If you’re filing a workers’ compensation claim and have a history of a prior injury in NY, your employer’s insurance carrier may try to reduce your benefits using a process called apportionment. This can significantly reduce your total benefits, so it’s important to understand your rights and options. At Nappa, Monterosso & Poznansky, LLP, our workers’ compensation lawyers in Staten Island have more than three decades of experience helping injured workers fight back when insurers use apportionment to minimize their benefits.
Key Takeaways:
- Apportionment allows part of your disability to be attributed to a prior injury or another outside factor, which can impact your benefit amounts.
- A preexisting condition doesn’t automatically bar you from receiving workers’ compensation in New York.
- Insurers may try to blame old injuries like a previous fracture or unrelated habits like smoking to pay less on your work injury claim.
- As the largest workers’ compensation law firm in Staten Island, our team knows how to counter apportionment with solid medical documentation and compelling legal arguments.
What is Apportionment in a Workers’ Compensation Claim?
Apportionment divides the cost of your NY workers’ compensation benefits. It typically occurs when an insurance company claims that a permanent disability stemming from a work injury or occupational disease was caused due to a preexisting condition or outside factors unrelated to your job.
When you have more than one workplace injury claim, the New York Workers’ Compensation Board (WCB) looks at how much each injury actually contributed to your disability and then splits the costs of your benefits accordingly. The WCB may also apply apportionment if an insurer argues that part of your permanent disability is due to an injury or condition that occurred outside the workplace.
Either way, if your claim is under review for apportionment, it doesn’t mean it is invalid. Navigating this issue can stressful, especially when you’re trying to adjust to life with a disability. An experienced Staten Island workers’ compensation lawyer can help make sure that the WCB’s determination is fair and accurate.
Common Apportionment Scenarios
Under NY workers’ compensation law, your employer is only required to cover a disability or occupational disease that is truly related to your work. Because of this, employers and insurers have a financial incentive to divide liability whenever possible. A few common situations that involve apportionment issues include:
- A worker has two separate workplace injuries that affect the same body part. Each claim will be evaluated by the WCB to determine how much it contributed to the current disability.
- A worker who smokes develops a lung disease after years of toxic chemical exposure on the job. The insurance company may require an independent medical examination (IME), and their doctor may conclude that smoking played just as much of a role as the chemical exposure in the workplace did.
- Someone breaks their leg in a workplace accident. If that same leg was injured years earlier, an insurance company doctor may claim the old injury made the leg weaker and more prone to a new break.
- A worker who does data entry is diagnosed with carpal tunnel syndrome, but also spends a significant amount of time playing guitar in a band. A doctor may say the off-hours activity contributed to the repetitive stress injury just as much as the job did.
Our workers’ compensation attorneys have successfully handled cases involving nearly every scenario imaginable. We know how to challenge insurance company determinations and fight to help you get the full benefits you deserve.
How the Insurance Company Builds Their Case
When apportionment is applied, it lowers the percentage of disability attributed to your current work injury, which reduces your overall benefit award. This is one of the most common tools insurance carriers use to minimize benefits and payouts.
To build an apportionment argument, an insurer will typically send you for an IME with a doctor of their choosing. They may also request medical records and other information from prior workers’ compensation claims, personal injury claims, or even your own health insurance to look for anything that pre-dates your workplace injury. The WCB weighs the IME report against your own treating physician’s opinion, so it’s vital to have strong medical documentation and evidence that supports your work injury.
What the WCB Considers in Apportionment Workers’ Compensation Cases
Apportionment disputes are usually resolved in a hearing before a Workers’ Compensation Law Judge. The judge will review all medical evidence from both sides before issuing a decision about percentage of disability.
Treatment History
Your medical history matters just as much as your current diagnosis. If your records show gaps in treatment or a return to full duty with no restrictions before you suffered a new injury or illness, that can undercut an insurer’s argument that an old condition is still contributing to your disability today.
Contrasting Medical Opinions
The judge doesn’t simply accept the IME doctor’s conclusion. They compare your treating physician’s and the IME doctor’s opinions by side. In many cases a treating physician’s opinion carries weight because they’ve consistently been a part of your treatment, while the insurer’s doctor typically only performs an IME one time.
Diagnostic Testing
Diagnostic tests can settle disputes that medical opinions alone cannot. MRIs, X-rays, other tests performed before and after your workplace injury can show whether a condition has actually worsened. This type of evidence is often convincing, as it provides tangible proof of your condition before the work injury occurred.
How Thorough Documentation Can Make or Break Your Case
Judges have discretion in how they apportion disability. That’s why it’s so important to have a knowledgeable workers’ compensation lawyer who knows which kinds of evidence hold up in a hearing. This includes:
- Medical records showing a prior injury had fully healed
- Proof that you were performing full duty without restrictions before the new work injury
- A consistent treatment history that demonstrates that the primary cause of disability is the new injury
- Employer records and witness statements can back up what medical records already show
If your benefits have already been reduced due to apportionment of a NY workers compensation claim, you have the right to appeal. An attorney can handle all aspects of your appeal, gather evidence, prepare you for hearings, and advocate voraciously on your behalf.
Why Choose Our Staten Island Workers’ Compensation Lawyers?
Deep local roots and knowledge —As the largest workers’ compensation law firm in Staten Island, we’ve spent decades building relationships with the WCB, judges, court staff, and medical providers throughout the greater NYC area. Our experienced attorneys understand the complex aspects of New York law in cases involving apportionment.
Compassionate representation — We understand that apportionment disputes add financial and emotional pressure at an already difficult time. Our team supports you through the process and fights to get the workers’ compensation benefits you need.
Direct, bilingual communication —Our responsive team is happy to give you updates on your case and answer any questions you may have. Unlike many other firms, Partner and attorney Rolando Cubela serves our Spanish-speaking clients directly.
Contingency fee structure —We take workers’ compensation and Social Security Disability claims on contingency, so there’s no upfront cost to you and we only get paid if your case is successful.
Find a Workers’ Compensation Attorney Near You in Staten Island
If you’re dealing with a prior medical history insurance adjusters are using against you, you don’t have to navigate apportionment on your own. The team at Nappa, Monterosso & Poznansky, LLP can protect your rights and help you understand your options. Contact us or call 718-273-9000 today to schedule a free consultation with a worker’s comp lawyer near you in Staten Island. We serve clients throughout the greater New York City area.
