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Victor Fusco

Victor Fusco’s Answers

101 total

  • If my father has a possible case or action he could pursue

    My father was ran over by his foreman on a construction job they didn't call ambulance owner of company took him to clinic threatend him to lie about wat had happend he was scared the owner wrote n told him to say a piece of wood fell on his foot ...

    Victor’s Answer

    He does have a claim as the other lawyers stated. A C-3 should be filed immediately. The company's WC insurance carrier should be locatable on the Workers Compensation Board Website. He needs to see a Workers Compensation coded doctor who has the savvy to know that some employers are bad operators and intimidate workers. You dad should notify his union this company is not playing by the rules and intimidating workers. The new leadership of the carpenters in NY will not stand for this kind of intimidation of its workers. There may also be other liability against another party that may come out on careful questioning by an attorney, and additional benefits your dad may be entitled to. Don't delay, get him to an experienced workerscomp/disability attorney immediately.

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  • Do I have a case of discrimination, workers comp, and practicing medicine with out a license.

    I work at ups . I been call lier and everything that I'm saying its bullshit about my medial condition, my doctor said I may moved a disc in my cervical spine and may pinched a nerve , ( it is that discrimination) and on top of that they are denie...

    Victor’s Answer

    You need to retain a Workers Comp Attorney who knows the ropes in New York. UPS fights almost every claim, your experience is not unique. You need to file a proper claim and get a hearing to resolve these issues. I don't see actionable discrimination in the facts as you have stated them but perhaps in a more detailed interview more facts may arise.

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  • Does anyone have advice or know who might take this case. Can I fire my attorney and talk with the NSIF on section 32 offer.

    Currently have a worker's comp case and an attorney. However I am very dissatisfied with my current attorney because he does not get back to me in a timely manner amongst other reasons, and am trying to find a new one. However the attorneys I have...

    Victor’s Answer

    Although "not getting back to me" is a common complaint, you might consider that the attorney may be waiting for the carrier to get back to him/her. As Mr. Feld said the lawyer will receive a fee for the work he/she did whether or not you discharge him/her. Realize also that up in your area the lawyer has to do a lot of traveling from the office to the comp board and most of the attorneys up that way practice in several areas, and are doing a lot of time traveling, waiting in court. Attorneys also need time to review files for upcoming hearings. Most comp attorneys, at least the ones that work for me don't even get back into the office until 4:30 PM, and try to return as many calls as they can u til about 6. Then they grab a quick bite and start reviewing their hearings for the next day, write whatever appeals need to be filed, dictate whatever letters need to go out to doctors or insurance companies, and respond to appeals by carriers, and review all the mail that came in that day. On a good day they knock off at about 9 PM, after starting their day at 8 am, and yes as managing attorney I get complaints that the lawyer didn't get back to me, when our records show the lawyers paralegal has spoken to the client several times a week and converyed all the information there was to be conveyed. They've explained the case status several times, and advised about the law, problems in the case, whether doctors have not been cooperating or submitting reports. In your case with PTSD is your doctor coded by the Workers Comp Board? Is the doctor submitting reports? Its likely the PTSD is being controverted notwithstanding that it arose from an assault. Is the carrier questioning whether the assault was over a personal - rather than work - issue. I think you should be glad an attorney took your case and unless its been established and the carrier has payment liability you
    a long way off from a section 32. If they are offering one without liability being established, they will probably offer a low ball number - just for the sake of giving you something to make you go away. You should develop a little patience. Make an office an appointment with your attorney to let him/her know what's going on with you and to review the file and get a timeline from the attorney. You are correct in saying another attorney is unlikely to substitute. You are naive if you think the SIF is going to be willing to negotiate with someone who is claiming they have PTSD which is an anxiety disorder, for fear that no matter what they do they risk being charged with taking advantage of a person not able to understand the ramifications of the Section 32 becuse of the PTSD.

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  • Does workmans comp still cover my claim even after I leave there? For how long does that coverage last?

    I'm going to file a workmans comp claim at work. I plan to leave this company within the month. I'm from South Dakota. I work in the construction field.

