Author: discoverbluewave

Another Defense Victory for John Land

Congratulations to John Land on securing a complete disallowance of a controverted New York Workers’ Compensation claim involving an alleged left shoulder injury.
 
The claimant alleged that a shoulder injury occurred while driving an NFTA bus, claiming that a seatbelt caused the condition. However, the defense worked with the employer and claims administrator to produce evidence demonstrating that there was no specific accident, sudden stop, collision, seatbelt defect, or other forceful event that could support the alleged mechanism of injury. Video footage and waybill records also failed to substantiate the claimant’s account.
 
A key turning point in the case was the defense’s cross-examination of the claimant’s treating physician. Although the physician initially related the shoulder condition to the history provided by the claimant, he ultimately conceded that ordinary seatbelt pressure would not cause the claimed pathology. He further testified that a forceful event, such as a sudden stop, collision, or significant jerking motion causing the seatbelt to lock, would be necessary to produce the injury alleged. The physician also acknowledged that he had not reviewed the relevant video evidence or prior shoulder treatment records.
 
At the September 23 hearing, the Workers’ Compensation Law Judge disallowed the claim in its entirety, specifically relying on the critical concessions obtained through the defense’s cross-examination. The testimony ultimately supported the defense position that the necessary mechanism of injury never occurred.
 
This result highlights the importance of thorough investigation, strategic medical cross-examination, and careful development of factual evidence in defending contested claims.
 
Please join us in congratulating John on another outstanding result for his client!

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Another Outstanding Result for the Client
 
Congratulations to Nicole Graci on achieving an exceptional outcome through strategic analysis and negotiation in a complex healthcare reimbursement matter.

After a detailed review of the underlying workers’ compensation claim and the treatment sought through two Health Insurance Matching Program (HIMP) liens, she identified substantial issues regarding the causal relationship between the alleged treatment and the established workers’ compensation claim. Although the treatment involved the same body site as the established claim, a thorough comparison of the evidence in the workers’ compensation file against the treatment billed on the HIMPs revealed significant opportunities to challenge the claimed reimbursement amounts.

In addition, the defense conducted a detailed review of the charges using the New York State Workers’ Compensation Fee Schedule, identifying further reductions that significantly decreased the claimed exposure.

As a result, Nicole successfully negotiated favorable resolutions of two separate HIMPs on the same claim, generating more than $45,000 in savings for the client while minimizing litigation costs and avoiding prolonged disputes.

This outcome highlights the value of careful claim review, strategic analysis of medical causation issues, and a thorough understanding of New York workers’ compensation reimbursement and fee schedule requirements.

Congratulations to Nicole in securing this outstanding result and delivering meaningful savings for the client.

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Another Outstanding Result

Congratulations to Wendy Hauck on securing a favorable outcome in a complex New York Workers’ Compensation permanency dispute involving a claimant who underwent multiple knee surgeries, including a total knee replacement.

The claimant argued that the current schedule loss of use award should be calculated independently of a prior established knee claim and sought an award above the previously awarded schedule loss of use. Wendy carefully analyzed the claimant’s extensive medical history and developed compelling medical evidence demonstrating that the prior knee pathology and surgeries could not be separated from the condition that ultimately led to the total knee replacement.

Through detailed preparation of the medical record and expert evidence, Wendy successfully established that the claimant was not entitled to an additional increase in schedule loss of use beyond that supported by the medical evidence. The Workers’ Compensation Law Judge found the carrier’s medical expert more credible and agreed that the claimant’s examination findings did not support an enhanced award.

The Judge ultimately determined that the claimant sustained an overall 35% schedule loss of use of the left leg but allowed the carrier to take credit for a prior 20% schedule loss of use award, resulting in an effective 15% schedule loss of use payable on the claim.

This result highlights the importance of thorough medical development and strategic analysis of prior awards when defending permanency claims. Wendy’s careful preparation of the medical evidence played a key role in securing a favorable outcome for the client.

Please join us in congratulating Wendy Hauck on another excellent result.

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Russ also successfully defeated the claimant’s attorney’s attempt to preclude key IME reports, persuading the Judge that the carrier had fully complied with applicable Board requirements regarding the submission of video evidence.

