Extreme Hardship Redetermination: What You Need to Know
Keeping on top of changes to workers’ compensation law is important, but it can be hard to understand how such legislation might impact your company. Alliance Risk Group is well-versed in workers’ compensation law–it’s what we do! Read on to learn how an update to New York State WCL Section 35(3) might affect you!
New York State WCL Section 35(3) involves the concept of Extreme Hardship Redetermination. Essentially, this means that a claimant can request to be reclassified to Permanent Total Disability or Total Industrial Disability due to extreme hardship.
The Workers’ Compensation Board defines an extreme hardship as one that “exceeds the usual or expected, and may include information about expected retirement income.” To determine whether a hardship is considered extreme, judges “will consider the evidence provided in Form C-35 regarding the value of the injured worker’s assets, monthly expenses, and household income from a spouse or other people in the household. Judges will also consider any other factors listed in the injured worker’s application for reclassification.”
According to the new legislation, claimants who are found to have a loss of wage-earning capacity (LWEC) of greater than 75% may now apply for such determination (formerly the threshold was greater than 80%). The rule also applies to claimants whose claims were previously adjudicated with a LWEC greater than 75%.
In order to successfully seek an Extreme Hardship Redetermination, claimants must submit the following information:
- Monthly expenses for housing, credit cards, living expenses, transportation, food, personal care, housing, utilities, and other expenses such as child/dependent care, taxes, student loans, child support, etc.
- Household income, including income from a spouse or other people in the household, including any pension or net disability income, as well as Social Security Disability or retirement. If the Social Security Administration is applying an offset against Social Security Disability Insurance (SSDI), the applicant should indicate the full amount of SSDI that will be payable after the workers’ compensation benefits cease.
- All expenses and household income listed on Form C-35.
What does this mean for you? Unfortunately, a claimant who is seeking reclassification can mean a significant expense to your company. If they are approved for the Redetermination, your costs could skyrocket. While you can’t prevent this from occurring in all cases, effective due diligence measures as soon as you learn of a claimant’s attempt to be reclassified are imperative and can save your company tremendous amounts of money.
Alliance Risk Group is well-versed in comprehensive workers’ compensation investigations. Let us help you to mitigate your claim by confirming either that the claimant’s assertions of extreme hardship are accurate or finding evidence to contradict their claim. Depending on the needs of your case, we can suggest investigative services to best mitigate your potential losses.
We offer a Claimant Monitoring Service, Social Media Investigations, and Surveillance, all of which can be used to determine whether your claimant’s Extreme Hardship Redetermination is legitimate. Alliance also now offers unique surveillance options, such as Remote Camera Surveillance and Strategic Surveillance. Contact us today at email@example.com and let us help you determine if any of your claimants might warrant further due-diligence to mitigate your risk.