    Victor’s Answer

    I can tell you that in New York once your claim is established it can last forever theoretically at least for medical treatment. Today most claims are scheduled. In other words a percentage loss of use for an extremity or percentage disability rating is made and you receive benefits or what some call a settlement in accord with the degree of loss of use or degree of work loss. If the claim happened in South Dakota there are notice and petition requirements:
    An Employee must report the injury to the employer as soon as practicable. Written notice should
    be provided to the employer no later than three business days after the injury occurred, but
    actual knoweldge is sufficient.
    Employer must provide a written report to the Department of
    Labor and Regulation within seven days, not counting Sundaysand legal holidays, after the
    employer has knowledge of an
    injury which requires medicaltreatment other than minor first aid or which incapacitates the employee for a period of at least seven calendar days. Employer must report the injury to its case management plan within 24 hours of the injury.
    The Insurer is required to send a copy of the injury report to the Department of Regulation within
    10 days. The insurer shall make an investigation of the claim and notify the injured employee and
    the Department in writing within 20 days if denying liability for the reported injury in whole or in
    part. A 30 day extension may be granted upon request.
    Medical Benefits
    Employer must provide employee with necessary medical treatment during the disability or treatment of
    an injury covered under the workers compensation titles in South Dakota.“The employee shall have the initial selection to secure the employee’s own physician, surgeon, or hospital services at the employer’s expense.” SDCL § 62-4-1. If the employee decides to change providers at a later date, he or she must get approval from the employer.
    Employer/insurer has the right to an IME of their choice every 4 weeks. SDCL § 62-7-1. Claimant’s right to
    compensation payments shall be suspended until such exam is conducted if the claimant refuses to submit
    himself to the exam or unncessarily obstructs the same from occurring. No comp shall be paid for such
    period of time. SD CL § 62-7-3.

    SDCL § 62-7-35 The right to compensation is barred unless a written petition for hearing is filed by the
    employee with the Department within two years after the insurer issues a denial of the claim.

    SDCL § 62-7-35.1 Where benefits have been tendered due to an injury, any claim for additional
    compensation shall be barred, unless a written petition for hearing is filed within three years from the date
    of the last payment of benefits.

    SDCL 62-7-35.3 The right to compensation is barred if no medical treatment has been obtained within
    seven years after the employee first files the first report of injury.

    Benefit rate is calculated as 66 2/3 of the earnings for the 52 weeks preceding the injury and includes
    overtime pay at the straight time rate.

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  • Is this additional compensation a long process? Will they issue back pay?

    I am interested in obtaining additional benefits from Workers Compensation via WCL 15 (3) (v). I am concerned about the process to obtain additional compensation through this method. I have fulfilled the needed Active Work Search via Acess VR , Wo...

    Victor’s Answer

    I agree with the other attorneys but would just like to add that these days everything seems to be turning into a "long process." You have nothing to lose (but time, aggravation) in pursuing these benefits. You apparently have counsel, let them drive the bus and deal with the headaches.

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  • Should you request a reasonable accommodation without a lawyer? & Which doctor should provide such medical documentation?

    An orthopedic doctor performed my surgery but the another doctor that perform the nerve conduction test made the determination of how much damages was done to the nerves. Which doctor should I go to for the medical documentation for reasonable acc...

    Victor’s Answer

    It is best to have an assessment of your residual functional capacity from a doctor well versed in disability evaluation if yours is an exertional impairment, such as an orthopedic injury. A doctor should make a medical determination of your difficulties (be they physical or internal- for example Lupus causing extreme fatigue) in doing the functions required on your job, and set forth what accomodations are needed, i.e orthopedic chair, armrest, change desk height. In physical accommodations usually a "physiatrist" (or specialist in Physical Medicine & Rehabilitation is most likely able to do this type of assessment. For internal conditions a specialist's report, assuming yours is willing to write one, would carry a good deal of weight, but your family doctor can also do this. Do not be upset if the doctor wants to charge you for their time in preparing the report. That is standard practice these days. It is the burden of the applicant to show they have a condition warranting an accommodation and to say what that accommodation may be, and to offer alternative ways of achieving the accommodation. In other words, you need to put your plan in place and bring it to the employer. The accommodation must be reasonable and within the company's ability to pay, however you are permitted to chip in or pay for the accommodation yourself - if perhaps your work area needs to be reconfigured and the boss is fighting off bankruptcy as is.

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  • Is the $251,000 the total of my wcmsa and section 32 settlement ? Also which amount for msa will it be, the 123 or the 178

    I just received a letter from cms about my wcmsa arrangement. The carrier proposed $123,917 for future medical items and services. Cms proposed $178, 688 in future medical items, services and future prescription drugs ( I am currently not taking a...

    Victor’s Answer

    While I agree with the answers above, your attorney can negotiate the terms of the MSA if you are willing to be patient, since CMS works at a snails pace. I presume he may have used an expert to arrive at his figure for MSA. Maybe that expert can file a report taking issue with Medicares estimates and substantiating it. They will consider it and maybe reduce their demand. It happens now and then, except most claimants are not willing to wait, and some carriers aren't willing to wait either. As the other attorneys here wait till he/she gets back, but also ask if there is some room to bargain. Claimant does not need to hire a lawyer, he has one.

