Decoding New York’s Grave Injury Exception: A Legal Perspective

A lack of comprehension regarding workers’ compensation insurance matters is unfortunate, as it frequently results in deserving workers not receiving their rightful compensation. Especially those hard workers who have been victims of grave injuries. Instances have occurred where individuals inadvertently relinquish their entitled rights, or companies exploit their lack of awareness, persuading them to settle for significantly less than they deserve. That’s why our experienced legal team at Cellino Law is dedicated to assisting hard-working New Yorkers in navigating and securing the compensation they rightfully deserve for their grave injury claims.

Understanding the grave injury meaning is crucial for individuals seeking comprehensive insight into the profound impact and severe consequences of serious physical harm. In the section below, we’ll try to break down the term and bring light to its implications and the legal landscape surrounding it.

But first, it is important to note that…

You Cannot Sue Your Employer in the State of New York

you cannot sue your employer in New York

Well, at least you cannot sue them directly. In New York, the ability to directly sue an employer for on-the-job injuries is generally restricted due to the state’s workers’ compensation system. This system mandates that employees receive compensation through insurance, preventing direct claims against employers for workplace injuries.

This comes with advantages and drawbacks; and the drawbacks generally tend to lean towards the employees. That’s because workers’ compensation typically offers considerably less compensation than a first-party lawsuit. In other words, it’ll cover your medical expenses, but only covers about 2/3 of lost wages. And here’s the kicker: workers’ comp does not cover pain and suffering.

The advantage of workers’ compensation over a lawsuit lies in the absence of the need to establish “liability” in a workers’ compensation case. Differently put, if you suffered an accident on the job, you don’t have to prove that your employer was negligent. Even if the accident was your fault, you will still get compensated as long as it happened while you were on the job.

Of course, a successful lawsuit provides complete compensation for wage loss, full coverage for medical treatment, and comprehensive compensation for pain and suffering.

However, there are exceptions from the workers’ comp rule, particularly in cases involving “grave injuries”. This is where an injured employee may be eligible to hold their employers liable through third-party lawsuits.

New York’s Grave Injury Exception and Third-Party Claims

In situations where a third party, such as a manufacturer (of tools, machinery, machinery components, electrical equipment, etc) is responsible for the injury, the injured worker can initiate a third-party lawsuit. This involves suing the responsible party. The third-party may then include the employer of the plaintiff in the lawsuit to seek contribution if the court awards compensation. The qualification for such claims often hinges on the severity of the injury, meeting the criteria of a “grave injury” under New York law.

What Defines a Grave Injury in the State of New York?

To begin with, the word “grave” itself suggests a serious injury. But not all severe injuries fall into the “grave injury” category. New York Workers’ Compensation Law Section 11 defines it as it follows (at least for now):

“An employer shall not be liable for contribution or indemnity to any third person based upon liability for injuries sustained by an employee acting within the scope of his or her employment for such employer unless such third person proves through competent medical evidence that such employee has sustained a “grave injury” which shall mean only one or more of the following: death, permanent and total loss of use or amputation of an arm, leg, hand or foot, loss of multiple fingers, loss of multiple toes, paraplegia or quadriplegia, total and permanent blindness, total and permanent deafness, loss of nose, loss of ear, permanent and severe facial disfigurement, loss of an index finger or an acquired injury to the brain caused by an external physical force resulting in permanent total disability.”

Now, although the statute addressing grave injuries appears to be well-defined, litigation has arisen in the past over the interpretation of the grave injury definition. One of the most notable cases directly regarding this matter is Castro v. United Container Mach. Group, Inc. (96 N.Y.2d 398, 761 N.E.2d 1014, 736 N.Y.S.2d 287, 2001 N.Y. LEXIS 1869 (N.Y. 2001)), where the issue of the “loss of multiple fingers” was scrutinized. The worker, who lost the tips of multiple fingers while operating a die-cutting machine during employment, contended that losing multiple tips constituted a loss of multiple fingers. However, the Court, emphasizing the clarity of the statute, determined that the loss must pertain to entire fingers, not just parts of multiple fingers. Consequently, the Court ruled that the worker did not suffer a grave injury as defined by the statute, absolving the employer of liability for contribution or indemnification related to the worker’s loss.

But the good news is…

You Can Still Sue an Insurance Company

If you find yourself facing resistance from a workers’ compensation insurance company aiming to minimize payments for medical treatment and lost wages, legal recourse is available. This is where the skills of a workers’ comp attorney come in.

Suing for an Inadequate Decision

Insurance companies may employ various tactics, potentially in contradiction to your doctor’s opinions, to reduce their financial obligations. Disputes with insurers may arise when they insist on returning you to work before you are fully recovered, often through independent medical exams or vocational expert assessments.

When confronted with such situations, pursuing litigation could be a viable option, and consulting with a workers’ compensation attorney becomes crucial. An attorney can guide you through the process, ensuring your legal rights are protected and assisting in preparing for meetings or interviews. Documentation is key in such cases, and maintaining records of all communications with the insurer and your employer strengthens your position.

Suing for Bad Faith

Beyond disputes over benefits, another scenario where legal action may be warranted is when an insurance company engages in bad faith practices. Bad faith actions include unjustly denying claims or benefits without proper cause. Insurers are obligated to conduct thorough and timely investigations, and any failure to meet these responsibilities could be deemed bad faith. Additionally, if an insurer refuses to pay an approved settlement amount or denies necessary treatments for a specific injury, it may be acting in bad faith.

Here are a few examples of bad faith tactics that insurers may use:

  • Refusing to pay for certain medical procedures (i.e. a CT scan after a fall).
  • Refusing to pay for treatment required by conditions and complications generated by the injury.
  • Refusing to pay for certain means required by the grave injury victim, such as a wheelchair or a prosthetic.
  • Purposefully dragging out the investigation process, causing unnecessary delays in determining claim validity and resolution.
  • Dodging calls and emails.
  • Assessing the value of a claim unreasonably low, often in an attempt to minimize payouts to policyholders.

Legal counsel is often critical in evaluating whether a workers’ comp insurer is truly acting in bad faith. An attorney specializing in workers’ comp can analyze the specifics of your case and advise you on the appropriate course of action.

Contact a Workers’ Comp Attorney Today

At Cellino Law, our legal team will carefully assess your workers’ compensation claim and, based on the findings, provide recommendations for the most appropriate next steps. It’s essential to bear in mind that your employer and their insurers aim to minimize costs, making this evaluation a crucial step even in cases where your claim is approved.

Whether your worksite injury falls into the grave injuries category or not, our New York workers’ comp attorneys stand ready to support you throughout your claim process. We are committed to tirelessly advocating for the benefits and compensation you rightfully deserve. Also, we manage workers’ comp cases on a contingency fee basis. In other words, we do not receive payment for our services until you receive compensation for your losses.

For personalized guidance, contact us at (888) 888-8888 to locate your nearest office and schedule a thorough free case evaluation.

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