Following testimony and legal argument the Judge found that the claimant violated Section 114-a. The Judge not only imposed a mandatory penalty of no compensable lost time from December 2025 forward, and the Judge also imposed a discretionary penalty of a permanent lifetime ban from any further indemnity benefits.

This result highlights the importance of meticulous factual investigation, strategic medical development, and effective legal advocacy when pursuing a fraud allegation in workers’ compensation claims.

Please join us in congratulating Russell Hall on this exceptional victory for the client!

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Congratulations to Wendy Hauck on another outstanding result!

In a New York Workers’ Compensation claim involving an alleged left knee injury, Wendy successfully guided the defense strategy surrounding the claimant’s permanency claim and helped develop the medical evidence that ultimately led to a favorable outcome for the client. The claimant sought a schedule loss of use award based on a medical opinion that assessed a 10% loss of use of the knee. However, the defense carefully scrutinized the medical evidence and challenged the validity of that opinion.

After reviewing the record, the Workers’ Compensation Law Judge found that the claimant’s medical report failed to comply with the requirements of the 2018 Impairment Guidelines. The Judge noted that the physician relied on outdated standards, failed to provide the measurements required by the Guidelines, and, despite claiming permanency, reported that the claimant had full range of motion. As a result, the Judge found the permanency opinion less than credible.

The Judge further concluded that the claimant’s successful surgical outcome did not automatically entitle the claimant to a schedule loss of use award and found that the evidence did not support any permanency award. The request for a schedule loss of use finding was therefore denied in its entirety.
Wendy’s attention to detail in preparing and analyzing the medical evidence played a critical role in securing this result and protecting the client’s interests.

Please join us in congratulating Wendy on this excellent victory!

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Another Outstanding Defense Victory

Congratulations to Dylan Prendergast on securing a favorable decision in a long-running New York Workers’ Compensation claim involving an attempt to expand an established claim from 1996 to include consequential left carpal tunnel syndrome and left cubital tunnel syndrome. 

The claimant argued that decades of treatment for their established 1996 shoulder injury caused the development of additional nerve conditions in the left arm. Dylan carefully analyzed the extensive medical history and diagnostic testing. He then elicited strong supporting testimony in his depositions of the medical experts.  

There was a significant gap between the original accident and the onset of the alleged conditions. Dylan also pointed out that the claimant developed the same condition on the opposite side without any occupational cause, supporting the position that the conditions were idiopathic rather than consequential to the work injury.  

The Workers’ Compensation Law Judge credited Dylan’s argument over the claimant’s and concluded that the claimant did not demonstrate the necessary causal connection between the established claim and the alleged consequential conditions.  

This case shows the importance of a thorough review of the medical record, strategic expert testimony, and careful development of the factual and medical evidence needed to successfully defend complex consequential injury claims. 

Please join us in congratulating Dylan on this excellent result!

The claimant argued that decades of treatment for their established 1996 shoulder injury caused the development of additional nerve conditions in the left arm. Dylan carefully analyzed the extensive medical history and diagnostic testing. He then elicited strong supporting testimony in his depositions of the medical experts.

There was a significant gap between the original accident and the onset of the alleged conditions. Dylan also pointed out that the claimant developed the same condition on the opposite side without any occupational cause, supporting the position that the conditions were idiopathic rather than consequential to the work injury.

The Workers’ Compensation Law Judge credited Dylan’s argument over the claimant’s and concluded that the claimant did not demonstrate the necessary causal connection between the established claim and the alleged consequential conditions.

This case shows the importance of a thorough review of the medical record, strategic expert testimony, and careful development of the factual and medical evidence needed to successfully defend complex consequential injury claims.

Please join us in congratulating Dylan on this excellent result!

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Another Outstanding Defense Victory

Congratulations to John Land on securing the complete disallowance of a contested New York Workers’ Compensation claim involving alleged neck and upper back injuries.

After detailed review of prior medical records, and cross examination of the treating providers, we successfully prevailed on our argument that the claimant failed to meet the burden of proof necessary to establish the claim.