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  • What can i do legally about this?i was outta work and medical bills are a lot

    i was t boned in a 20 mph school zone during hours.i was in my UPS cargo van. the kid that hit me left 145 foot skid marks and still hit me hard enough to break bones and spin the van 180 degrees around and up on a lawn and into a garage.he was at...

    Victor’s Answer

    In New York you would be eligible first for Workers Comp which would pay all your bills and part of your lost wages. I'd also have you apply for No -Fault in case the Workers Comp case hit a bump in the road (sorry for the pun) and was stalled. You can in NY get up to 80% of your pay with 2/3 coming from comp up to a set max of $840.00 and the rest from NoFault. Then we would sue the owner of the vehicle anyway for allowing him to drive it, or making it possible for him to get the keys without express permission. If the kid is a minor we'd sue his parents for lack of supervision. Finally if you are (or will be) ,out of work for more than 12 months due to serious injuries we'd apply for Social Security Disability. Even f you intend to go back to work, as long as your out more than 12 months we'd put in the application because even if nyou return to work after 14 months you might be entitled to at least a closed period of disability. There are many fine lawyers in Texas who handle these areas of law. Speak to some of them. My answers are based on NY law and the law in Texas as to Comp and No-Fault and liability suits may be different. Social Security is Federal Law - the same everywhere. Good luck to you.

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  • Why is Medicare involved at all. Shouldn't workman's comp pay 100 percent of charges no matter my age or personal insurance?

    have filed a workman's comp claim..just received notification from Medicare that they were advised of this. And asked(by Medicare) if want 25 per cent of claims paid or 5000 settlement.

    Victor’s Answer

    I think this requires elaboration as to what happens in real life. In many states, particularly New York, doctors find it very difficult to deal with Workers Compensation. In some cases if a carrier or a state insurance fund or self insured employer write the doctor and say the claim is denied because we have determined this case is not a workers compensation injury, they accept that as the last word, even though the state Workers' Compensation agency has yet to pass judgement on the issue. Upon receipt of such a notice they send the bill to medicare noting Workers Comp denied the claim, in which case if that were true, Medicare would pay the bill. So we settle many workers comp claims that have Medicare (or Medicaid) liens. When a case is settled under workers comp a legal fiction arises that treats the settlement as payments into the future at the same rate as the final comp check. So medical treatment for related sites of injury - particularly if the settlement contemplates no further medical treatment, become the claimant's responsibility. Medicare demands the parties set aside some money for potential medical care, so they don't get stuck with the bill. That is called a "Medicare Set-Aside" and the penalties against insurers for settling without taking Medicare's present and future interests in the matter, are rather onerous. Finally, with all due respect, you are living in the dream world if you think carriers actually do what you would think the law compels them to all your medical. We spend more time litigating medical payment issues than we do claimant issues. Certainly if you are claiming a work-related heart attack, a carrier will contest and withhold payment of medical bills until you've won a favorable determination on the issue. The last sentence of your question is unclear, but I am assuming they are asking for a $5000 set aside, unless they actually paid out $5000 to cover care the carrier did not pay for. You better have your attorney explain what this is, and what the number is based upon - payments made already to your providers or is it a set aside for future medical treatments.

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  • Has anyone ever had a claim approved by the social security appeals council?

    What were the circumstances?

    Victor’s Answer

    Yes, and I agree with the other attorneys, it is not often and often a "big victory" is that they send the case back to the ALJ with instructions for a new hearing, or sometimes just a new decision in accord with the instructions. More often than not they direct the ALL to apply the proper regulations and rulings or to develop more evidence pertinent to the critical issue. For example, where the claimant's attorney persuasively argued the claimant met one fo the listings, if the ALJ used perfunctory language saying the "impairment does not meet the listings" the Council may direct the ALJ to summon a medical advisor and develop further testimony and evidence on the issue. It may tell the ALJ to get a current consultative exam. Or, where the ALJ finds the claimant can do sedentary work per the grid, but there is a question of transferability of skills at the claimant's age, the ALK may be directed to secure testimony of a Vocational Expert on the issue of whether claimant had any skills and if so are they "directly" transferable (in certain scenarios). And, it's important to brief the Appeals Council on your contentions. You MUST go through this step to get to Federal Court. If you don't raise your issue before the Appeals Council some Federal Courts may refuse to deal with it as having not been raised before the Commissioner. At the very least, you may have to deal with that argument as a defense by the US Attorney. Don't give them that opportunity! Raise all issues at the hearing and again before the Council.

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