A shoulder injury can rob you of strength, range of motion, and the ability to perform simple tasks you once took for granted. Even after extensive medical treatments, physical and occupational therapy, and surgery, you may never recover your previous physical abilities.
If your shoulder injury happened at work, you may be entitled to a Schedule Loss of Use award under New York State Workers’ Compensation laws. Our shoulder injuries lawyers in New York City can help you get the full benefits you deserve and guide you through the legal process.
Our team at O’Connor Law has assisted thousands of injured New Yorkers with their Workers’ Compensation cases since 2009. Contact us today to schedule a free case review and find out how our New York City Schedule Loss of Use lawyers can help.
How Our Workers’ Compensation Lawyers Can Help
When you get hurt at work, you might expect Workers’ Compensation insurance to immediately kick in and help with your medical care and lost wages. Unfortunately, it doesn’t always happen that way. Insurance companies may challenge aspects of your case or deny your claim outright.
Sometimes, it can even feel like insurers aren’t on your side, and that’s because they’re not. They’re businesses with bottom lines to worry about, and they hire powerful lawyers to make sure their interests are well protected. If the insurance company has a legal team, why don’t you?
When you work with our New York City Workers’ Compensation lawyers, you have an ally that tips the scales in your favor. We know the insurance company playbook because we’ve been on the other side of the table. We’re here to fight for your rights every step of the way.
What Is a Schedule Loss of Use Injury?
A Schedule Loss of Use injury in New York results in a permanent loss of function in a specific body part due to a work-related injury. When a doctor determines that you’ve reached Maximum Medical Improvement (MMI) and still have a lasting impairment, you may be eligible.
MMI is when your medical condition has stabilized but is not expected to improve any further, regardless of treatment. This often occurs within 9-12 months of an injury or surgical procedure.
Your benefit is intended to provide compensation for the long-term physical limitations caused by your injury. Unlike traditional Workers’ Compensation payments, benefits are based solely on the degree of functional loss, not on ongoing medical needs or time missed from work.
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What Is the Process for Determining Schedule Loss of Use?
Our shoulder injury attorneys in New York City will walk you through the procedure for qualifying for a Schedule Loss of Use award. Working with a knowledgeable Workers’ Compensation lawyer means a lower possibility of delay or denials.
Submitting the Medical Report
After reaching Maximum Medical Improvement, either the treating doctor or the insurance company’s Independent Medical Examiner must submit a report using form C–4.3. This specific, state-required form is critical; without it, the Workers’ Compensation Board won’t take action or advance the SLU process.
Board Issues Notice
Once the Board receives a properly completed C-4.3, it usually takes one to two months to issue an EC-81.7 notice. This document gives the insurance company 75 days to respond to the medical opinion submitted.
Insurance Company Options
In response, the insurance company can submit its own opinion, accept the original doctor’s opinion, request to cross-examine that doctor, or file a legal memorandum arguing that the opinion is insufficient or inaccurate.
SLU Evaluations in New York
SLU evaluations are strictly based on the 2018 Impairment Guidelines. These are clinical and objective, focusing only on a measurable range of motion. Pain, suffering, reduced strength, or other subjective factors are not taken into account.
The guidelines also include ranges that doctors interpret differently, as they assign loss in terms of degrees.
Once an SLU Rating Has Been Determined
Once your schedule loss of use rating is determined, the insurance provider has the right to order an Independent Medical Examination if it wishes to contest the impairment rating. If your rating stands, to arrive at your award amount:
- Apply the New York Workers’ Compensation Schedule: New York Workers’ Compensation law sets a maximum number of benefit weeks for each body part, based on the Schedule Loss of Use table.
- Calculate Your Weeks Awarded: The percentage of loss is then applied to the maximum weeks allowed for that body part. Your attorney can help you understand how this calculator applies to shoulder injuries.
- Determine Your Benefit Amount: Your benefit amount equals two-thirds of your average weekly wage for the 52 weeks before your injury multiplied by the awarded weeks. Any temporary disability benefits previously paid will be deducted from your final award.
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How Long Does It Take to Get a Schedule Loss of Use Award?
When you experience a shoulder injury, it takes time to go through the healing process, procedures, and physical therapy. Only once you’ve exhausted all avenues of improvement may a doctor determine your permanent condition.
Once the C-4.3 form is submitted, the entire SLU process usually takes between 12 and 18 months to reach a final decision.
In the meantime, you may qualify for Workers’ Compensation benefits to help with medical care and lost wages. It is important to consult with a New York City shoulder injuries lawyer whenever you experience a shoulder injury at work to make sure you get the help you need.
Reaching an Agreement
Treating doctors often assign higher degrees of loss, while insurance doctors tend to assign lower degrees. These differences rarely lead to negotiated settlements. Instead, most cases go to depositions, which extend the process and raise legal costs.
If No Agreement Is Reached
If the parties don’t resolve the disagreement within the 75-day response period, the attorneys usually write to the judge. The Board may then issue a decision that grants an additional 75-90 days to settle or proceed with depositions.
This decision itself can take one to two months to be added to the board file.
Final Steps
If the case continues, depositions are conducted. Both parties then submit legal briefs for review. Afterward, the Board issues a final decision. This last phase also requires time and depends on the complexity and scheduling of the case.
Get Help From a Shoulder Injury Attorney in New York City
All it takes is one shoulder injury, and your life may never be the same. Even after surgery and physical therapy, you might not regain your former strength and flexibility. That could mean you can no longer do your job, and it might prevent you from enjoying life as you once did.
It’s hard to accept a lifelong physical limitation, but if you were injured at work, a Schedule Loss of Use award could ease your financial burden. Our shoulder injury attorneys in New York City can handle your case and fight for the benefits you need to improve your quality of life.
At O’Connor Law, our team has over 35 years of combined experience handling complex Workers’ Compensation issues for injured New Yorkers. Call today to schedule a free consultation and discuss your Schedule Loss of Use case.
