Attorneys Lawrence Lindsay and Matthew Mosher discuss workers’ compensation, personal injury claims, and the importance of understanding your rights.
An injury can change a person’s life in an instant. Beyond the physical pain, injured workers and their families may suddenly face medical bills, lost wages, insurance questions, and a legal system they have never had to navigate before.
Viola, Cummings, Lindsay & Mosher represents injured and disabled people throughout Western New York and beyond. Based in Niagara Falls, with additional offices in Lockport, Tonawanda and Corning, the firm reports more than 150 years of combined experience in matters including personal injury, workers’ compensation, Social Security disability, medical malpractice, wrongful death, civil litigation and criminal defense.
Buffalo Rising spoke with Lawrence Lindsay, the firm’s managing partner, about New York’s workers’ compensation system and with partner Matthew Mosher about personal injury claims, insurance coverage and the challenges injured people face.
Workers’ Compensation with Lawrence Lindsay
Lindsay earned his bachelor’s degree from the University at Buffalo in 1988 and his law degree from the University of Toledo College of Law in 1991. Admitted to the New York State Bar in 1992, he has practiced before the New York State Workers’ Compensation Board, Social Security Administration, New York State Supreme Court, and Family Court.
How has the workers’ compensation system in New York changed over the years, and do you feel those changes have generally helped or complicated things for injured workers?
There have been significant changes to the compensation system since 2007. That year saw the implementation of statutory caps on the length of time an injured claimant may collect benefits for certain non-schedule permanent partial disabilities.
Since then, there has also been a direction by the Workers’ Compensation Board to, in my opinion, control treatment, or, in the Board’s view, streamline treatment, by requiring doctors to use an online medical portal for prior authorization requests involving certain physical therapy, diagnostic testing, surgeries, medications, and other care.
Treatment that is consistent with the state’s Medical Treatment Guidelines does not always require prior authorization. In my experience, however, doctors often request confirmation in order to ensure payment. That can add time and, if an insurance carrier denies the request, can force an additional review.
For treatment that varies from the Medical Treatment Guidelines, a doctor must submit a variance request. If the carrier does not grant the request through its two levels of review, the provider may seek review by the Medical Director’s Office of the Workers’ Compensation Board. In practice, that process can substantially delay a decision about treatment.
Many workers are hesitant to file a claim because they fear retaliation or simply do not know their rights. What do you most want Western New York workers to understand when they are hurt on the job?
Workers should understand that reporting an injury to an employer is not the same as filing a claim with the Workers’ Compensation Board. Employers and insurance carriers have their own reporting responsibilities, but an injured worker should not assume that those reports have opened a Board case.
The worker should notify the employer as soon as possible and file an Employee Claim (Form C-3) directly with the Board. Under the Board’s general guidance, an employee must notify the employer within 30 days and file Form C-3 within two years of the accident, or within two years of when the employee knew or should have known that an occupational disease was related to the job. There can be exceptions and different rules depending on the circumstances, which is one reason it is important to seek advice promptly.
Are there industries or types of claims you are seeing more of right now, and what is driving that?
I would say not really. You have your typical spinal injuries or limb injuries, and then you have repetitive-motion claims as well.
What I am hearing from clients is that an employer used to have more people on staff, and now clients are being asked to do the work of one-and-a-half or two people. They are getting hurt doing so.
Why is the free-consultation and contingency model so important for people who have never hired a lawyer before?
In a New York workers’ compensation claim, an attorney cannot charge a claimant directly or collect a fee unless it is approved by the Workers’ Compensation Board. The fee is deducted from compensation awarded to the claimant; there is no upfront, out-of-pocket attorney fee.
That is very important because injured workers may already be receiving less than they did while working and have even less available to hire an attorney out of pocket.
For someone who is ready to take the first step, what is the best way to reach you, and what can that person expect from the first conversation?
We can be reached by phone or email and will set up an in-person or telephone appointment promptly, generally within 24 hours. That allows us to complete the necessary paperwork and file it with the Workers’ Compensation Board so that we can request access to the injured worker’s compensation file as soon as the Board processes the paperwork. Processing time can vary and may take several days.
Personal Injury with Matthew Mosher
Mosher earned both his bachelor’s degree and law degree from the University at Buffalo and graduated from law school in 2004. He joined the firm in 2007 and focuses on personal injury matters including automobile and truck accidents, slip-and-fall claims and vaccine-related cases. He is admitted to practice in New York State and federal courts, including the United States Court of Federal Claims.
How have personal injury claims in New York changed during your career, and do you feel those changes have generally helped or complicated things?
Personal injury cases have changed drastically over my 20 years of practice, and never to the benefit of the injured party. Insurance companies have strong lobbyists and spend significant sums to make it more difficult for injured plaintiffs to recover against negligent defendants.
Among the biggest changes are those that allow Medicare and, depending on the policy and applicable law, certain private health plans to seek reimbursement from a settlement for medical expenses they paid in connection with an injury.
One thing that has not changed, but should have by now, is New York’s mandatory minimum automobile liability coverage. For most vehicles, New York requires only $25,000 in bodily-injury liability coverage for injury to one person in a crash. A negligent driver could cause a serious injury and, if that driver has only the minimum coverage and there are no other applicable sources of recovery, the injured person could be limited in what can be recovered from that policy.
What advice would you give families who want to protect themselves?
One way to protect yourself is to ask your insurance professional about Supplementary Uninsured/Underinsured Motorist coverage, commonly called SUM coverage.
SUM coverage may protect you when you are injured by a driver who has no insurance or whose bodily-injury liability limits are lower than the SUM limits on your own policy. The availability and amount of coverage depend on the policy and circumstances. A claim under your own policy does not guarantee that your overall premium will remain unchanged, so consumers should discuss coverage limits, exclusions and pricing with a licensed insurance professional.
It cannot be easy for someone to ask for help after being seriously injured. Does your approach differ when the other party is an individual rather than a corporation or insurance company?
We almost exclusively represent injured people rather than insurance companies and corporations. The key is to try to alleviate the things that frighten people most, such as the payment of medical bills and lost wages. This gives the injured person the ability to focus on getting better as quickly as possible and regaining a normal daily life.
What drew you to personal injury law, and was there an experience early in your career that confirmed you were in the right area of practice?
I was drawn to personal injury because it always seemed as though the plaintiff was the underdog, while defendants and their insurance carriers had all the resources and money behind them. Nothing feels better than beating the bully.
The firm handles practice areas beyond personal injury, including workers’ compensation and Social Security disability. How can that depth of experience benefit a client whose circumstances touch more than one area of law?
The crossover among personal injury, workers’ compensation, and Social Security disability can be incredibly difficult to navigate. By having knowledge and experience in all three areas, we can determine the most effective and efficient way to pursue the compensation to which an injured person may be entitled.
There are stringent rules when those areas of law meet, and failing to follow them can be detrimental to a case.
Viola, Cummings, Lindsay & Mosher is located at 770 Main Street in Niagara Falls, with additional offices in Lockport, Tonawanda and Corning. To learn more or request a free consultation, call 716-285-9555 or visit vclniagara.com.
This article is for general informational purposes only and does not constitute legal advice. Laws, deadlines, insurance policies, and the facts of each matter vary. Reading this article does not create an attorney-client relationship. Anyone seeking guidance about a specific matter should consult a qualified attorney.