Despite giving the claimant a second bite at the apple to cure the defects in her medical evidence,, the Workers’ Compensation Law Judge was ultimately compelled to agree with our position, finding the evidence insufficient and disallowing the claim in its entirety, resulting in no indemnity exposure and no liability for medical treatment.

This outcome reflects John’s diligent advocacy, careful case preparation, and commitment to delivering exceptional results for clients.

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Another Successful Defense Result in a Controverted Mental Stress Claim

Congratulations to Brian Schaedler and Rachel T. on securing the complete disallowance of a contested New York workers’ compensation claim involving allegations of PTSD, depression, anxiety, and other psychological injuries allegedly arising from workplace events.

The claimant alleged that routine workplace interactions, performance discussions, coaching sessions, management oversight, and workplace investigations caused significant psychological injury and exacerbated pre-existing conditions.

The defense developed a strong factual and medical record through witness testimony, documentary evidence, medical development, and strategic cross-examination. The evidence established that the employer’s actions consisted of ordinary supervisory responsibilities, including performance coaching, productivity reviews, workplace investigations, and efforts to address confidentiality concerns. The record further demonstrated that the claimant was never disciplined, demoted, suspended, threatened, or subjected to any extraordinary workplace event.

The defense also successfully challenged the medical basis of the claim, identifying significant weaknesses in the PTSD diagnosis and causation opinions, including a lack of objective support, reliance on subjective complaints, and substantial pre-existing mental health treatment unrelated to employment. The employer’s psychiatric expert concluded that the claimant did not meet the criteria for PTSD and that any symptoms were related to the claimant’s perception of workplace stress rather than any extraordinary work-related event.

Following extensive briefing, the Workers’ Compensation Law Judge agreed and disallowed the claim in its entirety, finding that the alleged stressors constituted ordinary workplace supervision and lawful personnel actions undertaken in good faith, not compensable mental stress under the Workers’ Compensation Law.

This result reflects the importance of thorough factual development, effective medical cross-examination, and a strategic understanding of New York’s mental stress standards. Congratulations to Brian, who led the litigation, and Rachel, who assisted in preparing the Memorandum of Law, on an outstanding team victory.

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Congratulations to Glenaida Mercado on an outstanding workers’ compensation victory that secured substantial credits and significantly limited future exposure for our client.

The case involved two separate claims spanning several years. In a 2019 claim, the claimant suffered a left shoulder injury after hearing a pop while lifting pallets and was ultimately awarded a 15% Schedule Loss of Use of the left arm, totaling $22,965.23.

Years later, in a 2024 claim, the claimant sustained a right shoulder injury after feeling a pinch and pop while lifting sheets. Following arthroscopic surgery, the claimant made an excellent recovery and was released to return to work at full duty. However, upon returning to work, he asserted that the pain in his left shoulder had become unbearable and sought to establish the left shoulder condition as a consequential injury flowing from the right shoulder claim.
Glenaida aggressively litigated the issue and developed compelling medical evidence. During depositions, the claimant’s treating physician acknowledged that he had not reviewed the claimant’s prior 2019 left shoulder claim and he based his opinion that the left shoulder was consequential largely on the claimant’s self-reported history. The physician further conceded that he could not determine the age of the left shoulder pathology and agreed that it was unlikely the pathology developed during the short period following the right shoulder surgery.

Supported by strong case law establishing that a consequential injury requires more than subjective complaints of pain or overuse, Glenaida argued that there was no evidence of a new injury. The Workers’ Compensation Law Judge agreed.

This finding had enormous financial significance. Glenaida secured a ruling that payments made after the claimant was released to full-duty work were considered an overpayment. Equally important, because the claimant had already received a prior left shoulder Schedule Loss of Use award on the 2019 case, our client is entitled to apply the $22,965.23 credit before any additional benefits can be paid on that claim.

Outstanding work by Glenaida in a case that required strategic litigation, effective deposition testimony, strong medical development, and a deep understanding of New York workers’ compensation law. Results like this demonstrate how careful claim analysis can create substantial savings and protect clients from unwarranted future exposure.

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