Door Company. This case essentially revived a portion of the law that allows Claimant’s attorneys to collect hourly fees in certain instances when the Employer/Carrier wrongfully denies a requested benefit by the Claimant. Some will kick and scream that this is outrageous and a money grab and that premiums will go through the roof due to this. What people do not realize, or choose not to focus on, is that hourly fees are never due and owing from the carrier unless THEY WRONGFULLY DENY A BENEFIT THAT IS DUE AND OWING TO THE INJURED WORKER.

An injured Worker is Entitled to benefits under the Law

The benefit that they wrongfully denied, is a benefit that the injured worker is entitled to. A benefit that will assist the injured worker in getting back to work as soon as possible. This is the purpose of all benefits under the law. Essentially, the powers at be are raising rates to cover costs for their own mistakes and wrongful actions. I’m sure we all wish we could just simply pass the costs of our own wrong doings onto others. Without this, there is really nothing in the worker’s arsenal to make sure the carrier is doing what they are supposed to do. What incentive is there for an insurance carrier to provide benefits timely? Sure, some will do it because it is the law and right and what they are supposed to do, but some will not. It is the ladder that the threat of hourly fees protects the injured worker from. This helps employers.

Employers should want to make sure that their employees get good, efficient treatment and are back to work as soon as possible. They should want those who wrongfully deny their employees much needed benefits which in turn delays their return to work, to be held accountable. Without the fee provision, there really is no way to accomplish that. No substantive way.

Alternatively, some will argue that it is defense fees and attorneys that keep cases ongoing, delaying treatment and the injured workers return to gainful employment. Everyone can agree that defense attorney fees are not regulated nearly as much as Clamant attorney fees.

Some will say they are not regulated at all. For the most part, defense fees are based on billable hours. The simple math for this is, the more hours you work on a case, the more you bill, the more money you make. This could give attorneys an incentive to drag cases out longer than they should, especially if the fees are not regulated.
The reality is that there are bad actors on both sides, as in any industry. The parties need to work together and formulate a system that protects employees and employers.

Injured Workers should be the Focus

In a perfect world, the system would work seamlessly. The goal should be for this to be as efficient as possible so that the injured workers are able to return to work as quickly as possible, with as minimal of a financial burden on them and their families as possible. The parties from all interested groups have to come together and find a common ground that continues to protect the employee and the employer.

Throughout Mr. Masnikoff’s sixteen-year career, he has seen the law change many times. We take the time to make sure you fully understand the law and the complex issues that will arise. We would love to discuss your case and explain all of your options to make sure that you receive the benefits that you are entitled to and that those who wrongfully withhold those benefits are held accountable. If you or someone you know is in this situation, please give us a call at (877)817-4127.

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